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Long-term survival of endodontically treated molars without crown coverage: A retrospective cohort study
Abstract
Teeth are weakened after endodontic treatment and should, ideally, be crowned, especially posterior teeth. However, this is not always possible. Information about the longevity of endodontically treated teeth without crown coverage may assist in selecting appropriate treatment modalities.
The aims of this cohort study were to evaluate the survival rate for endodontically treated molars without crown coverage and to identify possible related factors.
A total of 220 endodontically treated permanent molar teeth in 203 subjects on a waiting list for fixed prosthodontic treatment at the Faculty of Dentistry-Mahidol University, Thailand, were included. Follow-up data were derived from a clinical examination and review of the dental record and radiographs. Subjects were not included in the study if teeth had provisional crowns, definitive restorations with cuspal coverage, or with dowel and core and/or crown restorations. The outcome evaluated was defined as a failure if there were negative findings in the condition of a tooth that required a restoration, tooth repair, or extraction. Tooth loss due to endodontic and periodontal reasons was excluded. The independent variables assessed were patient age, gender, location (maxilla or mandible), the existence of an opposing dentition and adjacent teeth, remaining tooth structure, and types of restorative material. Kaplan-Meier analysis with a 95% confidence level was used to calculate the survival probability, and a log-rank test was used to determine whether significant differences existed.
Overall survival rates of endodontically treated molars without crowns at 1, 2, and 5 years were 96%, 88%, and 36%, respectively. With greater amounts of coronal tooth structure remaining, the survival probability increased. Molar teeth with maximum tooth structure remaining after endodontic treatment had a survival rate of 78% at 5 years. Restorations with direct composite had a better survival rate than conventional amalgam and reinforced zinc oxide and eugenol with polymethacrylate restorations.
Within the limitations of this study, the amount of remaining tooth structure and types of restorative material have significant association with the longevity of endodontically treated molars without crown coverage.
... 4 On some occasions, other materials are used with those bonded restorations, such as temporary crowns or orthodontic metal bands. 3 Although the sealing ability and ability to protect the remaining tooth structure have been proven in both laboratory [5][6][7] and clinical study, 8,9 previous studies have shown that delaying crown placement for >4 months after endodontic treatment increases the risk of extraction by threefold compared with crowns placed 4 months. 10 This is because prolonged duration before crown placement can lead to leakage of the intermediate restoration. ...
... In addition, retrospective studies have also demonstrated that direct restorative materials have a lower survival rate than permanent cuspal coverage restorations. 2,9 Thus, it can be concluded that endodontically treated teeth should receive permanent cuspal coverage restoration as soon as possible after receiving intermediate restoration to achieve successful outcomes. ...
... [24][25][26][27] Unfortunately, significant differences were not identified when comparing the two groups of interest. Even factors that have shown an effect on the success rate of endodontic treatment in previous studies, such as the presence of a preoperative endodontic lesion, 27,28 long time-lapse between intermediate restoration to final restoration, 10,15 and types of intermediate restoration, 9 also failed to demonstrate an effect on the success outcome by regression analysis. This may be due to the insufficient number of samples when grouped into two or three categories, resulting in a lack of statistical power to identify differences. ...
Objective This study aimed to assess the impact of intermediate restoration time-lapse on the survival rate and changes in radiographic periapical lesions of endodontically treated teeth.
Materials and Methods The included treatment records and periapical films of 62 patients were divided into two groups based on the time-lapse of intermediate restoration: within 4 months group (≤4 m group) and more than 4 months group (>4 m group).
Statistical Analysis Survival analysis was conducted using Kaplan–Meier and log-rank test. The predictive clinical factors were assessed using a Cox regression model and hazard ratio, considering both clinical and radiographic outcomes from the latest recall appointment. Changes in periapical index (PAI) scores on radiographs were evaluated using the Chi-square test. Statistical significance was set at p < 0.05.
Results The mean survival rate of endodontically treated teeth was 77.4%. The survival rates of the ≤4 m group and >4 m group were 83.3 and 69.2%, respectively, without statistical significance. None of the clinical factors significantly affected the clinical outcome. However, the >4 m group exhibited significantly worse changes in PAI scores between the final restoration appointment and the latest recall.
Conclusion Different time-lapses for intermediate restoration did not significantly affect the survival rate. However, an intermediate restoration time-lapse of more than 4 months tended to result in worse changes in PAI scores.
... Kaplan-Meir method has been developed as a criterion-based evaluation, classifying the remaining tooth structure into three types: type I cavity preparation when the remaining wall thickness is at least 2, type II for moderate remaining tooth structure representing class II cavity preparation with no less than two walls with at least 2 mm thickness, and type III for minimum remaining tooth structure as the remaining coronal tooth structure had less than two walls with at least 2 mm thickness. The survival rate of the three types in the first, second, and fifth years were 96%, 88%, and 36%, respectively; the median survival time (95% confidence range) was 3.7 years (2.9 to 4.5 years ) [20]. Another study has been concluded, which found that the lower the remaining tooth structures, the lower the success rate of restorative treatment of ETT [5,21]. ...
... Currently, it appears that the most successful method for restoring teeth that have had endodontic treatment is by preserving intact coronal and radicular tooth structure and maintaining cervical tissue to create a ferrule effect, which are crucial to optimize the biomechanical behavior of the restored tooth [3]. Moreover, the use of adhesive procedures in the restoration of ETT, which will not undergo full coronal coverage, aids in strengthening the remaining tooth structure and optimizing the stability and retention of the restoration [20]. ...
... In a retrospective study, after endodontic treatment, molar teeth that had maximum tooth structure remaining had a survival rate of 78% at five years; however, severely compromised endodontically treated molars restored with direct composite resin had a survival rate of 18% at five years [20]. A previous study found that over 70% of endo-treated posterior teeth have already lost more than two-thirds of their coronal tooth structure, making a bonded restoration unfeasible [26,27]. ...
One of the controversial topics in dentistry is restoring endodontically treated posterior teeth. Most posterior teeth that undergo endodontic treatment are subjected to a high rate of fracture due to excessive amount of loss of tooth structure. The aim of this review is to evaluate and compare the restorative and prosthetic treatment options to provide clinical recommendations for restoring endodontically treated posterior teeth. Both Medline on PubMed and Google Scholar were utilized for the search. The terms on our keyword list were "crown," "onlay," "endo-crown," "amalgam," and "composite," with the time frame from 1977 to 2024. We also examined the reference lists of potentially relevant papers for any recent review articles. Our analysis examined review articles found through computerized searches, along with relevant citations from the bibliographies of those studies. This review will focus on the dental restorative options and the amount of remaining tooth structure in determining the final restoration of an endodontically treated posterior tooth. This narrative review addresses different treatment options for endodontically treated posterior teeth based on the amount of remaining tooth structure. In addition, it compares the survival rate and the limitations among direct and indirect restorations.
... The amount of tooth structure that remains after endodontic treatment is an essential factor in determining the strength and lifetime of the endodontically treated teeth (2,(4)(5)(6)(7)(8). The loss of dental structure increases the cuspal deflection, particularly in the posterior teeth which are more Uvod Priprema zuba za indirektnu estetsku restauraciju zahtijeva uklanjanje velike količine tvrdoga zubnog tkiva, često i više od 60 % (1). ...
... Preostali dio tvrdoga zubnog tkiva koji ostaje nakon endodontske terapije ključan je čimbenik koji određuje snagu i dugovječnost endodontski liječenih zuba (2, 4 -8). Gubitak zubne strukture povećava otklon kvržica osobito na stražnjim zubima zato što su podložniji okomitom opterećenju susceptible to vertical stresses (6). Occlusal preparation results in a 20% reduction in stiffness, whereas MOD preparation leads to a stiffness loss of about 60% (6,9,10). ...
... Gubitak zubne strukture povećava otklon kvržica osobito na stražnjim zubima zato što su podložniji okomitom opterećenju susceptible to vertical stresses (6). Occlusal preparation results in a 20% reduction in stiffness, whereas MOD preparation leads to a stiffness loss of about 60% (6,9,10). In addition, the removal of the pulp leads to a decrease in the sensory feedback mechanism (3). ...
Objectives
The aim of this randomized controlled trial was to see if the minimally invasive approach (reduced restoration thickness) would result in good clinical success of monolithic ceramic crowns compared to conventional layered all-ceramic crowns, and thus be an alternative to conventional tooth preparation.
Materials and methods
The ceramic that was investigated was IPS e.max lithium-disilicate ceramic produced using two different processing methods. A comparison was made between monolithic crowns with reduced thickness and standard layered crowns. Fifty-two patients, who had undergone endodontic treatment on either a premolar or molar, were randomly assigned into two groups. The teeth intended for layered crowns underwent to a 2 mm occlusal reduction with a 1 mm rounded shoulder, whereas the teeth intended for monolithic crowns underwent to a 1 mm reduction in the occlusal area with a 0.6 mm rounded shoulder. The clinical success was evaluated in eight categories using modified United States Public Health Service (USPHS) criteria. The observation period was 36 months, with control appointments every 6 months.
Results
There was no significant difference in clinical success between monolithic and conventional layered crowns after 3 years. One monolithic crown fractured while all other crowns were intact and the survival rate was 96%. All layered crowns were intact and the survival rate was 100%.
Conclusion
The results of this study indicate that the minimally invasive approach can be a good alternative to conventional tooth preparation. IPS e.max lithium-disilicate ceramic demonstrated an exceptional three-year survival rate independently of the thickness of the material.
... The authors came to the conclusion that if an adequate repair had been offered, more than 50% of the tooth removal may have been avoided. [14,15] To the best of our knowledge, however, there are currently very few clinical investigations on the single impact of the restoration after the root canal therapy on the survival of teeth. Hence in this study, the clinical longevity of the routine practice is tested by analyzing the fracture rate as well as the survival of the teeth that were restored endodontically with various materials. ...
... The patients' gender had no bearing on the outcomes. [15] The age was not correlated in the study; however, it was observed that the maximum number of the subjects who had a coronal fracture was over 40 years of age. This may have been due to lost tooth structure to extensive cares or tooth attrition. ...
... [19,22,23] Today, composites are regarded as the best restorations immediately following RCT because of this significantly greater stability of the root canal-treated tooth and bacteriostatic nature. [15] In earlier research, crowned teeth fared better in terms of survival than teeth with alternative restorations. [11,24] In the current study, complete crowns had a considerably lesser mean breakage rate than teeth replaced with GIC or amalgam. ...
Introduction: The best treatment for the deeply carious tooth that cannot be restored is by the root canal therapy. This method has saved many patients from the loss of tooth. The common practice is either to deliver a full crown or close the access cavity with restoration. Hence in this study, the clinical longevity of the routine practice is tested for by analyzing the fracture toughness and the survival of the teeth that were restored endodontically with various materials.
Materials and Methods: The hospital records were retrospectively evaluated from 2000 to 2010 for a decade. The demographics as well as the survival and the failure rates noted and compared for the various types of the restorations. The number of the walls of the teeth was also compared.
Results: Thousand teeth were considered in the study. Less than 7% of teeth had coronal fractures. Of the 93% teeth that had survived, the most common restoration was Individual post (+ crown) followed by GIC, amalgams, and crowns. The mean survival of the crown+ bridge & gold restoration was highest. The mean survival was 10 ± 2 years for the restored teeth without any fractures at the coronal level. The failure was greatest for the GIC followed by amalgam, and the variations when compared with other restorations were significant. There was no significant difference for the number of the walls on the crown; however, the number of walls present was proportional to the survival rate.
Conclusion: The teeth that were covered with a crown were comparatively fracture resistant and had a better survival rate compared to other restorations. GIC showed highest fracture, and the post core with crown had the best survival. Restoration of the lost crown architecture and the reinforcement are the best methods that can be followed for the survivals.
Keywords: Endodontically restored teeth, full crowns, restorations
... [7][8][9][10] The greatest preservation of remaining tooth structure showed higher fracture resistance and also increased the survival rates of endodontically treated teeth. 7,[11][12][13][14] Among posterior teeth, the highest rate of clinical fractures was in maxillary premolars due to unfavorable anatomic shape, making them more susceptible to cusp fracture. 15,16 In addition to the tooth structure lost during endodontic treatment, non-carious wedge-shaped cervical lesions are another factor reported to occur significantly in premolars, further weakening tooth strength. ...
... As a conservative concept for endodontic preparation restricted to endodontic access, direct composites can be used as definitive restorations to avoid further tooth preparation, which weakens tooth strength. 8,10,14,21,22 In vitro, a high fracture resistance of ETT restored with resin composite has been reported. 23,24 However, as a protective concept, posterior ETT should receive a cuspal-coverage crown restoration to protect the teeth from fracture. ...
... Several studies have reported that cuspal-coverage restorations significantly improved the success rate and longevity of endodontically treated posterior teeth. 4,6,10,14 Additionally, posts are another option being used to restore ETT. Posts are normally used only to retain the core material of ETT, but they do not reinforce the root. ...
The purpose of this study was to evaluate the effects of fiber posts and different restorations on the fracture resistance of endodontically treated maxillary premolars with cervical cavities. In forty extracted human first maxillary premolars, cervical cavities were prepared simulating cervical lesions and randomly divided into four groups (n=10): COM-NP, endodontically treated teeth (ETT) restored with resin composite without fiber posts; ON-NP, ETT restored with CAD/CAM ceramic onlays without fiber posts; COM-P, ETT restored with resin composite and fiber posts; and CR-P, ETT restored with CAD/CAM ceramic crowns and fiber posts. After the fiber posts and restorations had been cemented with resin cement, all specimens were loaded onto the long axis in a universal testing machine until fracture at a speed of 0.5 mm/min. Fracture load (N) and fracture modes were evaluated in all specimens. The mode of failure was determined by visual inspection. Data were analyzed with Welch's ANOVA and Games-Howell tests (p<0.05). Fracture load for all groups were (N): COM-NP (933.48±242.53); ON-NP (1871.45±313.59); COM-P (1510.17±251.87); and CR-P (2189.97±600.38). COM-NP had the lowest fracture resistance, significantly different from those of the other groups (p≤0.05). Statistically significant differences were observed among groups (p≤0.05), except in the ON-NP to CR-P groups (p=0.471). All groups showed the non-restorable fracture mode. Cuspal-coverage restorations significantly enhanced the fracture resistance of endodontically treated maxillary premolars with cervical cavities. Placement of fiber posts improved the fracture resistance of endodontically treated teeth but did not make the failure restorable.
... Occlusal enamel was beveled at 45 0 . The extension was not balanced equally between the buccal and palatal orifices but rather slightly favored the buccal orifice [7] (Fig 2b). ...
... The 'ninja' access outline was derived from the oblique projection toward the center of the root canal orifices at the occlusal plane from CBCT. By doing this, localization of all the root canal orifices were possible but from different visual angulations [7] (Fig 2c). ...
... According to the Nagasiri and Chitmongkolsuk study, greater remaining tooth structure means greater longevity for the teeth. [16] The restorative treatment plan for an endodontic treatment tooth is affected by several factors, such as the quality and quantity of residual tooth structure, remaining adjacent teeth, occlusion, and the planning of the restoration to be placed on the tooth. It is essential to achieve a stable and functional occlusion, choose the appropriate restoration material and design, and ensure a successful treatment outcome. ...
... The goal of caries control is to excavate all caries tooth structure and preserve healthy tooth structure to provide support for the restoration, but at the same time, we have to remove any dentine wall less than 1-mm thickness to avoid tooth fracture during functional loads. [15,16] The amount of remaining healthy axial walls plays an important role in the fracture strength of root canal-treated teeth and the determination of the treatment plan. The more remaining tooth structure after caries control can improve the teeth fracture resistance and minimize the restorative treatment need. ...
Abstract
The restoration of endodontically treated teeth (ETT) indeed poses several challenges in dental practice. It includes procedures
that are associated with several areas in the dental field, such as endodontics and restorative dentistry. The goal of restoration
of endodontic-treated teeth is to prevent micro-leakage, protect teeth from fracture, and replace the structures lost during caries
control or trauma. The restorative treatment plan of endodontic-treated teeth depends on many factors but mainly the quantity
and quality of the residual tooth structure. The aim of the review is to benefit the dentist determine the restorative treatment
needed for endodontically treated teeth.
Key words: Composite resin, Cuspal-coverage restoration, Endodontically treated, Post, Teeth restoration
... This study will be the first to assess the root fractural resistance of two different nonmetal posts, quartz fiber posts and glass fiber posts, with different ferrule heights (1 mm vs. 2 mm) as most of dentists prefer using non metal posts when the esthetic is essential but they are concerned about the fracture resistance of both types. Teeth may be exposed to a wide range of injuries that put the vital functions of the pulp at risk 24 . Sometimes the influences are non infectious and include trauma from accidents that interfere with the tissue's neuro-vascular supply 25 . ...
... If it is done imprecisely it may result excessive removal and weakening of tooth structure, damage to periodontal tissues and perforation 109 . To avoid these problems, non-cutting round bur is used to 24 remove the gutta-percha without removing dentin structure and avoid raising tooth surface temperature, which may damage the periodontium 110,111 . Regarding chemical removal of gutta-percha, it is believed that these materials such as eucalyptus oil, turpentine oil and chloroform are toxic and possibly carcinogenic 112,113 . ...
A Comparative Evaluation of Root Fracture Resistance of Endodontically Treated Teeth using Two Fiber Posts with Two Ferrule Heights
... If any fracture had not occurred during the observation period, the treated tooth was described as "survival". The fracture assessment criteria, described in previous clinical studies (20,21), were used in this study. Fracture restorability was classified into a restorable fracture (can be repaired or replaced; with either a direct resin composite or stainless steel crown) and an unrestorable fracture (the fracture extends considerably subgingivally necessitating extraction of the tooth). ...
... However, the result of this survival analysis should be interpreted with caution because there was a small number of VPT-treated teeth reaching more than 5 years follow-up. The 5-year cumulative survival probability (66.02 %) of VPT-treated teeth in our study is higher than that of root canal-treated teeth in one study (approximately 45%) (19) but is lower than those of root canal-treated teeth (approximately 80%) in two studies (14,21). Although the data from different studies could not be directly compared because they differ in several aspects, it may be speculated that not only the type of endodontic treatment performed (VPT versus RCT), but the existing features of the treated teeth (thin versus thick dentine wall) may also have contributed to number of fractures. ...
Objective
This study aimed to evaluate the survival from fractures and risk factors of VPT-treated permanent molars restored with direct resin composites in young patients.
Methods
The dental records of patients aged 6 to 18 years with VPT-treated permanent molars restored with resin composites were retrospectively evaluated for the presence of fractures on these teeth. Kaplan-Meier methods were used to estimate the survival probabilities. The potential risk factors were assessed using the multivariable Cox proportional hazard model.
Results
A total of 234 treated molars from 189 patients were included. An overall average follow-up time was 33.34±20.54 months (ranging from 6 to 83 months). At the end of the study, 21.8% of molars had fractures with the majority of them (92.2%) were restorable. Radiographically, only 3.9% of the fractured molars had periapical lesions and considered VPT failures. The percentages of the fracture types are as follows: 54.9% natural tooth structure fracture, 27.5% restoration fracture, and 17.6% combination fracture. The most common fracture location among the 37 molars with natural tooth fracture (either alone or in combination with restoration fracture) was at the marginal ridge (59.5%), followed by the marginal ridge extending to cusp (21.6%), and the cusp itself (18.9%). The cumulative survival probabilities of these teeth decreased over time, reaching 66.02% (95% CI: 55.89–74.36) after 5 years. VPT-treated molars in the mandible had a 2.1 times higher risk of fracture than those in the maxilla. Furthermore, the molars treated with partial and coronal pulpotomy had 2.4 times and 4.6 times higher risks of fracture when compared to those with indirect pulp capping, respectively.
Conclusion
In VPT-treated permanent molars in young patients, more fractures were seen in mandibular teeth and in teeth with pulp roof removal (partial and coronal pulpotomy). Clinicians should plan for proper restoration on these teeth.
... Reasonably, the amount of residual tooth structure has an impact on the survival of root filled teeth. Although this has not been extensively studied, some studies suggest an association (Al-Nuaimi et al., 2020;Nagasiri & Chitmongkolsuk, 2005). Nagasiri and Chitmongkolsuk (2005) concluded that the amount of remaining tooth substance is a factor associated with tooth survival for teeth not being crowned after root canal treatment; the survival rate was highest for teeth with a maximal amount remaining, corresponding to a Class I cavity with a minimum of 2 mm thickness of the surrounding cavity walls, whilst a lower survival rate was observed for teeth with a less amount remaining. ...
... Although this has not been extensively studied, some studies suggest an association (Al-Nuaimi et al., 2020;Nagasiri & Chitmongkolsuk, 2005). Nagasiri and Chitmongkolsuk (2005) concluded that the amount of remaining tooth substance is a factor associated with tooth survival for teeth not being crowned after root canal treatment; the survival rate was highest for teeth with a maximal amount remaining, corresponding to a Class I cavity with a minimum of 2 mm thickness of the surrounding cavity walls, whilst a lower survival rate was observed for teeth with a less amount remaining. Al-Nuaimi et al. (2020) reported the extraction rates to be three times higher for molars with a volume of remaining tooth substance corresponding to less than 30% (12.5%) compared with teeth with >30% remaining (3.5%); however, the difference was not statistically significant. ...
Background
There are several measures that are, or could be, in use in relation to estimating the outcome of endodontic treatments. It is important to reflect on when and why a certain outcome measure is used; when caring for an individual patient it is obvious that the goal always should be a tooth in a healthy state, that is striving to remove any infection and aim for the tooth to have healthy periapical tissues. For patients in general and for society, it is also interesting to know if endodontic treatments will lead to retention of teeth in a functioning state. From epidemiological studies, with high prevalence of root filled teeth with periapical radiolucencies, it is implied that dentists and/or patients accept the retention of a root filled tooth with persistent apical periodontitis. In conjunction with an endodontic treatment the prognosis is considered and since the prognostic factors seem to be somewhat different depending on whether one is considering for example the outcome ‘healthy periapical tissues’ or ‘tooth survival’ they are equally important to know. Factors affecting the outcome ‘healthy periapical tissues’ probably has to do with removal of infection and reconstituting the barrier to prevent leakage whilst ‘tooth survival’ is more likely associated with factors outside of the classical endodontic field such as restorability and avoidance of further destruction of tooth substance.
Objective
This narrative review will focus on tooth survival after endodontic treatment and root canal treatment will be the focus.
Method
The search was performed in PubMed.
Results
As a crude estimation, there is to be an annual loss of 2% of teeth which have received a root canal treatment.
Conclusion
Of the pre‐, peri‐ and postoperative factors that have been studied in conjunction with root canal treatments the restoration of the tooth is the factor that has been most extensively studied. Many studies imply that root filled teeth restored with indirect restorations have a better survival than teeth restored with direct restorations, it is not possible to determine whether this indeed is a prognostic factor.
Registration
None.
... Causes of failure include persistent or recurrent endodontic disease, unrestorable caries, restorative failure, irretrievable cusp or crown fracture, vertical root fracture or periodontal disease. Whilst endodontic research is replete with clinical studies on the success rate of root canal treatment, it is acknowledged that structural failure is the most common reason for the extraction of root filled teeth (Al-Nuaimi et al., 2020;Nagasiri & Chitmongkolsuk, 2005). As a result, there has been increasing interest in the structural and biomechanical effects of root canal treatment and subsequent post-endodontic restorative procedures on restoration and tooth survival. ...
... However, despite the limitations of largely retrospective research, the number of residual walls does appear to be an important variable for the survival of root filled teeth. Teeth with noor only one residual wall appear to have reduced survival rates when compared to those with more than one wall (Dammaschke et al., 2013;Ferrari et al., 2012;Nagasiri & Chitmongkolsuk, 2005). ...
This narrative review will focus on a number of contemporary considerations relating to the restoration of root filled teeth and future directions for research. Clinicians are now more than ever, aware of the interdependence of the endodontic and restorative aspects of managing root filled teeth, and how these aspects of treatment are fundamental to obtaining the best long‐term survival. In order to obtain the optimal outcomes for patients, clinicians carrying out endodontic treatment should have a vested interest in the restorative phase of the treatment process, as well as an appreciation for the structural and biomechanical effects of endodontic‐restorative procedures on restoration and tooth longevity. Furthermore, the current available research, largely lacks appreciation of occlusal factors in the longevity of root filled teeth, despite surrogate outcomes demonstrating the considerable influence this variable has. Controversies regarding the clinical relevance of minimally invasive endodontic and restorative concepts are largely unanswered with respect to clinical data, and it is therefore, all too easy to dismiss these ideas due to the lack of scientific evidence. However, conceptually, minimally invasive endodontic‐restorative philosophies appear to be valid, and therefore, in the pursuit of improved clinical outcomes, it is important that the efficacies of these treatment protocols are determined. Alongside an increased awareness for preservation of tooth structure, developments in adhesive bonding, ceramic materials and the inevitable integration of digital dentistry, there is also a need to evaluate the efficacy of new treatment philosophies and techniques with well‐designed prospective clinical studies.
... Endodontically treated teeth are reported to have reduced resiliency and proprioception with decreased protective reflex mechanisms 1 . This predisposes to overload incidences resulting in catastrophic mechanical failures during function. ...
... Alpha 120 (100.0%) 120 (100.0%) that the materials chosen for restoring endodontically treated teeth are crucial for the tooth's lifespan [23]. The study found no significant differences in retention and gross fracture scores between the two groups. ...
Aim
The purpose of this study was to evaluate the performance of polyethylene fiber reinforced resin composite fillings compared to bulk fill resin composite fillings in endodontically treated teeth over a two-year monitoring period.
Method
A total of 240 individuals with endodontically treated lower molars and a moderate amount of tooth structure were divided into two equal groups of 120 each. One group received polyethylene fiber reinforced bulk fill resin composite restorations while the other group received only bulk fill resin composite restorations, both applied as per manufacturer guidelines. Two proficient experienced blinded assessors assessed the restorations using modified USPHS criteria at baseline, 6, 12, and 24 months.
Statistical analysis used
Data analysis involved the utilization of Mann-Whitney U, Friedman’s test, and Nemenyi post hoc test, with age data being displayed as mean and standard deviation. The significance level was established as p < 0.05, and R software was utilized for statistical analysis.
Results
There were no notable distinctions in any parameters or scores between the intervention and comparator groups at various time points. Alpha scores were present for retention, gross fracture, and secondary caries at all follow up intervals.
Conclusion
Both direct resin composite restorations reinforced with polyethylene fibers and direct bulk fill resin composite restorations placed in endodontically treated molars with moderate remaining tooth structure demonstrated satisfactory clinical outcomes during a 24-month follow-up period.
Clinical relevance
Bulk fill resin composites directly placed in endodontically treated molars with moderate remaining tooth structure showed promise as a treatment option over a two-year period.
Clinical trial registration
(06-01-2022) on https://ClinicalTrials.gov with the ID (NCT05180903).
... (Setcos et al., 2006) Nagasiri ve Chitmongkolsuk altınla restore edilen dişlerin amalgam veya kompozitle restore edilen dişlere göre daha dayanıklı olduğunu göstermiştir. (Nagasiri & Chitmongkolsuk, 2005) KOMPOZİT Brunton ve arkadaşları, birkaç diş renginde kaplama malzemesinin kırılma direncini değerlendiren in vivo, randomize, kontrollü bir çalışma gerçekleştirdi. İndirekt kompozit restorasyonların, benzer bir tasarıma sahip seramik veya fiberle güçlendirilmiş kompozit restorasyonlara kıyasla kalan dişe daha fazla koruma sağladığı sonucuna vardılar. ...
Inlays and onlays can be preferred for the restoration of teeth with excessive material loss that are not suitable for direct restorations or where direct restorations have failed. It is also a conservative alternative to full veneer crown preparations. Unlike full ceramic veneers and ceramic crowns with metal substructure, they offer the opportunity to change the appearance of the tooth with less material loss. Restorations that do not include the tubercles in the occlusal regions of the teeth are considered inlays, while restorations that include the tubercles are called onlays.
... Studies have shown that teeth restored with indirect methods have a higher survival rate compared to those treated with direct restorations. 6 However, the higher cost and longer treatment time associated with indirect restorations can be a deterrent for some patients. ...
The restoration of endodontically treated teeth is a critical aspect of dental practice, with the choice between direct and indirect restoration techniques being central to optimizing clinical outcomes. Direct restorations, such as composite resins, offer advantages in terms of cost, time efficiency, and preservation of tooth structure. However, their long-term performance, particularly in posterior teeth, may be compromised by issues such as marginal leakage, wear, and discoloration. Indirect restorations, including crowns, onlays, and inlays, provide enhanced durability, fracture resistance, and aesthetic outcomes, particularly for teeth that have undergone significant structural loss. These restorations, often made from ceramics or metals, offer superior longevity but come with higher costs and longer treatment times. The aesthetic performance of restorations plays a significant role in patient satisfaction. While direct restorations allow for immediate aesthetic adjustments and are generally more affordable, they may suffer from discoloration and wear over time. Indirect restorations, particularly porcelain-based options, offer better color stability and natural appearance, making them a preferred choice for patients with high aesthetic demands. Cost-effectiveness is another critical factor influencing clinical decision-making. While direct restorations are more affordable initially, their long-term cost-effectiveness may be compromised by the need for repairs or replacements. Indirect restorations, despite their higher upfront cost, often prove to be more economical in the long run due to their durability and reduced need for maintenance. The decision between direct and indirect restoration techniques should be individualized, considering factors such as tooth location, the extent of damage, aesthetic requirements, and financial constraints. A comprehensive evaluation of these factors, along with clear communication with the patient, is essential for achieving optimal clinical outcomes. Indirect restorations generally offer better long-term performance, particularly for heavily compromised teeth, while direct restorations remain a viable option for cases where cost and time efficiency are prioritized.
... For many years, access cavity was practiced by removing the entire roof of the pulp chamber to better visualize the pulpal floor, as well as to ensure canal identification, straight-line access, shaping, irrigation, and obturation [2]. Meanwhile, numerous studies have demonstrated that this kind of access cavity results in a significant loss of tooth structure, lowering the fracture resistance of the treated teeth [3]. ...
The era of minimally invasive dentistry has led to the development of new access cavity designs. The impact of various access cavity designs on the fracture resistance of teeth has been extensively studied. The primary aim of this systematic review and meta-analysis is to evaluate and compare the effects of recent modifications in endodontic access cavity design- specifically, conventional, conservative, and truss designs on tooth fracture resistance. Three independent reviewers searched studies across six different databases (PubMed, Scopus, EBSCOhost, BVS, Wiley, and Google Scholar) from January 2000 to July 2024, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The articles were then screened using strict inclusion and exclusion criteria. A quality assessment was performed using a modified version of the quality assessment of in-vitro studies according to the QUIN (Quality Assessment Tool For In Vitro Studies) tool, categorizing the selected articles into low, moderate, and high risk of bias. Quantitative data synthesis was conducted to combine equivalent results using STATA. Forest plots were created with the level of significance set at 0.05 (p = 0.05). Out of 243 articles, 14 met the strict inclusion criteria. Among the selected articles, 11 showed a low risk of bias and three showed a moderate risk. The meta-analysis revealed that fracture resistance of conservative and truss access designs is significantly higher than that of conventional endodontic access, with a standardized mean difference (SMD) of 2.61 (95% 1.47 to 3.74; p-values <0.001) and SMD = -1.26 (95% confidence interval (CI): -1.81 to 0-0.71; p<0.001). The heterogeneity (I²) values for these comparisons were 92% and 65.6%, respectively. The extent of the access cavity has a substantial impact on tooth fracture resistance. Newer conservative and truss endodontic access designs offer better fracture resistance compared to conventional endodontic access.
... Today, the best protocol for post-endodontic restoration depends on individualized factors, such as residual tooth structure, periodontal health, occlusal forces, and patient oral hygiene [6]. Additionally, the principles of minimally invasive dentistry prioritize preservation of the entire sound structure of the tooth, to enhance its resistance, and direct composite restoration is regarded as a feasible restorative option because of the superior performance characteristics of resin composite materials and the quality of bonding adhesive systems on enamel and dentine [2,7]. Some clinical reports found that endodontically treated teeth last longer if they have an artificial covering crown [8,9]. ...
Purpose: Non-vital teeth usually exhibit substantial loss of coronal and radicular tooth structure, and use of posts after root canal treatment is controversial. This review examined whether placement of posts influences clinical behavior and survival probability of endodontically treated teeth (ETT).
Methods: An electronic search, without time restrictions, for publications written in English was undertaken in PubMed, Scopus, and Web of Science. Terms related to four main components (endodontically treated teeth, fixed prosthesis, post restoration, and survival rate) were used for the database search strategies.
Results: 57 studies met the inclusion criteria and were included in the qualitative analysis. Of the publications chosen for qualitative analysis, 17 clinical studies (11 prospective and 6 retrospective studies) were found to be suitable for quantitative analysis. These studies included 7,278 patients (7,330 ETT), with a mean age ± standard deviation (SD) of 45.46 ± 12.1 years. There was a statistically significant difference in survival rate between ETT with or without posts (P < 0.001).
Conclusion: As compared with teeth with no posts, post placement on ETT may improve clinical performance and survival probability of endodontically treated teeth.
... To maintain the coronal and radicular dental structure, anterior teeth undergoing endodontic operations that result in minimum tooth structure destruction could be conservatively restored using bonded restorations. For the rebuilding and rehabilitation of teeth that have undergone endodontic treatment, materials that could adhere properly to the dentin are always a viable possibility (4,5) . To conserve the most of hard tissue as feasible, the kind of restoration is often determined by the location of the tooth on the dental arch and the amount of residual tooth structure. ...
Aim: To evaluate the bacterial coronal leakage assessment of direct inlay composite versus indirect ceramic restoration of (MOD) cavity in endodontically treated maxillary premolars with single root. Method: 30 human maxillary premolars with single root of fully developed apex extracted were selected. Every tooth has decoronated to 3 mm coronal to cementoenamel junction using diamond disc bur for standardization. ProTaper rotating tools were employed to chemo mechanically prepare the root canals and for radicular preparation to size F3 finishing file. ProTaper obturators #F3 were Coronal Bacterial Leakage Assessment Of Direct Inlay Composite Versus Indirect Ceramic Restoration In (Mod) Cavity Of Endodontically Treated Maxillary Premolars With A Single Root Vol.29 No.01 (2022): JPTCP (376-384) Page | 377 employed to obturate the canals and resin sealer (ADSEAL) were used for filling the canals via the lateral condensation method. Two mm apically of the coronal gutta percha was removed to make a space for liner material. Above the gutta-percha to the level pulp chamber floor, glass ionomer restorative was utilized as a liner material. The premolars were allocated into 2 identical test groups (group 1&2) of 10 premolars each in accordance with the final restoration techniques (direct & indirect) with other two groups of positive control with 5 intact teeth, and negative control with 5 teeth with empty (MOD) preparation of the cavity following endodontic therapy without placement of the final restoration. The specimens were subjected to thermocycling then bacterial coronal leakage assessment was done for all teeth by using two-chamber. Results: Group 1: Direct Inlay (Composite Resin) recorded 43% leakage versus 57 % without leakage. On other hand Group 2: Indirect (Ceramic Inlay) recorded 34% leakage versus 66 % without leakage, but without statistically significant differences. Conclusion: Ceramic Inlay as indirect technique of coronal restoration of endodontically treated teeth gives superior results in relation to direct Inlay Composite Resin in coronal bacterial leakage assessment. Introduction: The general consensus is that the root canal system must be completely obturated and decontaminated for endodontic treatment to be successful (1). Inadequate coronal sealing, bacterial survival both within and outside the root canal, underfilling the canals, irregular canal geometry, and iatrogenic mistakes are typically the causes of endodontic failures (2). Both a strong apical seal and an entire coronal seal are necessary for endodontic treatment to be successful. It is necessary to consider coronal microleakage as a potential cause of root canal treatment failure. Patients need to be made aware of the importance of the coronal seal through and following obturation because inadequate coronal restoration results in higher failures (3). The results of endodontic therapy and teeth preservation are enhanced by the insertion of a final filling. The chances of a successful outcome of endodontic therapy are significantly reduced in the absence of a permanent filling. To maintain the coronal and radicular dental structure, anterior teeth undergoing endodontic operations that result in minimum tooth structure destruction could be conservatively restored using bonded restorations. For the rebuilding and rehabilitation of teeth that have undergone endodontic treatment, materials that could adhere properly to the dentin are always a viable possibility (4,5). To conserve the most of hard tissue as feasible, the kind of restoration is often determined by the location of the tooth on the dental arch and the amount of residual tooth structure. A crown can more effectively preserve posterior teeth that have undergone endodontic treatment, whereas a direct composite restoration is the material preferred for anterior teeth that have undergone tiny to moderate restoration. Additional materials and methods utilized for a long time post endodontic filling materials consist of ceramic full/partial crowns, gold and ceramic on-lays, and amalgam restorations (6). Clinical studies have demonstrated that post endodontic coronal microleakage might permit bacterial infiltration into the filled root canal system, leading to reinfection and endodontic therapy failures. A sufficient coronal seal is necessary for endodontic treatment to be successful. Following the obturation process is finished, a tightly sealed coronal filling is necessary to stop oral bacteria from getting inside (2). The reasons for the improvement in endodontic success by placement of proper coronal restoration are firstly the coronal seal that prevents re-infection of bacteria into the filled root canals, secondly the protection of the remaining tooth structure from fracture. For this reason, a selection of coronal restoration after endodontic treatment must be considered to protect or reinforce the remaining tooth structure. In daily practice, several dental practitioners usually prefer to select cuspal or full
... In the literature, there are treatment options for the restoration of endodontically treated teeth, such as post-core and total or partial crowns, and advancements in adhesive technologies provide the opportunity to create conservative and aesthetically pleasing dental restorations entirely with composite resin materials [19,20]. A retrospective study reported that the 5-year survival rate of severely damaged endodontically treated molars restored directly with composite resin was 18%, while the cumulative survival rate increased to 78% when the maximum amount of dental tissue was present [21]. For endodontically treated posterior teeth exhibiting conservative endodontic cavity designs, the most suitable access restoration consists of a direct restoration using a resin composite due to its high bond strength to the dental substrate [22]. ...
Objective
This study aimed to evaluate the fracture strength of teeth restored using fiber-reinforced direct restorative materials after endodontic treatment with a conservative mesio-occlusal access cavity design.
Materials and methods
A total of 100 extracted intact mandibular first molars were selected and distributed into a positive control group where teeth left intact and the following four test groups comprised of teeth with conservative mesio-occlusal access cavities that had undergone root canal treatment (n = 20/group): access cavity without restoration (negative control), bulk-fill resin composite with horizontal glass fiber post reinforcement, fiber-reinforced composite with bulk-fill resin and bulk-fill resin composite. Following thermocycling (10,000 cycles), fracture resistance was measured using a universal testing machine. Statistical analyses (one-way analysis of variance and the Tamhane test) were performed, and statistical significance was set at p < 0.05.
Results
Groups with minimally invasive access cavities had lower fracture strength than intact teeth, regardless of the restoration material (p < 0.05). Fiber-reinforced composite groups demonstrated higher fracture strength than bulk-fill resin composite alone (p < 0.05). Fracture types varied among groups, with restorable fractures predominant in the fiber-reinforced composite groups.
Conclusion
This study suggests that using fiber-reinforced composite materials, especially in combination with bulk-fill resin composites, can effectively enhance the fracture strength of endodontically treated teeth with conservative access cavities. However, using only bulk-fill resin composite is not recommended based on the fracture strength results.
Clinical significance
When teeth that undergo endodontic treatment are restored using a conservative access cavity design and fiber-reinforced composite materials, especially in combination with bulk-fill resin composites, the fracture strength of the teeth can be effectively increased.
... However, the amount of remaining crown structure is one of the important factors affecting long-term tooth preservation. 1 In 2010, Clark and Khademi introduced a minimally invasive approach to accessing the pulp chamber for posterior teeth, aiming to preserve 4 mm of tooth structure around the cervix to enhance stress distribution and prevent fractures. 2 Different designs of access openings have been proposed based on this concept, categorized by their morphology. ...
Background/purpose
The success of root canal treatments is influenced by the shape of the access opening and the outcomes of root canal enlargement. The aim of this study was to evaluate the impact of various rotary instruments on the maintenance of the root canal's central alignment post shaping, considering a range of access cavity designs.
Materials and methods
Using digital tooth simulation, 4 sets of 12 teeth underwent traditional (TradAC) or conservative (ConsAC) access cavity preparations. Root canals were enlarged with TruNatomy or ProTaper Ultimate rotary instruments. Canal transportation and centering ratio were separately measured. Statistical analysis was performed using JMP trial 17 software.
Results
The analysis revealed no significant difference in buccal and lingual canal transportation among different rotary instruments or canal enlargement designs (P > 0.05). TradAC yielded higher centering ratios in MB and ML canals, while ConsAC excelled in the distal canal for the TruNatomy group. Conversely, in the ProTaper Ultimate group, ConsAC demonstrated higher ML canal ratios (P < 0.05).
Conclusion
TruNatomy maintained superior canal centering with ConsAC, while ProTaper performed better with TradAC.
... However, compared to vital teeth, endodontically treated teeth (ETT) are more susceptible to bio-mechanical failure because of the loss of structural strength associated with, cavity preparation, trauma, or caries rather than physical dentin changes or dehydration. Moreover, the survival rate of ETT depends primarily on the remaining tooth structure after RCT (1,2). To date, no agreement in the literature regarding which type of restoration or material that can properly restore ETT (3). ...
... This vignette survey investigated the perceived effect of multiple prognostic tooth-related factors by GDPs such as remaining tooth structure (including remaining number and thickness of walls), 5,24,25,26,27,28 number of proximal contacts, 12, 24, 16 tooth location, 13 cracks, 29,30 and periodontal disease 31,32,33,34 due to their established signi cance in the current literature. Tooth mobility, skeletal class and lateral guidance have not been well documented but were provided as an option during factor assessment. ...
Aims: To assess and compare how UK general dental practitioners restore endodontically treated molars and what tooth-related factors they consider relevant to their management.
Method: An online cross-sectional vignette survey was sent out to UK dentists via email and the use of social media platforms. Three clinical cases were designed.
Results: 394 participants completed the survey. GDPs showed a preference towards restoring the endodontically treated molars with indirect restorations such as crowns and onlays. Material election varied, with a notable inclination towards gold and lithium disilicate. This was influenced by factors such as the number of remaining tooth walls, thickness of walls, and the presence of parafunction.
Conclusion: Clinicians generally agreed on whether to place a direct or indirect restoration but there was greater disagreement when deciding on the type of restoration and material. Further evidence and education are required to help UK dentists decide more objectively whether to place an onlay or a crown, what material to select, and what prognostic factors are most pertinent to the case.
... However, this is likely due to the limited number of teeth that were restored with a crown (n = 15), as fixed prosthodontics are not covered by Queensland Health at the GUDC and incur private fees. Furthermore, the short minimum follow-up period of 1 year may not reflect the increased longevity of teeth restored with a crown, which is well established in the literature and more apparent with longer follow-ups (Aquilino & Caplan, 2002;Nagasiri & Chitmongkolsuk, 2005). Both a successful endodontic outcome and a successful periodontal outcome led to highly F I G U R E 2 Success, survival, and failure rates of statistically significant variables compared to the overall final outcome. ...
Objectives
The objective of this retrospective study was to determine possible prognostic factors of endodontic‐periodontal lesions and to compare success, survival, and failure outcomes of treated endodontic‐periodontal lesions across different treatment modalities, demographic variables, and anatomical tooth variations.
Materials and Methods
Data was collected from patient records in the patient management system (Salud, Titanium Solutions) from the Griffith University Dental Clinic between January 2008 and December 2021. The search strategy used the terms “endodontic periodontal lesion,” “periodontal endodontic lesion,” “endo perio lesion,” “perio endo lesion,” and “EPL.” The 88 cases which met inclusion and exclusion criteria were analyzed.
Results
The overall success rate was 46.6%, with 21.6% of teeth surviving and 31.8% of teeth failing. Bone loss extending to the apical third (OR = 0.3, 95% CI [0.104, 0.866]), and probing depths of 5–7 mm (OR = 0.147, 95% CI [0.034, 0.633]) and 8‐10 mm (OR = 0.126, 95% CI [0.029, 0.542]) were associated with a statistically significant lower odds of success ( p < .05). A history of no periodontal disease (OR = 7.705, 95% CI [1.603, 37.037]) was associated with a statistically significant higher odds of success ( p < .05).
Conclusion
Practitioners should be aware of bone loss to the apical third, deep probing depths, and a history of periodontal disease as possible prognostic factors that can affect the success rate when treating endodontic‐periodontal lesions. Further research with more stringent control over operator factors should be done to investigate these variables.
... The endodontically treated posterior teeth with two-surface cavity preparation were resulted in a 46% loss in tooth stiffness and the teeth with MOD cavity resulted in a 63% lost [2]. In Nagasiri's long-term research, tooth failure was identified in 101 teeth (45.9%) of 220 endodontically treated molars without crown coverage teeth at 5 years and the survival rate of the molars were 36% [3]. As the American Association of Endodontists (AAE) guidelines state, a full cuspal protective restoration could protect the remaining tooth structure and provide coronal sealing for endodontically treated posterior teeth. ...
Objective
The aim of this study was to evaluate the outcome and risk factors for chairside CAD/CAM full cusp coverage restorations on endodontically treated posterior teeth after 3 years of follow-up.
Methods
A total of 245 endodontically treated posterior teeth of 224 patients were included and restored with CAD/CAM full cusp coverage all-ceramic restorations according to a standardized protocol. Patients were recalled after treatments 1 to 3 years and underwent clinical and radiological examinations. At recall, modified FDI criteria were used to determine treatment outcomes by 2 evaluators. Success was determined when FDI scores were 1–2, and failure was indicated when FDI scores were 5. Logistic regression analysis was performed to evaluate potential risk factors.
Results
A total of 183 patients presented at recall, and the clinical outcomes of 201 teeth were analyzed with a recall rate of 82.0% for teeth and 81.7% for patients after 1–3 years of follow-up.185 of 201 teeth were found to have FDI scores of 1–2, and the success rate was 92%. No teeth were extracted during the follow-up period. Fourteen failed cases with an FDI score of 5 presented restoration dislocation, fracture of restoration or/and tooth. Logistic regression analysis revealed that oral parafunction (OR 2.281, 95% CI 2.2 ~ 47.5, P value 0.01) was a risk factor for success rate.
Conclusion
Chairside CAD/CAM all-ceramic full cusp coverage restoration was (could be) a promising alternative for restoring endodontically treated posterior teeth.
... 11 A study by Nagasiri and Chitmongkolsuk study demonstrated that a greater amount of remaining tooth structure was associated with increased longevity of the tooth. 12 Undeniably, conservative bonded options, like endocrowns, offer several advantages including preservation of dental and periodontal tissues, reinforcement of healthy residual dental tissues, and aesthetic, ergonomic and economic benefits. The concept of endocrowns has become an attractive option for the restorative treatment of molars with extensive coronal destruction. ...
... Endodontik tedavili dişin kalan yapısal bütünlüğü, restorasyon sonrası dişin prognozu belirleyen önemli bir faktörlerdendir. 4,5 Dişin dayanıklılığı ve yapısal deformasyona karşı direncini korumak, özellikle endodontik tedavi sonrası yapılan restoratif tedavilerin en önemli amacıdır. Karmaşık kök kanal anatomisi, endodontik tedavi sırasına önemli zorluklar oluşturabilir. ...
... 14 Regarding fracture resistance of endodontically treated teeth, the highest values were observed for the Truss cavity group compared to CAC and TAC (p < 0.05). This may be related to the lower percentage of dentin removal (5.51%), since the volume of lost coronal dentin plays a significant role in the prognosis of endodontically treated teeth, 26,34 regardless of remaining filling material and voids observed with this access type. Similar data were found in the analysis of the failure pattern, in which all groups showed a higher prevalence of favorable and restorable fractures (Type I, II and III), 35 similar to the control group (p > 0.05). ...
The survival of endodontically treated teeth depends on the remaining tooth structure. The aim of this study was to evaluate the impact of different access cavities on root canal preparation, restorative protocol, and fracture resistance of endodontically treated teeth. Fifty-six mandibular molars were divided into control (n=8) and experimental (n=16) groups according to access cavity: Traditional, Conservative, and Truss; and redistributed (n=8) according to instrumentation protocols: Reciproc Blue and R-motion. After, teeth were scanned in micro-CT and then filled and redistributed according to composite resin restoration (n=8): Filtek One BulkFill and Filtek Z350. A new micro-CT scan was performed to analyze the restorative material. Then, samples were submitted to fracture resistance testing and the failure pattern was determined. Data were analyzed using paired T-test, ANOVA, Tukey, and chi-square tests (α=0.05). In Truss, R-Motion promoted less transportation in different thirds of root canals. Higher percentages of voids (5.05%) and filling material (11.7%) were observed in Truss. Fracture resistance values were higher for the control group, followed by Truss, Conservative, and Traditional. The predominant failure pattern was type-II. In Truss, reciprocating instruments with smaller taper showed less canal transportation. Also, Truss provided higher values of fracture resistance, although it presented a higher percentage of voids and remaining filling material. Thus, in Truss, reciprocating files with smaller taper showed less canal transportation, and these cavities provided higher values of fracture resistance, although it presented a higher percentage of voids and remaining filling material.
... Furthermore, full retreatment may require access enlargements to excavate around and remove posts in the canals that will be retreated, resulting in the weakening of the tooth structure due to the removal of unnecessary dentin and potentially iatrogenic errors. The advantage of selective root-canal retreatment becomes particularly evident due to the established correlation between the remaining coronal tooth structure and the success (Al-Nuaimi et al., 2017) and long-term survival (Al-Nuaimi et al., 2020;Nagasiri & Chitmongkolsuk, 2005) of root-filled teeth. By opting for selective retreatment, the need for more extensive interventions and access openings can be avoided in many cases, minimizing damage and maximizing the retention of the structural integrity of the tooth (Nudera, 2015). ...
Aim
Selective root‐canal retreatment has been proposed as an alternative to full retreatment in multirooted, root‐canal‐filled teeth with evidence of apical pathology, where only the affected root(s) is retreated. Whilst this option may save costs initially, failures and retreatments may compensate for these initial savings. We assessed the cost‐effectiveness of full versus selective root‐canal retreatment using data from a recent clinical pilot study, employing a modelling approach.
Methodology
A Markov model was constructed to follow up a previously root‐canal treated maxillary molar with apical pathology on a single root (mesio‐buccal), receiving either selective or full root‐canal retreatment. A private‐payer perspective in Dutch health care was adopted. Permanent molar teeth with apical lesions on the mesial root were simulated over the lifetime of initially 50‐year‐old patients. Teeth could have endodontic complications and require interventions such as retreatment or tooth extraction and replacement. Costs were calculated based on the Dutch dental fee catalogues. Monte‐Carlo microsimulations were performed to assess lifetime costs and effectiveness (measured as tooth retention time), and the resulting cost‐effectiveness. Probabilistic joint uncertainty and sensitivity analyses were performed, and cost‐effectiveness at different willingness‐to‐pay‐thresholds was evaluated.
Results
In the base‐case scenario, selective retreatment was less costly (2137; 2.5%–97.5% percentiles: 1944–2340 Euro) and more effective (19.6; 18.3–20.8 Years) than full retreatment (2495; 2305–2671 Euro; 16.5; 15.2–17.9 Years) in 100% of the simulations and regardless of the willingness‐to‐pay threshold. Only in a worst case scenario was selective retreatment more costly, but remained more effective.
Conclusions
Selective retreatment, when clinically applicable, is likely to be more cost‐effective than full retreatment in endodontically treated molars with persistent apical periodontitis. Our results should be interpreted with caution because the quality of the underlying data is limited.
... The study found that endodontically treated teeth that did not receive full cuspal coverage following endodontic treatment were lost at a six times greater rate than teeth crowned after obturation [15]. Most retrospective studies have shown that, in general, crowns are more efficient in terms of increasing the success rates [15,16]. Other authors even analyzed the time span between the end of the root canal treatment and the placement of restoration and found that success rates decrease with time, where the authors showed that teeth not crowned within 4 months after obturation were extracted at a 3.0 to 6.0 times greater rate than teeth crowned right after obturation [15,17]. ...
Although much progress has been obtained in terms of the Endodontic treatment, the literature shows that true success can be only achieved with adequate coronal seal to avoid bacterial contamination, and protect the tooth structure from fracture. There are many options available to the clinician to restore the endodontically treated tooth; however, there is not much evidence available on what alternative is better than another. This review will critically present the current knowledge on restorative choices, including posts and endocrowns, showing advantages and disadvantages of different treatment forms. With this knowledge, we will also introduce the concept of biomimetics to endodontically treated teeth, and how the nature of their remaining tooth structure can benefit from this approach. This concept entails the use of mechanisms and biologically produced materials to restore a tooth in a way that would mimic its natural structure, with the purpose of achieving better longterm prognosis. KEYWORDS Endodontics; Dental restoration; Biomimetics; Adhesion; Tooth fracture.
... These findings may be because those who have graduated a while ago may have had some kind of postgraduation training or attended continuing education courses, suggesting that they are more likely to be exposed to new techniques. [1][2][3][4]17] When it comes to postgraduate education, the evidence suggests that dental specialists are better informed with the literature and attend meetings more frequently, directly influencing their clinical decisions and, as a result, their practices. These dentists are better equipped to incorporate new technology into their clinical practice.However, there was no significant relationship between the level of expertise and the type of post used in this investigation. ...
Background
In endodontics, dentist's choice for using posts/materials relevant to posts used to restore endodontic-treated teeth is influenced by clinical experience, whether concerning the length of practice time and level of specialization.
Objective
Traditional restorative approaches are being modified as newer materials become available and patient preferences shift. The purpose of the study was to see if dentists' preferences for using posts and other materials associated to post used to restore endodontically treated teeth are influenced by practical experience, whether measured by the length of clinical practice time or level of specialty.
Methodology
A cross-sectional study was conducted with dentists ( n = 100) working in Karnataka utilizing a questionnaire. Data on sociodemographics, clinical experience, postgraduate training, and postendodontic restoration characteristics (posts/types of cement and rubber dam application) were obtained. The samples only included general and specialist dentists. A descriptive analysis was performed on the data. The Chi-square test and Fisher's exact test investigated the relationships.
Results
The most chosen materials were metal posts (60%) and resin cement (70%). There was a statistically significant association between clinical practice duration and postuse type ( P = 0.017). In addition, there was a highly significant relationship ( P = 0.001) between clinical practice time, level of specialty, and the use of rubber dams.
Conclusions
Dentists favored metal posts for post endodontic restorations, while resin-based cement was the preferred luting cement for the posts' cementation. Additional training and more clinical practice time were factors in several dental postselection decisions.
... Nowadays, all operations in the medical field are aimed basically at the conservation of the human body [7]. In Endodontics, the integrity of the tooth structure is a crucial factor that influences the case prognosis as it is directly related to the functional requirements of the tooth after restoration [8,9]. ...
Objectives: Post-treatment apical periodontitis is an inflammatory disorder of peri-radicular tissues caused by either persistent or secondary intra-radicular infection . The present study compared the prognosis of cases treated with the “selective root retreatment” concept to the traditional retreatment approach. Material and Methods: Forty patients complaining of failed root canal treatment having a periapical lesion in one root were selected. The cases were randomly divided into two groups; group (S): selective root canal retreatment in which only the affected root was retreated and group (T): traditional root canal retreatment in which all canals were retreated. The peri-radicular condition was evaluated radiographically using the Periapical Index (PAI) for one year. The chi-square test statistical tests analyzed the outcome data. Results: At the baseline examination, There was no significant difference between the two groups regarding the patients’ baseline mean periapical indices . After one year, we found that the mean periapical index declined without a significant difference between the two groups. Conclusions: The present study points to selective root retreatment as a successful “minimally invasive alternative” in cases of an independently diseased root. The remaining treated roots can be retained without intervention provided that they are confirmed: “healthy”. Clinical Relevance: Selective root retreatment is a promising conservative option in the treatment of failed endodontic cases with periapical pathosis related to an individual root.
... Past restorative practices are updated as newer materials emerge and patient preferences change (3) . As a restorative material, amalgam and composite resin are commonly used in core foundations (4) . A post is routinely put into the root canal system to retain the core in a badly traumatized tooth. ...
Objective: Traditional restorative approaches are being modified as newer materials become available and patient preferences shift. The purpose of the study was to see if dentists' preferences for using posts and other materials associated to post used to restore endodontically treated teeth are influenced by practical experience, whether measured by the length of clinical practice time or level of specialty. Methods: A cross-sectional study was conducted with dentists (n = 108) working at Hawler Medical University/College of Dentistry utilizing a questionnaire. Data on sociodemographics, clinical experience, postgraduate training, and post-endodontic restoration characteristics (posts/types of cement, rubber dam application) were obtained. The samples only included general and specialist dentists. A descriptive analysis was performed on the data. The Chi-square test and Fisher's exact test investigated the relationships. Results: The most chosen materials were metal posts (53.7 %) and resin cement (50 %). There was a statistically significant association between clinical practice duration and post-use type (P = 0.017). In addition, there was a highly significant relationship (P = 0.001) between clinical practice time, level of specialty, and the use of rubber dams. Conclusions: Dentists favored metal posts for post endodontic restorations, while resin-based cement was the preferred luting cement for the posts' cementation. Additional training and more clinical practice time were factors in several dental post-selection decisions.
Traditional endodontic retreatments usually target the entire root canal system. In contrast, selective root canal retreatment presents a new, targeted alternative that offers a less invasive solution. However, its promising approach faces potential obstacles due to a lack of long-term data, which might affect its widespread acceptance. This case report adds to the existing body of literature by offering an in-depth analysis of a long-term outcome following selective non-surgical retreatment, thereby bridging an important gap in knowledge. A 59-year-old male presented with post-treatment apical periodontitis (PTAP) in a maxillary first molar. Initial clinical examination revealed the patient was symptomatic, and the tooth responded negative to thermal tests and positive to vertical percussion. Radiographic assessment identified a radiolucency confined to the mesiobuccal root. No radiolucencies or signs of inflammation were observed in the distobuccal and palatal roots. These findings led to the decision to selectively retreat the mesiobuccal root non-surgically. This targeted approach aimed at addressing the inflammation while preserving the integrity of unaffected areas. The patient received selective non-surgical retreatment on the mesiobuccal root. During a nine-year follow-up, the patient remained asymptomatic, as confirmed by clinical observation. Periapical radiograph and Cone Beam Computed Tomography (CBCT) scan demonstrated complete healing of the treated root. Importantly, the untreated roots showed no signs or symptoms of apical periodontitis. This underscores the efficacy of the targeted treatment and its successful resolution of the inflammation. This case report aimed to show the long-term effectiveness and minimally invasive nature of selective root canal retreatment to address PTAP. It focused on the method’s capacity to preserve tooth structure with minimum intervention. The positive outcomes highlight the urgent need for more controlled studies. Such research would confirm the advantages of selective retreatment, with the goal of improving endodontic protocols and patient care.
Background. Foundation restorations involve the use of materials such as composite resins to partially restore defective dentin structures. They can be used to simplify the geometry of complex cavities, facilitate restoration insertion, and reduce the polymerization shrinkage of the adhesive. However, the stress distribution of teeth restored after foundation restoration placement is not fully understood.
Methods. The purpose of this finite element study was to analyze the stress distribution of onlays with composite resin foundation restorations to investigate the potential benefits of preserving the remaining dental tissue.A 3Dfinite element model of a mesial proximal defect of the mandibular first molar after endodontic treatmentwas established. Four types of onlay restorations (GA and GB: complete-coverage onlay; GC and GD: partial-coverage onlay) were designed using this model. After the models wereestablished, a fixed vertical load of 600 N and an oblique load of 200 N were applied, and the stress distributions were compared between the monolithic ceramic blockrestorations (GA and GC) and those with foundation restorations (GB and GD). The stress distributions of the onlays and models were also analyzed.
Results. Under vertical loading conditions, GD exhibited higher peak equivalent stress levels inthe onlay and adhesive layers. The maximum principal stress experienced by enamel was lower in GB and GD than in GA and GC, whereas it was greater in GB and GD than in GA and GC for the onlay and adhesive layer. Under oblique loading, the peak equivalent stress and maximum principal stress of the adhesive layer and enamel were the lowest in the GB and GD groups.
Conclusions. Foundation restorations provide good stress dispersion, which can improve the protection of the remaining dental tissue. However, onlay restorations after foundation restoration placement should be used with caution in patients with excessive occlusal forces. Oblique loading was more destructive to the adhesive layer and remaining dental tissue. Complete-coverage restorations have better stress dispersion than partial-coverage restorations.
Background
Analysis of the survival of root‐filled posterior teeth and the associated prognostic tooth‐related factors will enable clinicians to predict the outcome of root canal treatment.
Objectives
To investigate (i) the survival of root‐filled posterior teeth and (ii) the tooth‐related factors that may affect their survival.
Methods
Randomized controlled trials, comparative studies and observational studies assessing survival rates of root‐filled posterior teeth with a minimum 4‐year follow‐up period were identified through an electronic search of the following databases up to January 2023: The Cochrane Central Register of Controlled Trials, Medline via PubMed, the Cochrane Database of Systematic Reviews, Embase, Web of Science and NIHR centre for reviews and dissemination. Two reviewers (SP and ML) independently selected the final studies based on pre‐defined inclusion criteria. The Newcastle Ottawa Scale and the Cochrane Risk of Bias Tool for Randomized Trials were used to assess the risk of bias. Pooled weighted survival rates were analysed using a random effects meta‐analysis model using DerSimonean and Laird methods. Descriptive analysis of studies describing any prognostic tooth‐related factors was conducted.
Results
Of the 72 studies identified, data from 20 studies were included in the survival meta‐analysis, and data from 13 of these studies were included in the descriptive analysis of tooth‐related factors; 12 studies were retrospective, 7 were prospective, and one was a randomized control trial. The pooled survival rates at 4–7 years and 8–20 years of root‐filled posterior teeth regardless of tooth type was 91% (95% CI, 0.85; 0.95) and 87% (95% CI, 0.77; 0.93), respectively. The prognostic tooth‐related factors mentioned in the included studies were (i) remaining coronal tooth structure, (ii) ferrule, (iii) crown‐to‐root ratio (iv) tooth type and location (v) periodontal disease (vi) proximal contacts and (vii) cracks.
Conclusions
The meta‐analysis suggests that root canal treatment has a high medium to long term survival outcome. The narrative summary identified 7 factors that affect tooth survival. However, there is a paucity of evidence, and more research is needed in this area.
Registration
PROSPERO Registration: CRD42021227213.
Introduction: Diseases of the pulp and periapical tissue, which require endodontic treatment, are often accompanied by a large tooth crown defect caused by caries. Regardless of well-performed endodontic treatment, endodontically treated teeth are prone to fractures. This raises the issue of tooth restoration after quality endodontic treatment. Crowns represent dental restorations, made of ceramics or metal-ceramics, which, in addition to establishing the morphology of the teeth, also have the function of protecting teeth with a larger crown defect. The aim was to review the factors that could lead to the fracture of endodontically treated teeth. Conclusion: When deciding whether to restore an endodontically treated tooth with crowns, it is necessary to consider several factors, among which are the loss of hard tooth tissue, the structure of the endodontically treated teeth, the forces to which the teeth are exposed in the oral cavity, the instruments and materials used during the endodontic treatment, as well as the aesthetics of the endodontic treated teethProsthetic reconstruction with a crown proved to be significant in the protection of posterior endodontically treated teeth, while treatment of the front teeth with crowns is indicated for the teeth with major damage and aesthetic defects that cannot be repaired by other conservative procedures.
Aim
This study aimed to investigate the selection of postendodontic restorative materials and techniques for both anterior and posterior teeth by Indian endodontists and nonendodontists, along with other influencing factors.
Methods
A total of 700 dentists, including both endodontists and nonendodontists, participated in this survey. The survey consisted of 22 questions and was administered through Google Forms and various online platforms. Participants were required to provide informed consent before completing the questionnaire.
Results
The majority of endodontists (80.3%) and nonendodontists (72.6%) revealed a preference for resin composite as the primary restorative material for postendodontic restoration. Approximately half of the endodontists (50.0%) and 67.8% of nonendodontists typically waited for 1 week before proceeding with postendodontic restoration, with the presence of periapical lesions being the most common reason for this delay. Both endodontists (81.7%) and nonendodontists (73.4%) considered the amount of remaining tooth structure as the most crucial factor in guiding their choice of postendodontic restoration. The majority of both endodontists (75.3%) and nonendodontists (81.4%) preferred full-coverage crowns as the definitive postendodontic restoration. Furthermore, endodontists (95.4%) and nonendodontists (85.5%) reported that they only performed post and core restoration when necessary, and 84.7% of endodontists and 76.5% of nonendodontists believed that post and core restorations aided in supporting crowns.
Conclusion
The outcomes of the survey imply that while endodontists in India demonstrate a more comprehensive comprehension of postendodontic restoration concepts, nonendodontists also exhibit a sufficient level of understanding essential for achieving clinical success.
Background
This study evaluated the influence of deep margin elevation (DME) with composite resin when applied to deep margin defects in root–filled molars with mesiooccluso–distal (MOD) cavities, which were subsequently restored with computer-aided designed/computer-aided manufacturing (CAD/CAM) ceramic or composite onlays.
Methods
Forty–eight complete human third molars were removed and randomly distributed into 6 groups (n = 8). The MOD cavities were prepared with the distal gingival margin below the cementoenamel junction (CEJ) 2 mm and the mesial gingival margin above the CEJ 1 mm. All molars underwent endodontic treatment. The distal gingival margin was filled with 2 mm thick Filtek™ Z350 XT Flowable resin (FF) or Filtek™ Z350 XT Universal resin (FU) to the CEJ. Then, all molars were restored with onlays made by Vita MarkⅡ CAD (VC)/IPS e.max CAD (IC)/SHOFU ceramage (SC). Epoxy replicates were made before and after thermomechanical loading (5 ~ 55°C, 5000 cycles; 10 Hz at 360 N, 100000 cycles). Scanning electron microscopy (SEM) analysis was performed to analyze margin integrity. Statistical analysis was performed.
Results
All the interfaces exhibited a decrease in margin quality after thermomechanical loading(TML) (P < 0.05). At the onlay–resin interface, when comparing margin integrity with that of the same DME resin before TML, there were no significant differences among the FF/VC, FF/IC and FF/SC groups (P > 0.05), and there were no significant differences among the FU/VC, FU/IC and FU/SC groups (P > 0.05). After TML, FF/IC > FF/SC > FF/VC, and FU/IC > FU/SC > FU/VC, there was a significant differences among these groups (P < 0.05). When comparing marginal integrity with the same onlay material, there was no significant difference in marginal integrity between FU/SC and FF/SC, FU/IC and FF/IC, or FU/VC and FF/VC before and after TML (P > 0.05). At the resin‒dentin interface, before and after TML, the margin integrity of the dentin‒paste resin was greater than that of the dentin–flowable resin (P < 0.05).
Conclusions
In this study, after TML, the best marginal integrity was obtained at resin–onlay interface with IPS e.max CAD material. However, DME with paste or flowable resin had no significant effect on the marginal integrity of the resin–onlay interface. At the dentin–resin interface, this study revealed that the marginal integrity of the flowable resin was lower than that of the paste resin, but both resulted in acceptable marginal quality for use as DME materials.
creative commons attribution non-commercial License. Which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. Abstract Aim: To evaluate and compare the fracture resistance of mesio-occluso-distally involved endodontically treated maxillary premolars with/without an overlay preparation restored using different bulk fill composite resin and full crown restorations. Methodology: Standardized MOD cavities were prepared on 75 freshly extracted human maxillary premolars which were then subjected to endodontic treatment. The specimens were divided into 5 groups (n=15) based on preparation design and materials employed as: G1-MOD restored with nanohybrid composite, G2-MOD overlay with 2.5mm cuspal reduction restored with nanohybrid composite , G3-MOD restored with fibre reinforced composite veneered with nanohybrid composite, G4-MOD overlay with 2.5mm cuspal reduction restored with fibre reinforced composite veneered with nanohybrid composite and G5-MOD cavity restored with nanohybrid composite followed by PFM crow. Specimens were subjected to thermocycling and fracture resistance testing using Universal Testing Machine to assess the fracture resistance and mode of failure. One-way ANOVA test followed by Tukey's HSD Post hoc Analysis were done to compare the fracture resistance between 5 groups. Chi square test was used to compare the mode of failure between the groups.
Objective:
Teeth prepared for mesial-occlusal-distal (MOD) restorations have a significant risk of cusp fracture. Crowns and onlays can provide cusp coverage to reinforce posterior teeth at risk. Onlays are often more conservative of tooth structure which may be an advantage for teeth with large MOD preparations. It remains uncertain how onlays and crowns compare for posterior teeth with MOD tooth structure loss. The purpose of this systematic review was to compare the resistance to fracture, success rate, survival rate, and failure rate of teeth with MOD preparations restored with onlays or crowns.
Materials and methods:
An electronic search queried Medline (PubMed), Embase (Ovid), Scopus, the Cochrane Library, and grey literature (OpenGrey) from database inception through April 29, 2023.
Results:
After eliminating duplicates and irrelevant records, 32 manuscripts were assessed. Only three publications met the criteria for inclusion. Most exclusions were due to poor reporting of restorative design and the amount of tooth structure remaining, or due to combining various restorative designs. Due to the limited sample size and high heterogeneity, no meta-analysis was conducted. One study observed a better outcome for onlays and two observed no difference. All three studies reported the mode of failure for crowns as more catastrophic whereas teeth with onlays could be salvaged.
Conclusions:
Onlays may be an advantageous alternative to crowns for teeth with MOD preparations, but the level of evidence is insufficient to draw meaningful conclusions.
Clinical significance:
Current evidence is insufficient to determine whether onlays or crowns are providing a different outcome when used to restore posterior teeth with MOD tooth structure loss. However, the fracture of teeth with MOD tooth structure loss restored with onlays appears to be less catastrophic than when restored with crowns.
The restoration of endodontically treated teeth (ETT) is challenging as these teeth often present with structural deficiencies. Currently, there is no consensus regarding the final restoration choice. Historically, the full coverage crown was the universally selected treatment for endodontically treated teeth. With advances in adhesive and biomimetic dentistry, more minimally invasive treatment modalities have become a viable option. With this study, we aim to understand the restorative decision of the general dentist with or without additional training in biomimetic dentistry. Seventy-eight general dentists, with or without biomimetic training, were surveyed to determine their restorative preferences on five extracted posterior teeth, categorized according to volumetric loss of tooth structure, as indicated by the number of missing walls, the isthmus width, the presence or absence of marginal ridges, and cusps. CAD/CAM reconstructions were made with the teeth to analyze the volume of tooth loss and compare these with the survey results. Data were compared using the chi-squared test and Fisher’s exact test. The frequency of responses recommending a crown and the volume of tooth loss were correlated using the Pearson test (p < 0.05). For all five teeth, survey responses showed a statistically significant difference in the restorative decision of full coverage versus alternative restorations, with biomimetic dentists selecting a direct restoration or inlay/onlay in lieu of a full coverage crown (n = 63, p < 0.05). The age of the participant did not have a significant impact on the restorative decision making process for these teeth. The biomimetic trained dentists showed a greater tendency to select a crown option only when the volume of tooth loss was greatest, otherwise their restorative decisions tended towards the conservative treatment options. This study also demonstrates a novel method of digitally developing a volume of tooth loss to compare against the visual interpretation of the volume of tooth loss.
Değerli okuyucular, Diş hekimliği alanında önemli mesafeler kat etmiş değerli meslektaşlarımızın olağanüstü katkılarını ortaya koyan son kitabımızın heyecan verici haberini sizlerle paylaşmaktan mutluluk duyuyoruz. Diş hekimliği disiplinler arası araştırma ve işbirliği gerektiren çok yönlü bir alandır ve kitabımız radyoterapi ve kemoterapi alan hastalarda dental uygulamalar, temporomandibular eklem rahatsızlıkları ve güncel tedavi yaklaşımları, gümüş diamin florürün çocuk diş hekimliğinde kullanımı, çocuk diş hekimliğinde güncel anestezi uygulamaları, dental beyazlatma işlemleri, diş hekimliğinde yeni dönem dijital çağ: CAI/CAD/CAM teknolojisi ve ileri imkanlar, tek renk universal kompozitler, post-endodontik restorasyonlar ve sonlu elemanlar analizi gibi diş hekimliğinde geniş bir yelpazeyi kapsamaktadır. Bu kitabın ortaya çıkmasında gösterdikleri sarsılmaz destek ve özveri için yazarlarımıza ve yayın ekibimize içten şükranlarımızı sunmak istiyoruz. Bu kitabın, insanlığın geleceği için diş hekimliği literatürünü geliştirmek için yorulmadan çalışan bilim adamlarımıza ilham vermesi ve onları aydınlatması ümidimizdir. Saygılarımla, Doç. Dr. Ömer Hatipoğlu
Değerli okuyucular, Diş hekimliği alanında önemli mesafeler kat etmiş değerli meslektaşlarımızın olağanüstü katkılarını ortaya koyan son kitabımızın heyecan verici haberini sizlerle paylaşmaktan mutluluk duyuyoruz. Diş hekimliği disiplinler arası araştırma ve işbirliği gerektiren çok yönlü bir alandır ve kitabımız radyoterapi ve kemoterapi alan hastalarda dental uygulamalar, temporomandibular eklem rahatsızlıkları ve güncel tedavi yaklaşımları, gümüş diamin florürün çocuk diş hekimliğinde kullanımı, çocuk diş hekimliğinde güncel anestezi uygulamaları, dental beyazlatma işlemleri, diş hekimliğinde yeni dönem dijital çağ: CAI/CAD/CAM teknolojisi ve ileri imkanlar, tek renk universal kompozitler, post-endodontik restorasyonlar ve sonlu elemanlar analizi gibi diş hekimliğinde geniş bir yelpazeyi kapsamaktadır. Bu kitabın ortaya çıkmasında gösterdikleri sarsılmaz destek ve özveri için yazarlarımıza ve yayın ekibimize içten şükranlarımızı sunmak istiyoruz. Bu kitabın, insanlığın geleceği için diş hekimliği literatürünü geliştirmek için yorulmadan çalışan bilim adamlarımıza ilham vermesi ve onları aydınlatması ümidimizdir. Saygılarımla, Doç. Dr. Ömer Hatipoğlu
Large cavity designs and access cavities impair endodontically treated tooth fracture resistance. As the tooth's strength is known to reduce significantly after the root canal treatment, occlusal loading as a result of functions such as chewing, biting and certain parafunctional tendencies makes the endodontically treated tooth vulnerable to fracture. Hence, after endodontic treatment, it is vital to give adequate and appropriate restorative material to avoid tooth fractures. Accordingly, the choice for such restorative material should be dictated with the property of fracture resistance. The goal of this study was to conduct a systematic review and critical analysis of available data from in vitro studies examining the fracture resistance of endodontically treated teeth repaired with fiber-reinforced composites. A comprehensive literature search was performed using PubMed Central, Medline, Scopus, ScienceDirect, Google Scholar and LILACS. A manual search of the reference lists of the articles was also performed. Two reviewers scrutinized the papers for eligibility based on inclusion/exclusion criteria and extracted data. The studies were assessed for their potential risk of bias. A total of 15 studies met the inclusion criteria and were subsequently analyzed. Based on modified JBI & CRIS (checklist for reporting in vitro studies) guidelines, along with the methodology and treatment objective, we have formulated 13 parameters specifically to study the fracture resistance. The majority of the research had a moderate or high risk of bias. When compared to traditional hybrid composites, fiber-reinforced composites showed increased fracture resistance of endodontically treated teeth in the majority of investigations. On the other hand, limited evidence was found for the bulk fill composites. Moreover, moderate evidence was found for the fracture resistance of inlays and fiber posts with fiber-reinforced composites for core build up in endodontically treated teeth. No evidence could be found comparing the fracture resistance of crowns/endocrowns and fiber-reinforced composites in endodontically treated teeth. According to the research, using fiber-reinforced composites instead of conventional hybrid composites improves the fracture resistance of endodontically treated teeth. However, there was a high risk of bias in the research considered. No judgments could be reached about the superiority of one material over another based on comparisons between other core restorations.
Statement of problem:
After endodontic treatment, teeth may require additional treatment. Data regarding the number of treatments up to extraction after endodontic treatment are lacking.
Purpose:
The purpose of this retrospective study was to evaluate the number of consecutive restorative procedures performed on a specific tooth starting from endodontic treatment up to extraction. A comparison was made between crowned and uncrowned teeth.
Material and methods:
A retrospective study was conducted using 28 years of data from a private clinic. The total number of patients was 18 082 and included 88 388 treated teeth. The data were collected for permanent teeth that received at least 2 consecutive retreatments. The data included tooth number, procedure type, date of procedure, total number of procedures conducted during the study period, extraction date, time from endodontic treatment to extraction, and whether the tooth had been crowned or not. Endodontically treated teeth were divided into 2 groups: extracted and nonextracted. In each group, a comparison was made between crowned and uncrowned teeth and between anterior and posterior teeth by using the Student t test (α=.05).
Results:
In the non extracted group, teeth that were crowned required significantly (P<.05) fewer restorative treatments (mean ±standard deviation 2.9 ±2.1) than uncrowned teeth (5.01 ±2.98). For extracted teeth, the mean time from endodontic treatment until extraction was 10.39 years. Crowned teeth were extracted after a mean of 11.06 years and 3.98 treatments, while uncrowned teeth were extracted after a mean of 9.96 years and 7.22 treatments (P<.05).
Conclusions:
Endodontically treated teeth that were crowned required significantly fewer subsequent restorative procedures than uncrowned teeth and exhibited higher survival rates up to extraction.
Aim: Comparative evaluation of the fracture resistance of maxillary molar teeth restored with recent composite resins. Materials and Methods: Fifty freshly extracted molar teeth were selected. Ten specimens served as control –unrestored, unprepared, intact (Group 1). Mesio-occluso-distal cavity preparation was prepared on the rest of the specimens. These specimens were further divided into four groups: prepared but unrestored (Group 2), teeth restored with with Nano hybrid composite (Tetric N-Ceram, Ivoclar Vivadent). (Group 3), teeth restored with Micro hybrid composite (Polofil supra). (Group 4), and teeth restored with Nano filled composite (Filtek Z-350). (Group 5). The specimens were then subjected to compressive axial load using universal testing machine. Data were analyzed using data were analyzed using Statistical package for social sciences software (SPSS v 20.0, IBM Corp.) Results: The positive control group exhibited highest fracture load (377±63.8 Kg-force). There was less difference seen in between the all recent composite resins (P > 0.05). There is significant difference noted in fracture load between control group and treatment groups Conclusion: Type of the composite restoration makes little difference in the fracture toughness while restoring MOD cavities.
Background: post endodontic treatment which can minimally invasive and maximize the longevity of a root canal treated teeth is a dentist concern. One such approach is an Vonlay. So this study was conducted to evaluate the stress distribution pattern in endodontically treated mesio occlusally involved premolars restored with ceramic onlay, vonlay and full crown restorations. Materials and Methods: Results: Materials and Methods: Finite element model of single rooted maxillary premolar tooth was obtained. Standardised MO preparation, root canal preparation dimensions with corresponding material properties of the tooth, gutta percha, access filling composite material, LDS corresponding to different post endodontic restorative design were fed to the tooth model. Accordingly, 4 tooth models were obtained • Model 1-Intact tooth • Model 2-Onlay • Model 3-Vonlay • Model 4-Full crown A force of 300N was loaded at three points-the palatal cusp tip, the mesial and distal marginal ridges and the stress distribution was noted. Results: Maximum von misses stress was recorded at the point at which the load was applied and at tooth restoration interface cervically which was highest for full crown, followed by onlay and vonlay tooth models. Conclusion: 1. Full crown tooth model showed highest magnitude of stress, at load application areas and radicular dentine apical to CEJ. 2. Onlay, Vonlay tooth models showed lower stress values and a larger area of stress distribution seen as against full crown tooth model Conclusion: Within the constraints of this FEM study, it can be inferred that stress seen with indirect onlay, Vonlay as post endodontic restorative designs werev relatively less and can be regarded as suitable alternative to full crown restorations for restoring ETT maxillary premolar.
To determine the effect of cusp coverage with amalgam restorations on the fracture strength of weakened human maxillary premolars.
30 extracted human maxillary premolars were divided into three groups; Group A (control): uncut teeth, Group B: wide MOD cavities prepared and the pulp chamber's roof removed. The teeth were restored with amalgam without cusp coverage, Group C: same as Group B plus cusp reduction and restored with amalgam. The teeth were included in metal rings with self-curing polystyrene resin and stored in water for 24 hrs. The restorations were refined with rubber points, polished and further stored in water for 24 hrs before being subjected to a compressive axial load in a Universal testing machine at 0.5 mm/min.
The mean fracture strength obtained was: Group A: 173.3 Kgf, Group B: 47.3 Kgf and Group C: 127.7 Kgf. All values were statistically significantly different (P < 0.05). The amalgam restoration of weakened human premolars with cusp coverage amalgam significantly increased the fracture strength of the teeth (63%) as compared to teeth restored without cusp coverage. The results showed that cusp coverage with amalgam might be an option for restoring weakened endodontically-treated teeth.
Several reports revealed that the cracked-tooth syndrome is a common problem in dental practice, which often results in extraction of the affected incompletely fractured teeth. Predominantly restored teeth suffer from these incomplete fractures. Therefore, it is of outstanding importance to stabilize teeth weakened due to cavity preparation. Besides full cuspal coverage by partial or full crowns, bonded restorations have been proposed for internal splinting of restored teeth. Although contradictory data have been published, there is evidence that bonded amalgam or resin-based composite restorations (RBC) do not increase fracture resistance of teeth with wide occlusal-proximal cavities to values similar to sound, unrestored controls. Indirectly fabricated RBC inlays and various ceramic inlays, however, increased fracture strength to levels as high as those of sound caries-free teeth. Therefore, it is recommended that weakened teeth with wide cavities be strengthened by full cuspal coverage with cast or ceramic restorations, by bonded ceramic inlays, or by indirectly-fabricated bonded RBC composite inlays.
This study compared the cuspal fracture resistances of posterior teeth restored with five different adhesive restorations.
Eighty-four sound human molars were included in this study. Sample molars were divided into seven groups. The first five groups received mesio-occlusodistal cavity preparations and were restored with (1) amalgam combined with urethane dimethacrylate cement, (2) posterior composite, (3) direct composite inlay, (4) cast-metal inlay, and (5) complete ceramic inlay. The sixth and seventh groups were introduced in the study as controls. Samples of group 6 were prepared but were tested without restoration (prepared-only group). Samples of group 7 were intact teeth and were tested as unprepared. All samples were loaded axially until failure.
While the unprepared teeth had a significantly higher resistance than all other groups, the prepared-only teeth were the weakest. No significant differences were found in resistance to cuspal fracture among the restoration groups.
The difference between the mean cuspal fracture resistance of the unprepared and prepared-only groups was statistically significant. Restoration groups were stronger than the prepared-only group. However, differences between the restoration groups were insignificant.
We sought to examine the clinical conditions under which 25 endodontically treated teeth underwent vertical root fracture (VRF) and to relate this condition to the time elapsed from endodontic treatment to fracture.
This was a retrospective study in which we reviewed 25 case histories of patients with postendodontic VRF and studied the effect of various pretreatment and posttreatment factors as they related to VRF.
The mean time to VRF was 54 months; this was not significantly influenced by the presence or absence of prior restoration or by the presence or absence of a crown fitting. The use of a prefabricated, cylindrical, cemented intraradicular retainer increased the time between endodontics and VRF. Teeth restored with conventional amalgam took significantly longer to undergo VRF than those restored with composite or bonded amalgam. In contrast, amalgam-restored teeth suffered more coronal fractures before VRF than did teeth in the other 2 groups.
Abstract The cumulative survival rate of 190 endodontically treated posterior teeth were assessed in a retrospective study; all teeth had an MO/DO or an MOD cavity restored with a composite resin without cuspal overlays after previous acid-etching of the enamel. In contrast to our previous study on endontically treated posterior teeth restored with amalgam, the survival rate of the MOD resin-restored teeth was equal to that of MO/DO teeth. Teeth restored with a light-activated resin had a much lower survival rate than teeth restored with a chemically-activated material, the cause presumably being that the light-activated resins were insufficiently irradiated. Nearly 25% of the teeth had been restored with a microfilled resin for anterior use and these teeth had a lower survival rate than had teeth restored with a macrofilled or hybrid resin. It was also found that a beveling technique did not decrease the fracture rate while the use of an intermediate layer of low-viscosity resin resulted in a significant improvement.
The frequency of cusp fracture of endodontically treated premolars was investigated in a retrospective study. After endodontic therapy, the teeth were either restored with a MOD amalgam filling, or with an enamel-bonded MOD resin filling. A very high frequency of cusp fracture was found in premolars restored with amalgam: nearly one-third fractured within 3 years after endodontic treatment. The frequency of cusp fracture differed among the 4 amalgam-restored teeth; the lower first premolar had a 15-year survival rate of 74%, in contrast to an average of 32% for the other 3 premolars. No resinrestored premolar fractured during the first 3 years, and the difference between amalgam and resin-restored teeth was highly significant at the 0–3 year interval. However, fracture of resin-restored premolars did happen in the following 3–10 year interval. From a periodontal point of view, a low frequency of cusp fracture carries great weight, and it is therefore concluded that an enamelbonded resin filling may be a treatment option much preferred to amalgam in temporarily restoring endodontically treated premolars with MOD cavities.
To investigate the cusp fracture resistance of endodontically treated teeth, adhesively restored with various materials.
MOD preparations and endodontic treatment was carried out on extracted sound maxillary premolars. The cavities were restored with the amalgam Valiant in combination with Superbond or Panavia bonding, the resin composites Z100, Herculite XRV or Clearfil RP with their respective bonding systems, Z100 in combination with the glass ionomers Ketac Fil, Fuji II and Vitremer, and Tetric in combination with Compoglass. Fracture resistance was measured by axial loading in an Instron testing machine.
One of the restorative methods, resin composites in combination with dentin bonding systems in beveled MOD preparations rendered the tooth a cusp fracture resistance which did not differ significantly from that of sound natural teeth. Two other restorative methods, bonded amalgam and a sandwich of glass ionomer cement/resin composite in beveled preparations were significantly weaker in resisting cusp fracture than sound natural teeth, but still significantly stronger than the unrestored tooth with a MOD preparation. It was statistically apparent that several adhesive restorative systems could satisfactorily be used to restore teeth after endodontic therapy.
The biomechanical behavior of teeth under load indicates the need for appropriate methods of restoring endodontically treated posterior teeth to ensure their retention as functioning units of the dentition.
Longitudinal studies on tooth mortality are rare but the reasons for tooth mortality have been studied by several authors. The aims of this investigation were to study the reasons for and incidence of tooth mortality in an earlier described Swedish population of 200 patients on two occasions with an interval of 5-7 years, and to see if the reasons for extractions were correlated to posts, crowns or endodontic status, respectively. 197 (4.0%) of the 4889 teeth registered at the first examination were lost during the interval. 65 (33%) of the lost teeth were endodontically treated. 44 (68%) of these were registered as having one or more root with a root-filling ending more than 2 mm from the apex and 29 (45%) were judged to have an improper seal. In 93 of the 197 lost teeth it was possible to find the reason for extraction from the patient chart. Based on distribution of selected variables, these 93 teeth seemed to be representative of the whole group of 197. It was concluded that tooth losses were evenly distributed in the different age-groups and that above all molars but also premolars were lost more often than teeth in the frontal region. Furthermore, endodontically treated teeth were lost more often than other teeth and the quality of the root-filling affected the risk for losses while crowned teeth did not run a higher risk of being lost than teeth without crowns. Finally, it was found that caries, including pulpitis and apical periodontitis, was the main reason for tooth extractions.
This study compared biomechanical properties (punch shear strength, toughness, hardness, and load to fracture) of 23 endodontically treated teeth (mean time since endodontic treatment: 10.1 yr) and their contralateral vital pairs. Analyses using paired t tests revealed no significant differences in punch shear strength, toughness, and load to fracture between the two groups. Vital dentin was 3.5% harder than dentin from contralateral endodontically treated teeth (p = 0.002). The similarity between the biomechanical properties of endodontically treated teeth and their contralateral vital pairs indicates that teeth do not become more brittle following endodontic treatment. Other factors may be more critical to failure of endodontically treated teeth.
All endodontically treated teeth that were extracted over a 1-yr period in a busy group practice were evaluated for cause of failure. The 116 teeth collected were classified into major failure categories of prosthetic, periodontic, and endodontic origin. Of the teeth, 59.4% were prosthetic failures which were due primarily to crown fracture. Teeth that had been crowned had greater longevity than uncrowned teeth. Periodontal failures constituted 32% of the study. Only 8.6% of the failures were due to endodontic causes, but these failures became evident more quickly than those in the other categories. A classification of failures is presented, and the results are analyzed.
The cumulative survival rate (retention of both cusps) and the fracture pattern of 1639 endodontically treated posterior teeth were assessed in a retrospective study. All teeth had an MO/DO or an MOD cavity restored with amalgam without cuspal overlays. The 20-year survival rate of teeth with an MO/DO cavity was markedly higher than that of teeth with an MOD cavity. The lowest survival rate was found for the upper premolars with an MOD cavity: 28% of these teeth fractured within 3 years after endodontic therapy, 57% were lost after 10 years, and 73% after 20 years. Generally, the cusp most prone to fracture was the lingual one, and lingual fractures caused significantly more damage to the periodontal tissues than did facial or total crown fractures. The severity of periodontal damage increased with posterior location of the tooth. By far the most serious failures, irrespective of the cavity type, were found for the upper second molar, as 10 of 29 fractures led to extraction. It is concluded that amalgam, especially in MOD cavities, is an unacceptable material for restoration of endodontically treated posterior teeth if used without cuspal overlays.
The cumulative survival rate of 190 endodontically treated posterior teeth were assessed in a retrospective study; all teeth had an MO/DO or an MOD cavity restored with a composite resin without cuspal overlays after previous acid-etching of the enamel. In contrast to our previous study on endontically treated posterior teeth restored with amalgam, the survival rate of the MOD resin-restored teeth was equal to that of MO/DO teeth. Teeth restored with a light-activated resin had a much lower survival rate than teeth restored with a chemically-activated material, the cause presumably being that the light-activated resins were insufficiently irradiated. Nearly 25% of the teeth had been restored with a microfilled resin for anterior use and these teeth had a lower survival rate than had teeth restored with a macrofilled or hybrid resin. It was also found that a beveling technique did not decrease the fracture rate while the use of an intermediate layer of low-viscosity resin resulted in a significant improvement.
Endodontically-treated posterior teeth are susceptible to fracture; consequently, full-occlusal-coverage restorations are recommended. We designed this study to examine the potential for alternative restorative techniques for pulpless teeth, using strain gauges mounted on extracted maxillary second premolars to measure strains generated by nondestructive occlusal loading. Cuspal stiffness was evaluated on the following sequentially performed procedures: unaltered tooth, completion of all endodontic procedures, appropriate restorative preparation, and restoration. The restorative procedures evaluated were: (1) amalgam, (2) cast gold onlay, (3) composite restoration with enamel etch, and (4) composite restoration with enamel and dentin etch. Finally, all teeth were loaded to fracture. Cast gold was the strongest restorative material tested (2.11 relative stiffness, compared with that of the unaltered tooth at 1.00), and amalgam was the weakest (0.35 relative stiffness). Composite restoration and enamel plus dentin etch were almost as strong as the unaltered tooth (0.87 relative stiffness), while enamel-etch-only yielded lower stiffness (0.51).
Endodontically treated teeth are thought to be more susceptible to fracture as a result of the loss of tooth vitality and tooth structure. This study was designed to compare the contributions of endodontic and restorative procedures to the loss of strength by using nondestructive occlusal loading on extracted intact, maxillary, second bicuspids. An encapsulated strain gauge was bonded on enamel just above the cementoenamel junction on both the buccal and lingual surfaces, and the teeth were mounted in nylon rings leaving 2 mm of root surface exposed. Under load control, each tooth was loaded at a rate of 37 N per s for 3 s and unloaded at the same rate in a closed loop servo-hydraulic system to measure stiffness. A stress-strain curve was generated from each gauge prior to alteration of the tooth and after each procedure performed on the tooth. Cuspal stiffness, as a measure of tooth strength, was evaluated on one of two series of sequentially performed procedures: 1. (a) unaltered tooth, (b) access preparation, (c) instrumentation, (d) obturation, and (e) MOD cavity preparation; or 2. (a) unaltered tooth, (b) occlusal cavity preparation, (c) two-surface cavity preparation, (d) MOD cavity preparation, (e) access, (f) instrumentation, and (g) obturation. Results on 42 teeth indicate that endodontic procedures have only a small effect on the tooth, reducing the relative stiffness by 5%. This was less than that of an occlusal cavity preparation (20%). The largest losses in stiffness were related to the loss of marginal ridge integrity. MOD cavity preparation resulted in an average of a 63% loss in relative cuspal stiffness.(ABSTRACT TRUNCATED AT 250 WORDS)
Examined in this study were 191 patients with 206 complete or incomplete fractures of posterior teeth. The patients ranged in age from 14 to 76 years, with 66.5% younger than 40 years. The number of fractures occurring in each arch was almost equal. The mandibular first molar was the most frequently fractured posterior tooth. The lingual cusps of mandibular molars fractured more often than did the buccal cusps of mandibular molars by a ratio of 2 to 1. In maxillary molars, buccal and lingual cusps fractured with almost equal frequency, but, in maxillary premolars, the lingual cusps fractured slightly more often than buccal cusps. Data gathered on the widths of the isthmuses of restorations in 109 teeth showed that fewer fractures occurred in teeth with more conservative restorations, with widths of isthmuses a quarter of the inter-cusp distance, and intact marginal ridges.
Endodontically treated premolars were restored using 5 different methods. Copper rings were filled with commercial hard-setting cement and the teeth were placed into the cement up to the level of the cemento-enamel junction. The teeth were grouped according to restorative method, mounted in an Instron TT machine and the buccal walls subjected to a slowly increasing compressive force until fracture occurred. The force of fracture of the walls of each tooth was recorded and the results in the various groups compared. All teeth fractured in a similar manner irrespective of the restorative method used. The resistance to fracture of the teeth increased significantly when MOD cavities in the teeth were acid etched prior to the restoration with a composite resin. The use of a bonding agent after acid etching did not further increase the resistance to fracture of the premolars restored with a resin. The acid etch composite resin technique was as effective in preventing fractures of the teeth when 2 mm of the resin was removed and replaced with an amalgam as when the entire cavities were filled with the resin material.
Through a standardized procedure using clinical examination, interviews, and dental history, this 2-year study documents 100 cases of tooth fracture in 98 patients. For comparison, pertinent information was also recorded for more than 2,000 teeth in a randomly selected sample population. Two chief types of fracture were found: incomplete crown-root fractures and root fractures associated with earlier endodontic therapy.
Restorative dentists have the clinical impression that endodontically treated teeth are more friable and fracture more easily. The object of this study was to determine the water content of pulpless teeth as one of the possible factors contributing toward tooth brittleness. Extirpation of pulps from dog teeth was followed by extraction of the teeth after predetermined time intervals so that the value for the water content could be plotted against time. The total water content of each tooth was divided into the free water and bound water. The free water was determined gravimetrically. The bound water was tested by a Differential Thermal Analysis, which graphically reproduced the total moisture content of the calcified tissues. There was 9 per cent less moisture in the calcified tissues of pulpless teeth than in those of vital teeth.
One hundred and two patients with a total of 200 teeth that were treated endodontically were examined to determine how many teeth had fractured five years or more after treatment. The teeth of the study were considered in three different groups: total group, solo teeth, and abutment teeth for fixed partial dentures or fixed splints. One hundred and thirty-four teeth had had endodontic therapy only, whereas 86 had an internal supporting device inserted during endodontic therapy. All teeth were functioning favorably at the time of the study. There was no evidence of fracture of any tooth at least five years after endodontic therapy, whether an internal supporting device had been used.
The extent of cuspal flexure following endodontic and restorative procedures has important consequences for potential fracture. This study was undertaken to determine the extent to which cusps of molars are weakened by progressively larger restorative preparations and endodontic access. Cuspal flexure of 13 extracted, intact human mandibular molars was measured under controlled occlusal loading. A ramped load of 100 N was applied to the mesial cusps via a steel sphere, using a closed-loop servohydraulic testing machine. Lateral cuspal displacement was recorded by linear measuring devices (direct current differential transformers) accurate to 1 micron. Increasingly extensive MO or MOD cavity preparations followed by endodontic access were cut in each tooth. Cuspal deflection increased with increasing cavity size and was greatest following endodontic access. Cuspal deflections of more than 10 microns were observed. These findings reinforce the importance of cuspal coverage to minimize the danger of marginal leakage and cuspal fracture in endodontically treated teeth.
Endodontically treated molar teeth are considered susceptible to fracture because of loss of tooth bulk. This study evaluated the significance of retaining intact marginal ridges and selective cusp coverage in preserving tooth stiffness during restoration. Strain gauges were bonded to four cusps of 36 intact extracted human lower molars. Teeth were loaded mesially and distally in a closed-loop servohydraulic system to measure stiffness. Endodontic access was followed by mesio-occlusal or mesio-occluso-distal preparation. Teeth were restored with either amalgam (no overlay), amalgam overlay, or gold overlay with partial or complete cusp coverage. Relative stiffness was calculated for all test conditions. Preserving a marginal ridge in molars did not fully conserve the strength of adjacent cusps; selective cusp coverage reinforced only the capped cusps; full occlusal coverage with gold or amalgam strengthened all cusps, but gold did so more consistently. It is more important to cover cusps than to preserve tooth structure (including a marginal ridge) in endodontically treated molar teeth.
The moisture content of vital and endodontically treated teeth was compared in matched pairs of contralateral human teeth extracted for prosthodontic reasons. Samples from each tooth were weighed then placed in an oven to remove the unbound water from the dentin. Weighing was carried out daily until a constant weight was achieved for three days. The moisture content was then calculated and expressed as a percentage of the initial sample weight. It was found that vital dentin had a moisture content of 12.35% whilst dentin from endodontically treated teeth had a moisture content of 12.10%. These results indicated that there was no significant difference in the moisture content between endodontically treated teeth and vital teeth.
This case-control study characterized factors related to loss of root canal filled (RCF) teeth among members of the Kaiser Permanente Dental Care Program, a dental health maintenance organization based in Portland, Oregon.
Individuals were identified who were enrolled continuously from January 1, 1987, through December 31, 1994, underwent initial root canal therapy on a permanent tooth (excluding third molars) in 1987 or 1988, had a clinical examination within two years after endodontic access, and were at least 21 years old at access. Patients who lost the RCF tooth by December 31, 1994, were defined as cases (n = 96); those who did not were defined as controls (n = 120). Computerized data, dental radiographs, and chart entries were reviewed to ascertain variables of interest, and multivariable logistic regression was used to describe differences between the groups.
RCF teeth of cases had fewer proximal contacts at access than RCF teeth of controls (odds ratio = 2.7; 95% Cl = 1.4, 5.1). Cases were older (odds ratio = 1.4; 95% Cl = 1.1, 1.9 per 10-year increase) and more likely to have had a facial injury than controls (odds ratio = 3.6; 95% Cl = 1.2, 10.5). Cases also had more missing teeth (odds ratio = 1.5; 95% Cl = 1.0, 2.1) and more plaque (odds ratio = 1.7; 95% Cl = 1.0, 2.6).
Conditions evident during treatment planning may help dentists assess patients' chances of losing an RCF tooth.
The resistance to fracture of mandibular premolar roots before and after endodontic and restorative procedures was tested. Seven treatment groups were evaluated. A Universal testing machine was used to apply vertical and lateral (45-degree) forces. Overall, the untreated roots showed the highest resistance to fracture. Factors of importance to prevent fracture were found to be (a) the amount of remaining tooth structure; (b) strength of post and core; and (c) bonding between core material and dentin. These factors suggest that a composite core following the use of EDTA to remove the smear layer may be a successful treatment when sufficient tooth structure remains.
The recent introduction of new bonding agents has led some authors to suggest that certain endodontically treated posterior teeth could be restored with a bonded restoration instead of a full-coverage crown or onlay. To test the fracture resistance of endodontically treated premolars restored with and without bonding agents, we randomly divided 56 intact and caries-free maxillary premolars into seven groups as follows: unaltered teeth; access only; MOD prep and RCT; MOD prep, RCT, and amalgam restoration; MOD prep, RCT, and amalgam with 4-META bonding agent; MOD prep, RCT, and composite resin restoration; and MOD prep, RCT, and composite resin with 4-META bonding agent. The teeth were subjected to compressive fracture tests in a Zwick 1435 Universal Testing Machine. Unaltered teeth and those with access only demonstrated similar fracture strengths. Under the conditions of this study, there was no significant difference in fracture strength between the experimental groups.
The Ad Hoc Committee on Research in Fixed Prosthodontics established by the Academy of Fixed Prosthodontics publishes a yearly comprehensive literature review on a selected topic. The subject for this year is foundation restorations.
Literature of various in vitro and in vivo investigations that included technical and clinical articles was reviewed to provide clinical guidelines for the dentist when selecting methods and materials for restoration of structurally compromised teeth. Topics discussed and critically reviewed include: (1) desirable features of foundation restorations, (2) foundations for pulpless teeth, (3) historic perspectives, (4) cast posts and cores, (5) role of the ferrule effect, (6) prefabricated posts, (7) direct cores, (8) foundation restorations for severely compromised teeth, (9) problems and limitations, (10) future needs, and (11) directions for future research.
This comprehensive review brings together literature from a variety of in vitro and in vivo studies, along with technique articles and clinical reports to provide meaningful guidelines for the dentist when selecting methods and materials for the restoration of structurally compromised teeth.
Controversy exists over the most favorable material and type of restoration to be used to transitionally restore teeth destined to be crowned. This in vitro study uses fracture resistance testing to compare eight different transitional restorations in maxillary premolars. Ninety sound maxillary premolars were randomly selected and allocated to nine groups, each comprising 10 teeth. One group remained unrestored and was used as the control. Teeth in the remaining groups were prepared to a standard cavity form using: a copy milling process removing the palatal cusp. Restorations were placed using amalgam with dentin pins and cavity varnish; amalgam with an amalgam bonding agent; resin composite with dentin pins and a dentin bonding agent; resin composite with a dentin bonding agent only; resin-modified glass ionomer with dentin pins; resin-modified glass ionomer cement alone and cermet with dentin pins and cermet alone. Each restored tooth was then subjected to axial loading via a bar contacting the buccal and restored palatal cusps until failure of the restored tooth occurred. The mean load-to-fracture values were statistically compared and the modes of failure recorded. It was found that the choice of restorative material and type of restoration had little effect on the fracture resistance of the restored tooth with the exception of those teeth restored with reinforced glass ionomer cement alone, which exhibited a significantly lower resistance to fracture than the other restored teeth. However, the choice of restorative material/technique did influence the mode of failure. Failure in teeth restored with resin-modified glass ionomer cement alone produced the least damage to the remaining tooth tissue when failure occurred. Consequently, this material may offer the most favorable range of properties for the transitional restoration of extensively broken-down maxillary premolar teeth destined to be crowned. Furthermore, the findings of this study fail to support the use of dentin pins in the placement of bonded build-up restorations.
Crowns have been considered the restoration of choice for endodontically treated teeth, but their selection has been based primarily on anecdotal evidence.
This study tested the hypothesis that crown placement (coronal coverage) is associated with improved survival of endodontically treated teeth when preaccess, endodontic, and restorative factors are controlled.
A University of Iowa College of Dentistry treatment database was used to identify permanent teeth that had undergone initial obturation between July 1, 1985, and December 31, 1987. Study patients were restricted to persons with at least 1 dental visit in each 2-year interval from 1985 to 1996; a simple random sample of 280 patients (n = 400 teeth) was selected. Dental charts, radiographs, and computerized databases were examined to ascertain variables of interest and to verify study inclusion criteria. Kaplan-Meier survival estimates were generated for the 203 teeth that satisfied study inclusion criteria. Multivariate Cox proportional hazards regression models were developed, with standard errors adjusted to account for clustering of teeth within patients.
When tooth type and radiographic evidence of caries at access were controlled, the final Cox model showed that endodontically treated teeth not crowned after obturation were lost at a 6.0 times greater rate than teeth crowned after obturation (95% confidence interval: 3.2 to 11.3).
Within the limitations of this study, a strong association between crown placement and the survival of endodontically treated teeth was observed. These results may impact treatment planning if long-term tooth retention is the primary goal.
Controversy exists concerning the preferred type of final restoration of endodontically treated molars regarding their resistance to fracture under occlusal load.
The aim of this study was to assess the resistance to fracture of endodontically treated molars with various degrees of tooth structure loss restored with amalgam under simulated occlusal load.
. The study teeth consisted of 90 noncarious, nonrestored molars stored in physiological saline solution. The teeth were endodontically treated and randomly divided into 9 experimental groups of 10 specimens each with various degrees of tooth loss, ranging from a conservative endodontic access to removal of all cusps. All teeth were restored with a standardized technique to their original contour with amalgam. Each specimen was mounted onto a specialized jig for loading at the central fossa at a 30-degree angle to the long tooth axis. The resistance to fracture, under continuous compressive force at a cross-head speed of 2 mm/minute, was applied by a universal testing machine and was recorded. One-way analysis of variance with Scheffé contrast was used to statistically compare the differences between the groups at significance level P<.05.
One-way analysis of variance showed that the group with a conservative endodontic access (1137.6 +/- 311.6 N) and the group with removal of all cusps (1261.4 +/- 195.1 N) presented a significantly higher resistance to fracture when compared with the other groups (P<.05). There was no significant difference in resistance to fracture under the simulated load between the other 7 groups, which ranged from 655.8 +/- 229.4 to 906.3 +/- 168.1 N (P>.05).
Within the limitations of this study, the endodontically treated molars with a conservative endodontic access or after removal of all cusps that were restored to their original contour with amalgam presented the highest resistance to fracture under a simulated occlusal load.
Assessment of the resistance to fracture of endodontically treated molars restored with amalgam
- Assif
Three-year clinical comparison of survival of endodontically treated teeth restored with either full cast coverage or with direct composite restoration
- Mannocci