Cracked teeth pose complex restorative and endodontic challenges, with ongoing debate between minimally invasive methods aimed at preserving pulp vitality and full-coverage restorations designed to enhance structural stability. Advances in adhesives, bioactive materials, and digital workflows have encouraged biologically conservative treatments, yet long-term outcomes related to survival and vitality remain variable and inconclusive. This review critically appraises current evidence on the restorative management of cracked teeth, emphasizing how conservative and full-coverage interventions influence pulp vitality preservation and long-term prognosis. A systematic review of the literature was conducted using the PubMed and ScienceDirect databases. Studies published between 2017 and 2025 were selected based on their relevance to the restorative approach and pulpal outcome in cracked teeth. In conclusion, both conservative and full-coverage restorations can be effective when cases are properly selected. Conservative adhesive techniques and bioactive materials maintain pulp vitality, while full-coverage crowns are preferred for structurally compromised teeth. Clear diagnostic and reporting standards are needed to improve evidence consistency and guide treatment decisions.