Clinical evaluation of root filled teeth restored with or without post-and-core systems in a specialist practice setting

AIM: To assess survival rates and complications of root-filled teeth restored with or without post-and-core systems over a mean observation period of >or=4 years. METHODOLOGY: A total of 325 single- and multirooted teeth in 183 subjects treated in a private practice were root filled and restored with either a cast post-and-core or with a prefabricated titanium post and composite core. Root-filled teeth without post-retained restorations served as controls. The restored teeth served as abutments for single unit metal-ceramic or composite crowns or fixed bridges. Teeth supporting cantilever bridges, overdentures or telescopic crowns were excluded. RESULTS: Seventeen teeth in 17 subjects were lost to follow-up (17/325: 5.2%). The mean observation period was 5.2 +/- 1.8 (SD) years for restorations with titanium posts, 6.2 +/- 2.0 (SD) years for cast post-and-cores and 4.4 +/- 1.7 (SD) years for teeth without posts. Overall, 54% of build-ups included the incorporation of a titanium post and 26.5% the cementation of a cast post-and-core. The remaining 19.5% of the teeth were restored without intraradicular retention. The adjusted 5-year tooth survival rate amounted to 92.5% for teeth restored with titanium posts, to 97.1% for teeth restored with cast post-and-cores and to 94.3% for teeth without post restorations, respectively. The most frequent complications included root fracture (6.2%), recurrent caries (1.9%), post-treatment periradicular disease (1.6%) and loss of retention (1.3%). CONCLUSION: Provided that high-quality root canal treatment and restorative protocols are implemented, high survival and low complication rates of single- and multirooted root-filled teeth used as abutments for fixed restorations can be expected after a mean observation period of >or=4 years.     

Influence of the coronal restoration on the outcome of endodontically treated teeth

Abstract

Objective: The tooth weakens due to removal of hard tissue during an endodontic procedure. Many dentists find it difficult to choose between different coronal restorations after root canal treatment (RCT). Studies show that the coronal restoration may affect the endodontic prognosis. This student-based study had three aims. (1) Examine the choice of coronal restoration of endodontically treated teeth at a Scandinavian dental school, (2) examine the survival of these restorations and (3) evaluate the influence of the coronal restoration on the outcome of the RCT.

Material and methods: Radiographic and clinical examination was performed on 127 posterior teeth. The quality of the root canal treatment and the periapical status (PAI-index) were evaluated.

Results: 43.8% of the teeth were restored with an indirect coronal restoration and 47.2% with a direct coronal restoration. The period from finished root canal treatment until placement of a permanent coronal restoration was significantly longer for an indirect restoration than a direct restoration. The teeth treated with a PAI score of 1 and 2 following pulpectomy, necrotic pulp treatment and endodontic retreatment was 93.8%, 82.6% and 69.4%, respectively.

Conclusion: There was no significant association between choice of coronal restoration and PAI-score.     

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目的 探讨伴有根分叉病变的下颌第一磨牙残根的修复方法。方法 选择2007年8 月至2008年8月济南市口腔医院修复科收治的32例患者（共计36颗患牙）,对其下颌第一磨牙残根行根管治疗术后应用分根术将近远中根分开,分别进行桩核冠修复,并制作连冠。随访观察1年。结果 1年后复查,33颗患牙咀嚼功能良好,修复体稳固,无松动;X线片示牙槽骨无继续吸收或有少量新生;成功率为91.7％。结论 伴有根分叉病变的下颌第一磨牙残根经完善的治疗后行分根术保存修复,可以行使良好的功能。     

Influence of coronal restorations on the fracture resistance of root canal‐treated premolar and molar teeth: A retrospective study

To evaluate the influence of coronal restorations on the fracture resistance of endodontically treated teeth, 676 root canal‐filled and restored posterior teeth were evaluated after a mean period of 9.7 (±2.8; minimum: 5) years. A total of 86.2% of the endodontically treated and restored teeth survived the mean observation period of 9.7 years without fracture. The overall survival period was 13.6 (± 0.2) years. All teeth with gold partial crowns survived without fractures (n = 24). Teeth with crowns and adhesively sealed access cavities showed a mean survival period of 15.3 (± 0.4) years, with crown and bridge restorations 14.0 (± 0.3), with individual metal posts 13.9 (± 0.2), with composite fillings 13.4 (± 0.5), with prefabricated metal posts 12.7 (± 0.6), with amalgam fillings 11.8 (± 0.6) and with glass ionomer cements (GIC) 6.6 (± 0.5) years. Teeth with one or two surfaces restored by amalgam, composite or GIC showed a significantly lower fracture rate than teeth with three and more restored surfaces (P < 0.05). The mean fracture rate of teeth restored with GIC was significantly higher when compared with all other groups (P < 0.001). In general, endodontically treated teeth restored with prosthetic restorations demonstrated a significantly lower mean fracture rate than teeth restored with fillings. Cavities with up to three surfaces may well be successfully restored adhesively with composite filling material.     

The influence of coronal restoration type on the survival of endodontically treated teeth

The aim of this study is to investigate the association between coronal restoration type and survival of endodontically treated teeth. A review was performed of treatment records of patients who had endodontic treatment performed in the Department of Restorative Dentistry, University Dental School & Hospital, Cork, Ireland during the period 1993-96. Demographic and dental factors such as age, gender, tooth type, coronal restoration type, and tooth status recorded at a review appointment were recorded. Tooth status at review was defined as 'tooth present' or 'tooth absent' based on the presence or absence of the endodontically treated tooth recorded in the treatment records at a review appointment held a minimum of one year following obturation of the root canal system. Of 176 teeth (166 patients) treated, survival of endodontically treated teeth was significantly more likely where restored with cast restorations (91.7%), amalgam restorations (86.5%), or composite restorations (83.0%), than teeth restored with temporary restorations (34.5%) (p<0.0001) (mean follow-up time 38 months, range 12-60 months). Survival of endodontically treated teeth was found to be associated with permanent coronal restorations. Loss of endodontically treated teeth occurred more often with those restored with temporary restorations (34.5%) than other restoration types (p<0.05).     

Long-term survival of complete crowns, fixed dental prostheses, and cantilever fixed dental prostheses with posts and cores on root canal-treated teeth

PURPOSE: This study investigated the long-term survival of posts and cores on root canal-treated (RCT) teeth restored with complete crowns, fixed dental prostheses (FDPs), 3-unit FDPs, and cantilever FDPs (C-FDPs) made over a period of 16 to 20 years in an undergraduate clinic. MATERIALS AND METHODS: Complete treatment and follow-up records of 1,037 complete crowns, 134 three-unit FDPs, 322 FDPs, and 168 C-FDPs were available for analysis. All RCT teeth studied had a post-and-core buildup. Kaplan-Meier survival curves were used to evaluate the different types of fixed restorations. RESULTS: For complete crowns, the estimated survival rates at year 18 were 74.9% for the vital group and 79.4% for the RCT group (P = .602). For 3-unit FDPs, the survival rate at year 20 was 83.2% for the vital group and 60.5% for the RCT group (P = .108). For the FDPs, the survival rate at year 20 was 77.4% for the vital group, while for the RCT group with at least 1 RCT abutment, the survival rate was 56.7% (P = .002). For C-FDPs with vital abutments, the survival rate was 73.5% at year 16, while for the RCT group with at least 1 RCT abutment, the survival rate was 52.3% at year 18 (P < .01). CONCLUSIONS: There was no statistically significant difference in the long-term survival of complete crowns on vital abutments versus post-and-core complete crowns or in the survival of 3-unit FDPs on vital abutments versus those with at least 1 RCT abutment. For FDPs with more than 3 units and C-FDPs, the use of a post-and-core abutment led to significantly more failures.     

Teeth with large amalgam restorations and crowns: factors affecting the receipt of subsequent treatment after 10 years

BACKGROUND: The authors evaluated the factors associated with the receipt of subsequent treatment by teeth restored with a large amalgam restoration or a large amalgam restoration and crown restoration after 10 years. METHODS: The authors used retrospective data from the University of Iowa College of Dentistry (Iowa City, Iowa) administrative database and patient records to evaluate patient and tooth factors for their association with the two primary outcomes: receipt of any subsequent treatment and receipt of catastrophic treatment (extraction, endodontic therapy). RESULTS: The authors followed 518 teeth over a 10-year period (49 percent with large amalgam restorations and 51 percent with crowns). Sixty-four percent of the large amalgam restorations and 32 percent of the crowns received subsequent treatment during the 10 years. In addition to restoration type, the patient's sex, history of grinding teeth and having a broken tooth were related to the tooth's receiving subsequent treatment. Twenty-two percent of large amalgam restorations and 12 percent of crowns received catastrophic treatment with the odds of teeth with large amalgam restorations receiving a catastrophic treatment being 2.1 times the odds of teeth with crowns receiving catastrophic treatment. CONCLUSIONS: Teeth with crowns were less likely to receive any treatment or catastrophic treatment over 10 years than were teeth with large amalgam restorations. Patient and tooth factors also were related to a tooth experiencing subsequent treatment. CLINICAL IMPLICATIONS: Teeth with crowns received less subsequent treatment than teeth with large amalgam restorations. This could be related to both the difference in longevity between the two restorations, as well as how appropriately treatment was planned for each procedure. Cost differences between the two restorations need to be factored into the decision-making process.     

A systematic review of single-tooth restorations supported by implants

OBJECTIVES: To make an inventory of clinical studies on single-tooth restorations supported by implants using a systematic review procedure and to aggregate overall survival results. DATA SOURCES: Papers referring to single-tooth implants were located by a MEDLINE search 1990 to April 1998. Three hundred and twenty references were found, and they were subjected to a systematic review procedure. STUDY SELECTION: A three-step inclusion/exclusion procedure was applied to identify papers that represented: good scientific practice (GSP), reported results of all patients, implants and crowns for more than 2years, and had sufficient data to generate life-table analyses. The outcomes were 'implant failure' and 'crown completion'. Nine studies survived. These data showed an overall mean GSP of 0.37 with a predicted 4year implant survival of 97% (n=459), and an uncomplicated crown maintenance of 83% (n=240). CONCLUSION: Single-tooth implants show an acceptable short-term survival of 4years, but crown complications are common.     

Three-year clinical comparison of survival of endodontically treated teeth restored with either full cast coverage or with direct composite restoration

STATEMENT OF PROBLEM: Little information exists regarding the outcome of crown build-ups on endodontically treated teeth restored with metal-ceramic crowns or with only a direct-placed composite. PURPOSE: The aim of this study was to evaluate the clinical success rate of endodontically treated premolars restored with fiber posts and direct composite restorations and compare that treatment with a similar treatment of full-coverage with metal-ceramic crowns. MATERIAL AND METHODS: Subjects included in this study had one maxillary or mandibular premolar for which endodontic treatment and crown build up was indicated and met specific inclusion/exclusion criteria. Only premolars with Class II carious lesions and preserved cusp structure were included. Subjects were randomly assigned to 1 of the following 2 experimental groups: (1) teeth endodontically treated and restored with adhesive techniques and composite or (2) teeth endodontically treated, restored with adhesive techniques and composite, and then restored with full-coverage metal-ceramic crowns. Sixty teeth were included in the first group and 57 in the second. All restorations were performed by one operator. Causes of failure were categorized as root fracture, post fracture, post decementation, clinical and/or radiographic evidence of marginal gap between tooth and restoration, and clinical and/or radiographic evidence of secondary caries contiguous with restoration margins. Subjects were examined for the listed clinical and radiographic causes of failure by 2 calibrated examiners at intervals of 1, 2, and 3 years. Exact 95% confidence intervals for the difference between the 2 experimental groups were calculated. RESULTS: At the 1-year recall, no failures were reported. The only failure modes observed at 2 and 3 years were decementations of posts and clinical and/or radiographic evidence of marginal gap between tooth and restoration. There was no difference in the failure frequencies of the 2 groups (95% confidence interval, -17.5 to 12.6). There was no difference between the number of failures caused by post decementations and the presence of marginal gaps observed in the 2 groups (95% confidence intervals, -9.7 to 16.2 and -17.8 to 9.27). CONCLUSION: Within the limitations of this study, the results upheld the research hypothesis that the clinical success rates of endodontically treated premolars restored with fiber posts and direct composite restorations after 3 years of service were equivalent to a similar treatment of full coverage with metal-ceramic crowns.     

石英纤维桩对牙体缺损修复的临床疗效评价

目的：探讨石英纤维桩树脂核全冠修复残根、残冠的临床疗效。方法：以96例铸造金属桩核作为对照,随机选择牙体缺损病例61例、89个患牙,行完善的根管治疗后,利用RTD石英纤维桩、Pulpdent双固化树脂核材料恢复桩核,以全瓷冠或贵金属烤瓷全冠修复。分别于修复后1个月、6个月、1年、2年进行随访。结果：石英纤维桩修复后随访2年仅1个发生桩核脱落,1例出现纤维桩折断,89个基牙均未发生根折。总成功率明显高于铸造金属桩修复组（P〈0．05）。结论：石英纤维桩是一种较为理想的桩核修复方法。     

前牙缺损断面达龈下的修复治疗

目的：探讨牙体缺损断面达龈下的前牙修复治疗方案和疗效。方法：对患牙进行完善的根管治疗，治疗间隔期和术后观察期，用牙周塞治剂或丁香油氧化锌糊剂填塞、封闭龈下缺损腔。采用铸造纯钛桩核重建缺损牙核心部分，用金属陶瓷全冠或全陶瓷冠恢复牙冠形态、色泽和功能。通过定期复诊时患者主诉、医师进行的临床和X线牙片检查，综合评价修复效果。结果：通过对修复后患者1～5年的观察，发现229个修复牙，周围组织健康，占总数的87.07％。综合临床检查和患者满意度评价，医生对85.93％的患牙修复治疗结果感到满意，认为治疗结果不可接受的仅占患牙总数的4.56％。患者的满意度高于医师。结论：通过对断面达龈下的残留牙根进行细致地检查、诊断，合理地选择适应证，周密地设计治疗方案和实施治疗，大多数的患牙仍然能够发挥良好的功能。     

Long-term survival of direct and indirect restorations placed for the treatment of advanced tooth wear

Advanced tooth wear was restored with direct resin-based composites (RBCs) in 17 patients, and with indirect ceramo-metal crowns (CMCs) and full gold crowns in 8 other patients. The mean patient age was 64.9 (8.6 SD) years, with each patient having a mean of 13.8 (5.4) restorations. In this retrospective case series study, the mean restoration age was 5.0 (3.0) years for the direct and 5.9 (2.6) years for the indirect restorations. Over 10 years, cumulative survival estimates were 62.0% for direct and 74.5% for indirect restorations (P = 0.23). Survival estimates were 58.9% for anterior RBCs and 70.3% for anterior CMCs (P = 0.06). RBCs usually failed from fractures, and CMCs from complete losses. RBC failures were usually replaced or repaired, while CMC failures often required root canal therapies or extractions. The findings from this relatively small study require confirmation by large long-term controlled clinical trials.     

临时冠用于隐裂牙治疗的临床观察

把并发牙髓炎或根尖周炎的75例隐裂牙患者随机分成2组,实验组50例取单侧印模,患牙牙体预备后按原牙体形态制作塑料临时冠,根管治疗过程在临时冠的保护下进行,治疗结束1周后行永久性修复。对照组25例减低咬合后直接开髓、根管治疗。结果实验组有效率为90%,对照组为68%(χ2=4.20,P<0.05)。临时冠在隐裂牙的根管治疗中起到了较好的保护作用。     

应用髓室固位的金属嵌体冠修复磨牙重度牙冠缺损

目的:评价利用髓室同位制作嵌体冠修复磨牙残冠的效果.方法:对61颗磨牙残冠经完善根管治疗后,制作髓室固位的铸造金属嵌体冠,修复完成后,定期进行临床检查,评价修复效果.结果:经过1～5a的随访观察,61颗患牙经过修复治疗后获得满意效果,个别病例出现修复体颈缘密合不良、牙龈炎.或继发龋、食物嵌塞.结论:利用髓室固位的铸造金属嵌体冠治疗磨牙残冠,是一种简单易行、经济实惠、效果良好的修复方法,严格选择适应证以及准确的牙体预备和精确的加工制作,是修复成功的关键.     

Single-tooth implants and their role in preserving remaining teeth: a 10-year survival study

The use of teeth as abutments for fixed and removable partial dentures can result in biologically destructive consequences. Teeth adjacent to edentulous spaces should exhibit improved prognoses if restorative trauma is to be avoided or minimized. Implants offer a method of tooth replacement without relying upon the surrounding dentition for support. This investigation evaluates implant survival and prosthetic complications of implants that replaced single missing teeth and were placed in clinical practice during a 10-year period. It further examines preoperative status and survival of teeth adjacent to these implant restorations during the same 10-year time span. Ninety-nine patients treated with 116 implants and 112 single-tooth implant prostheses in a prosthodontic practice were examined between 1988 and 1998. The purpose of this study was to evaluate the role of implants in preventing the use of intact teeth for initial support of prostheses and in avoiding the use of additional teeth as abutments upon the replacement of existing restorations. Three implants failed over a 10-year period, for a survival rate of 97.4%. Complications included the loss of 2 implant crowns, screw loosening, broken screws, cement washout, margin exposure, and porcelain fracture. Of 196 teeth adjacent to edentulous spaces, 156 (79.6%) were intact or minimally restored. Only 3 of these teeth were restored as part of initial prosthodontic therapy. Over the ensuing 10 years, only 1 tooth required a replacement restoration, and 1 tooth was extracted. Results of this patient evaluation demonstrated that implant survival over a 10-year period was favorable, with minimal prosthetic complications. Furthermore, teeth adjacent to single-tooth implants exhibited an extremely low complication rate. This report indicates that implants can be effective in preserving intact teeth in patients undergoing initial prosthodontic therapy and in preventing the use of additional teeth as abutments in patients whose existing prostheses must be replaced.     

Factors affecting outcomes for single-tooth implants and endodontic restorations

Initial root canal therapy and implant placement are both common treatment modalities, and, as such, prognostic factors that influence the treatment outcomes of these two restorations should be identified. In a retrospective chart review, 196 implant restorations and 196 matched initial nonsurgical root canal treated (NSRCT) teeth in patients were evaluated for four possible outcomes-success, survival, survival with intervention, and failure. Results showed that smokers had fewer successes and more failures in both groups (p = 0.0001), whereas NSRCT outcomes were affected by periradicular periodontitis (p = 0.001), post placement (p = 0.013), and overfilling (p = 0.003). Outcomes for both groups were not significantly affected by diabetes, age, or gender. Implant group outcomes were not affected by implant length (from 10 to 16 mm), diameter (from 3.25 to 5.5 mm), or an adjacent endodontically treated tooth, nor were NSRCT outcomes affected by the number of appointments for the procedure.     

The Correlation of Crack Lines and Definitive Restorations with the Survival and Success Rates of Cracked Teeth: A Long-term Retrospective Clinical Study

IntroductionCracked teeth frequently require protective adhesive restorations. This long-term, longitudinal retrospective clinical study aimed to evaluate the factors influencing the success and survival rates of cracked teeth with crack lines (CLs) in different directions when restored early with onlays or full-coverage crowns.MethodsThe dental records of 71 patients with a total of 86 cracked teeth with different pulpal and periapical diagnoses and with follow-ups spanning over 1–11 years were included. Data regarding the demographics; clinical symptoms and signs; bruxism; occlusal interferences; eating habits; pulpal and periapical diagnoses; number, direction, location, and extent of CLs; probing depth; and coronary condition before and after the placement of definitive restorations were collected. Univariate associations between tooth survival and explanatory variables were assessed. The long-term survival rate was estimated using Kaplan-Meier analysis and the log-rank test. A multivariate analysis was performed using Cox regression analysis.ResultsThe overall success rate was 93.0%, and the overall survival estimates of cracked teeth restored early were 98.6%, 94.9%, and 55.9% at the 1-, 5-, and 11-year follow-ups, respectively. The direction of the CLs did not influence the survival of the tooth. No significant association was observed between the type of tooth, probing depth, root canal treatment, and tooth loss (P > .05). The multivariate analysis showed that previously treated cracked teeth (P < .05), the provision of onlay restorations (P < .05), and the placement of posts (P < .05) had higher correlations with tooth loss. Additionally, the placement of full-coverage crowns resulted in lower tooth loss compared with the placement of onlays (P < .05).ConclusionsPrevious endodontic treatment in teeth that subsequently develop CLs has a negative impact on the survival rate of the teeth. Moreover, early placement of full-coverage crowns should be implemented for cracked teeth regardless of the direction or the number of CLs because it is associated with a higher cracked tooth survival rate.     

Survival analysis of complete veneer crowns vs. multisurface restorations: a dental school patient population

The purpose of this study was to compare the longevity of crowns versus large multisurface restorations in posterior teeth. The investigation used the treatment database at Virginia Commonwealth University School of Dentistry. The inclusion criteria for the final data set used for analysis were: only one restored tooth per patient, premolars with three or more restored surfaces, molars with four or more restored surfaces, molars and premolars restored with complete veneer metal crowns, or crowns veneered with metal and porcelain. The Kaplan-Meier approach was used to visualize the survival curves, and the Cox proportional hazards model was used for analysis of predictor variables. The investigation indicates crowns survive longer than large restorations and premolar restorations survive longer than molar restorations. The median survival for crowns exceeded 16.6 years, with the median survival of premolar restorations being 4.4 years and molar restorations 1.3 years. An interaction between age and treatment was discovered, with overall survival decreasing as patient age increases. The doctor supervising the treatment also affected survival with treatment supervised by specialists lasting longer than treatment supervised by nonspecialists.     

Ten-year outcome of root fillings in the General Dental Services in England and Wales

Aim  To consider the survival of root canal treatment provided within the General Dental Services in England and Wales, with failure being defined as re-treating of a root canal, apical surgery or extraction.
Methods  A data set was established consisting of patients, 18 years or older, whose birthdays were included within a set of randomly selected dates and whose restoration records contained the placement of one or more direct restorations or crowns in courses of treatment between September 1990 and January 2002. The history of each root canal-treated tooth was consulted, and the next date for an intervention on the root canal of the tooth, defined as a re-treatment, apical surgery or extraction, was obtained. Thus, a data set was created of root canal-treated teeth, with the dates of root canal filling placement and the dates, if any, of re-intervention.
Results  Data for over 80 000 different adult patients were analysed, and a total of 30 843 root canal-treated teeth identified from the data over a period of 11 years. The proportion surviving without further treatment of the root canal was estimated at 74% within an observation time of up to 10 years, with survival being strongly correlated with the characteristics of the patient, including age and treatment history, with older patients having root canal treatment with earlier re-intervention than those of younger patients.
Conclusion  Within the data set analysed, an estimated 74% of root canal-treated teeth pass through 10 years without re-treatment, apical surgery or extraction.     

Success rates of prosthetic restorations on endodontically treated teeth; a systematic review after 6 years

The aims of this systematic review were to investigate the success rates of prosthetic restorations on endodontically treated teeth and their manner of failure. PubMed and hand literature searches were conducted on studies published until June 2012. Only clinical studies on human subjects referring to the success rates of prosthetic restorations on endodontically treated teeth with a follow‐up period of at least 6 years were reviewed. A total of four studies were identified. Meta‐analysis showed the success rate to be 92% (CI 82–98%) for single crowns on endodontically treated teeth and 79% (72–86%) for fixed dental prostheses. Only one study reported on removable dental prostheses with a success rate of 66%. Single crowns on teeth restored without posts demonstrated a success rate of 94% (CI 84–99%), whereas where posts were placed, the success rate was lower (92% CI 82–98%). Single crowns over cast post‐and‐cores and prefabricated posts showed success rates of 93% (CI 82–99%) and 94% (CI 90–97%), respectively; both differences were not statistically significant (significance level of 5%). The most common reason for failure was post‐debonding. Single crowns seem to be the best treatment modality for endodontically treated teeth. However, due to the low number of studies included and their design, the results of this systematic review should be interpreted with caution. Further clinical studies are needed to provide high‐quality evidence on the topic.