Objective: To complete a systematic review of the current evidence for treatment of a symptomatic cracked tooth. Methods: Article selection for cracked tooth was limited to the clinical crown and did not include craze lines or vertical root fractures. Three databases were searched electronically complemented by hand searching. Two independent reviewers determined eligibility, abstracted data and assessed study quality. A summary was established that analyzed three variables: type of treatment, study design and percent of patients that required root canal therapy (RCT) after treatment of the cracked tooth. Results: Of 158 articles retrieved and reviewed, six met inclusion criteria. A total of 365 teeth were enrolled in the selective studies. Treatment of 155 teeth was with a crown and 210 teeth with a bonded and non bonded amalgam, composite restoration or bonded indirect resin composite onlay. The highest level of evidence was a non-randomized, clinical trial. RCT was required in restorations that preserve tooth structures, such as bonded amalgams, bonded resins and onlays <10%. A less conservative treatment, coronal restorations, required RCT 11-21% after one year of initial diagnosis. Conclusions: Evidence about the percentage of teeth requiring RCT was limited; however, data indicated that bonded amalgams, bonded resins and onlays required RCT <10% within one to seven years after initial diagnosis.