A follow-up study of pulpotomies and root canal treatments performed under general anaesthesia

Objectives

A previous study considered whether the proportions of clinically satisfactory root canal treatments (RCT) done under general anaesthesia (GA) or under local anaesthesia were equivalent, but the proportion of treatment with long-term satisfactory endodontic outcomes remains unknown. Moreover, no evaluation of pulpotomies performed under GA has been reported.

Materials and methods

From 614 endodontic treatments (ETs) performed on permanent teeth under GA, 225 [193 RCT and 32 pulpotomies (P)] were examined after follow-up periods of 1–6 months (71 cases), 6–24 months (77 cases) and over 2 years (77 cases). Changes in the periapical index between the treatment date (T0) and the control time (T1) allowed the treatment to be classified as “success,” “uncertain outcome” or “failure.” Explicative variables for success of ET were the duration of follow-up and tooth-related criteria expected to affect the outcomes of endodontic treatment.

Results

Overall, 87 % of ETs were scored as “success,” while 9 % were uncertain and 4 % were failures. There was no difference in the distribution of success in relation with the type of tooth, the pulpal status, the level of endodontic difficulty, the periapical status or the technical quality of RCT. The proportion of endodontic cases with high level of difficulties was higher in the P group than in the RCT group.

Conclusion

Longer follow-ups and higher numbers of cases are needed to analyse the factors affecting success and failure in endodontic treatments performed under GA.

Clinical relevance

The relatively high rates of success of pulpotomies and RCT support undertaking endodontic treatment under GA.     

4-Year Follow-up of Full Pulpotomy in Symptomatic Mature Permanent Teeth with Carious Pulp Exposure Using a Stainproof Calcium Silicate–based Material

IntroductionThis study aimed to assess the pulpal and restorative outcome of full pulpotomy in symptomatic mature permanent teeth with carious pulp exposure over 4 years.MethodsUnder local anesthesia, full pulpotomy was performed using the aseptic technique and a stainproof calcium silicate–based material (NeoMTA Plus; Avalon Biomed Inc, Bradenton, FL). The pain level was scored preoperatively and at 1 week posttreatment. Clinical and radiographic evaluation was performed at 6 months, 1, 2, and 4 years. Kaplan-Meier survival analysis and Cox proportional hazards regression were used to analyze the data. Failed cases were classified as endodontic or restorative failure.ResultsFull pulpotomy was completed in 109 teeth in 90 patients with an age range of 14–60 years (mean = 25 years). The study sample available for follow-up was 100 teeth in 86 patients with a recall rate above 90%. Preoperative pulp diagnosis was reversible pulpitis in 39 teeth and irreversible pulpitis in 61 teeth. The cumulative survival rates of pulpotomy were generally high (ie, 98%, 97.4%, 93%, and 83.8% at 6 months and 1, 2, and 4 years, respectively). The overall mean survival time of pulpotomy was 3.89 years (95% confidence interval, 3.84–3.95). The mean survival time was significantly higher for patients aged ≤25 years. However, in the multivariate analysis, the only significant predictor of pulpotomy failure was severe preoperative pain. Over the 4 years, 23 cases failed; only 10 of 23 failures were classified as endodontic failure, and the success of pulpotomy can be assumed to be 90%.ConclusionsFull pulpotomy in cariously exposed pulp of mature permanent teeth sustained a high success rate over 4 years. The coronal seal is crucial for long-term survival.     

Effect of Repairing Endodontic Access Cavities on Survival of Single Crowns and Retainer Restorations

IntroductionThis retrospective study aimed to analyze the effect of repairing endodontic access cavities with composite on the survival of single crowns and retainer restorations of fixed or removable dental prostheses.MethodsDental records of patients attending a university dental clinic were retrospectively screened for single crowns and retainer restorations receiving endodontic treatment after crown placement. Survival (no further intervention) and failure (removal, loss or replacement of crown, replacement of access restoration, or recementation of restoration) of crowns and retainers with repaired endodontic access cavities were recorded. The mean annual failure rates were calculated, and the effect of individual-, tooth-, and restoration-related variables on survival was assessed by univariate log-rank tests and multivariate Cox regression analyses with shared frailty (P < .05).ResultsOne hundred eighty repaired crowns/retainers placed in 151 patients were included (4.5 ± 3.3 years follow-up). Survival after 2, 5, 7, and 10 years amounted to 82.7%, 71.5%, 67.3%, and 48.8% (mean annual failure rate = 9.0%, 6.5%, 5.5%, and 6.9%), respectively. Although tooth type, kind of restoration, endodontic irrigant, repair conditioning methods, and kind of composite affected survival in the univariate regression analyses, only the kind of restoration (single crown vs retainer restoration) remained significant in the multivariate Cox regression model.ConclusionsRepairing endodontic access cavities with composite increases the longevity of single crowns and retainer restorations.     

The efficacy of Portland cement as a pulpotomy agent in deciduous teeth

PurposeThe objective of this study was to compare the efficacy of Portland cement (Pc) in comparison with Mineral Trioxide Aggregate (MTA) as a pulpotomy agent in primary molars.Materials and methods64 Deciduous Mandibular Second Molar of children aged between 6 and 8 years were randomly distributed to either PC or MTA groups which was treated by a conventional pulpotomy technique. The teeth were restored with resin modified glass ionomer cement and stainless-steel crowns. All teeth were assessed clinically and radiographically for success and followed at 3, 6 and 12 months.ResultsAt 12 months follow-up, the Clinical success rates of MTA and PC were 100% and 93.3% respectively. The radiographic success rate of MTA after 12 months was 96.7% while PC was 93.3% respectively. However, the results showed no significant difference between the two groups.ConclusionThis study finding showed that PC can be used a as pulpotomy agent with high clinical and radiographic success rates similar to MTA. PC may serve as a good alternative to MTA for pulpotomies of primary teeth.     

Outcome of Endodontic Treatment through Existing Full Coverage Restorations: An Endodontic Practice Case Series

IntroductionThis case series assessed the outcome of nonsurgical endodontic treatment completed through retained full coverage restorations (FCRs) in a board-certified endodontist private practice. The number of cases completed by the first author was 153.MethodsAll cases were performed following a standardized protocol for treatment and restoration depending on the type of FCR. Number of cases that showed up for 2- to 4-year follow-up was 127, with 83% recall rate. The age range of patients was 33–95 years, with mean age of 54.734 years. The mean recall time was 2.448 years. FCRs and their distribution were as follows: 4 anterior teeth, 14 premolars, and 109 molars. There were 103 nonsurgical root canal treatments and 24 retreatments. Patients who presented for recall had 74 porcelain fused to metal crowns, 17 zirconia crowns, 15 abutments of porcelain fused to metal bridges, 14 lithium disilicate crowns, 5 gold crowns, 1 full metal crown, and 1 gold onlay.ResultsThere were no endodontically related failures. Six cases failed; 3 were due to vertical root fractures, 1 was due to horizontal root fracture, and 2 were due to extensive recurrent caries causing restorative failure. The percentage of healed cases following the American Association of Endodontists outcome criteria adopted in 2004 with intact retained FCR was 95.3%.ConclusionsThe results suggest predictable favorable outcomes for nonsurgical endodontic treatment through FCR following the proposed protocol for diagnosis, treatment, and restoration.     

Preoperative Intraligamentary Injection of Dexamethasone Can Improve the Anesthetic Success Rate of 2% Lidocaine during the Endodontic Management of Mandibular Molars with Symptomatic Irreversible Pulpitis

IntroductionThe aim of this randomized, double-blind clinical trial was to evaluate the effect of preoperative administration of intraligamentary injections of diclofenac sodium and dexamethasone on the anesthetic efficacy of 2% lidocaine given as an inferior alveolar nerve block in the endodontic management of symptomatic irreversible pulpitis.MethodsOne hundred seventeen patients randomly received 1 of the 3 intraligamentary injections before the endodontic treatment: 0.9% normal saline, 25 mg/mL diclofenac sodium, or 4 mg/mL dexamethasone. After 30 minutes, patients received an inferior alveolar nerve block with 2% lidocaine and 1:80,000 epinephrine. The teeth were tested with electric pulp testing after 10 minutes. In case of a positive response, the anesthesia was considered as “failed.” If the electric test response was negative, a rubber dam was applied, and endodontic treatment was started. Any pain during the treatment was recorded. The anesthesia was considered successful if the patients experienced no pain or faint/weak/mild pain during root canal access preparation and instrumentation (Heft-Parker visual analog scale score <55 mm). The effect of intraligamentary injections on maximum heart rates was also recorded. The anesthetic success rates were analyzed with the Pearson chi-square test at 5% significance.ResultsThe control, diclofenac sodium, and dexamethasone groups had anesthetic success rates of 32%, 37%, and 73%, respectively. Dexamethasone was significantly more successful than the control and diclofenac sodium groups (P < .001, χ²₂ = 14.7). There were no differences between the control and diclofenac groups (P > .05). All the solutions did not significantly affect heart rates.ConclusionsThe administration of an intraligamentary injection of dexamethasone before endodontic intervention of mandibular molars with symptomatic irreversible pulpitis increases the success rates of an inferior alveolar nerve block with 2% lidocaine.     

Which procedures and materials could be applied for full pulpotomy in permanent mature teeth? A systematic review

Objective: Coronal pulpotomies were recently re-investigated as an alternative to root canal treatment in vital permanent teeth. General dentists may be interested in knowing how to perform full pulpotomy, in particular in face of difficult endodontic cases of vital teeth.

Material and methods: A systematic review was undertaken on the PubMed and Cochrane databases in order to determine which procedure should be applied for pulp capping and coronal restoration in routine dental practice. Fifty-three publications were included and allocated to one of two methodological categories: histological and clinical studies.

Results and conclusions: There is no evidence to recommend one single procedure for full pulpotomy in vital permanent teeth that can be indicated for different pulpal diagnoses which differ greatly in terms of the inflammation process from healthy teeth to irreversible pulpitis. For each clinical case, all actions aiming to prevent pre-operative contamination, to control per-operative infection and to achieve a complete seal above the radicular pulp sections are unavoidable steps that should be complied with. Reproducing procedures adopted in high quality trials could insure high success rates.     

Strengthening of immature teeth during long-term endodontic therapy

Abstract A method to strengthen a nonvital immature maxillary central incisor during long-term endodontic therapy is described. Calcium hydroxide paste was packed into the root canal space, then removed to a level 3 mm apically to the osseous crest. A layer of IRM cement was placed over the paste to provide a bacteria-tight seal. The coronal portion of the root canal as well as the pulp chamber were acid-etched and filled with a composite resin in an attempt to strengthen the tooth. Access to the root canal was maintained by means of a vaseline-coated plastic post placed centrally in the resin. After polymerization of the resin the post was removed and the space was sealed with zinc oxide and eugenol cement. After completion of the endodontic treatment the space was filled with the composite resin.     

Factors Influencing Quality of Life after Surgical and Nonsurgical Interventions of Persistent Endodontic Disease

IntroductionNonsurgical endodontic retreatment and apical surgery are predictable procedures for the management of endodontically treated teeth with persistent disease. However, there is no information available that compares these treatment modalities based on patients’ oral health–related quality of life (OHRQOL). The aims of this study were to compare the OHRQOL of patients who received nonsurgical endodontic retreatment versus those who received apical surgery and to identify correlations between OHRQOL, clinician-assessed healing outcome, and other factors.MethodsPatients who received treatment at 2 dental hospitals with a recall period of 6–24 months were invited to participate. They underwent follow-up examination and were surveyed with the Oral Health Impact Profile (OHIP-14). Healing outcomes were determined by clinical and radiographic evaluation. Potential influencing factors for OHIP-14 scores were investigated.ResultsOne hundred fifty patients (75 patients from each group) participated in the study. There were no differences in OHIP-14 scores between both groups at the follow-up. The overall adverse impact on OHRQOL was low, with patients experiencing greater impact in the domains of “physical pain” and “psychological discomfort.” Women and patients who had preoperative pain reported a greater impact. There was an overall high healed and healing rate for both groups. No correlation was found between OHIP-14 scores and healing outcome.ConclusionsPatients who received nonsurgical endodontic retreatment and apical surgery reported comparable OHRQOL, with women and patients with preoperative pain reporting greater impact. Both treatments are viable options for the management of persistent endodontic disease based on clinician- and patient-reported outcome assessments.     

Success rates of a mixture of ciprofloxacin, metronidazole, and minocycline antibiotics used in the non-instrumentation endodontic treatment of mandibular primary molars with carious pulpal involvement

International Journal of Paediatric Dentistry 2012; 22: 217–227 Objective. To evaluate the clinical and radiographic success rates of three mixed antibiotics in the non‐instrumentation endodontic treatment of primary mandibular molars at 24–27 months postoperatively. Methods. Eighty cariously involved lower primary molars from 58 children (ages 3–8 years) received a 3Mix medicament by non‐instrumentation endodontic treatment and were then sealed with glass‐ionomer cement and composite resin before permanent restoration with stainless steel crowns. The patients received a clinical and radiographic assessment every 6 months over a 2‐year follow‐up period with an intra‐examiner reliability of 0.83–1.00 (κ value). Results. In 60 cases at 24‐ to 27‐month follow‐up, the success rates as determined by clinical and radiographic evaluation were 75% and 36.7%, respectively; however, the overall success rate of 3Mix non‐instrumentation endodontic treatment was 36.7% with 15.8% of cases demonstrating a pulpal response of internal resorption. Conclusions. Non‐instrumentation endodontic treatment using 3Mix‐MP showed good clinical success but had a low success rate based on radiographic evaluation at 2‐year follow‐up. Hence, 3Mix antibiotic treatment cannot replace a conventional root canal treatment agent as a long‐term therapy.     

Tricalcium silicate cement sealers: Do the potential benefits of bioactivity justify the drawbacks?

BackgroundGrossman described the ideal properties of root canal sealers. The International Organization for Standardization and American National Standards Institute and American Dental Association have codified some of his requirements in ISO 6876 and ANSI/ADA 57, respectively. In this narrative review, the authors combined the ideal Grossman properties and requirements of these standards, emphasizing the newer tricalcium silicate cement sealers. This chemical matrix for such sealers was developed on the basis of the success of bioactive mineral trioxide aggregate–type (tricalcium silicate cement) materials for enhanced sealing and bioactivity.MethodsThe authors searched the internet and databases using Medical Subject Heading terms and then conducted a narrative review of those articles involving the tricalcium silicate cement endodontic sealers.ResultsNinety-four articles were identified that discussed tricalcium silicate cement sealers. Tricalcium silicate cement sealers are partially antimicrobial and have bioactivity, which may presage improved biological sealing of the root canal system. Most other properties of tricalcium silicate cement sealers are comparable with traditional root canal sealers.ConclusionsWithin the limitations of this review, tricalcium silicate cement endodontic sealers met many of the criteria for ideal properties, such as placement, antimicrobial properties, and bioactivity, but limitations were noted in solubility, dimensional stability (shrinkage and expansion), and retrievability.Practical ImplicationsTricalcium silicate–based cements have been commercialized as bioactive, bioceramic endodontic sealers. Warm, cold, and single-cone obturation techniques are usable, depending on the commercial product. Some sealers can cause discoloration and are not easily retrievable, particularly when used to completely obturate a canal.     

Zirconia crowns as an esthetic alternative for oral rehabilitation in pediatric dentistry: A review

BackgroundThe success of rehabilitation in primary teeth may not rely only on the success of dental restoration, as esthetics is also important. As zirconia crowns combine resistance with esthetics, pediatric dentists must know the details regarding this material to be able to use it when required.ObjectiveTo review the literature and synthesize research regarding the use of prefabricated zirconia crowns.Material and methodsA systematic search of the literature was carried out in PubMed, MEDLINE EBSCO, BVS, Embase, and Scopus, with the search terms: “zirconia crowns”, “zirconia crown”, “prefabricated crowns”, “pediatric crowns”, “zirconia pediatric crown”, “deciduous”,” primary teeth”, “primary tooth”, “pediatric dentistry”, “primary molar” and “primary incisors”. After the screening for inclusion and exclusion criteria, 60 eligible articles were included, in English, Spanish or Portuguese, with no restrictions on the year of publication.ResultsZirconia crowns are indicated for primary teeth affected by early childhood caries, traumatic dental injuries and developmental defects of enamel. They present resistance, durability, higher esthetics proprieties (when compared to other materials for the full coronal coverage of primary teeth), good gingival health and biocompatibility, good parental and children's acceptance and satisfaction. However, some limitations are mentioned: higher costs, the necessity for greater amounts of tooth reduction and the impossibility of adjustments.ConclusionZirconia crowns, as no other material for the full coronal coverage of primary teeth, combine biocompatibility, resistance and ideal esthetic outcomes. This material, despite its limitations, is a great alternative for the rehabilitation of primary teeth with intense loss of structure.     

Do resin cement viscosity and ceramic surface etching influence the fatigue performance of bonded lithium disilicate glass-ceramic crowns?

ObjectiveTo assess the effects of a resin cement in high and low viscosity and distinct conditioning of the intaglio surface of lithium disilicate glass-ceramic crowns on fatigue performance of the crowns.MethodsProsthetic preparations (full-crown) in resin epoxy and crowns in lithium disilicate glass-ceramic were machined and allocated considering 2 factors (n = 10): “surface treatment” (HF – 5% hydrofluoric acid etching, followed by silane application; or E&P–self-etching ceramic primer) and “resin cement” (high or low viscosity). The preparations were etched with 10% hydrofluoric acid and an adhesive was applied. The intaglio surfaces of the ceramic crowns were treated as aforementioned (HF or E&P) and luted with high or low viscosity. The bonded sets were subjected to fatigue testing (step-stress approach: initial load of 200 N, step-size of 50 N, 10,000 cycles/step, 20 Hz) and complementary analyses (fractographic, topographic, and cross-sectional bonded interfacial zone analyses) were performed.ResultsTreatment with HF and silane with high viscosity resin cement (955 N/156,000 cycles) and E&P with low viscosity resin cement (1090 N/183,000 cycles) showed the best fatigue performance (statistical similarity between them). The failures originated from defects of the cement-ceramic interface, and the HF treatment induced a more pronounced topographical alteration.SignificanceDistinct topographical patterns from the HF and E&P treatments induced better fatigue results for the specific viscosity of the resin cement. Therefore, the fatigue performance depended on the existing topography, type of intaglio surface’s defects/irregularities after surface treatment, and how the luting agent filled the irregularities.     

Effects of Nd:YAG laser pulpotomy on human primary molars

The purpose of this study was to compare the effects of Nd:YAG laser pulpotomy to formocresol pulpotomy on human primary teeth. Patients with a primary tooth that required pulpotomy because of pulpal exposure to caries, were selected for this study. After removal of coronal pulpal tissue, Nd:YAG laser at 2 W, 20 Hz, 100 mJ or a 1:5 dilution of formocresol was introduced into the canal orifice for complete hemostasis. IRM paste was then placed over the pulp stump, and the tooth was restored either with composite resin or stainless steel crown. Sixty-eight teeth were treated with Nd:YAG laser and followed up for 6 to 64 months. Clinical success was achieved in 66 out of the 68 teeth (97 %), and 94.1 % were radiographically successful. In the control group, 69 primary molars were treated with formocresol and followed up for 9 to 66 months; 85.5 and 78.3% achieved clinical and radiographic success, respectively. The success rate of Nd:YAG laser pulpotomy was significantly higher than that of formocresol pulpotomy. The permanent successors of the laser-treated teeth erupted without any complications.     

Comparative Evaluation of Platelet-rich Fibrin and Mineral Trioxide Aggregate as Pulpotomy Agents in Permanent Teeth with Incomplete Root Development: A Randomized Controlled Trial

Introduction

The purpose of this study was to evaluate and compare, clinically and radiographically, the effects of platelet-rich fibrin (PRF) and mineral trioxide aggregate (MTA) as pulpotomy agents in permanent teeth with incomplete root development.

Methods

A total number of 70 children requiring pulpotomy in 70 permanent molars with incomplete root development were screened. Sixty-two patients met the inclusion criteria and were enrolled in the study. The patients were randomly allocated equally in 2 treatment groups. MTA pulpotomy was performed in group A (the control group), and PRF pulpotomy was performed in group B (the experimental group). The treated teeth were restored with amalgam followed by stainless steel crowns. Clinical and radiographic evaluations were performed after 6, 12, and 24 months. Thus, the data obtained were blindly analyzed using the chi-square test.

Results

There was no significant difference between the 2 groups in terms of clinical and radiologic success. Radiographically, all available cases (53 teeth) showed evidence of root growth and canal narrowing. Complete apical closure was observed in 88.8% in the PRF group (experimental group) and 80.07% of roots in the MTA group (control group), respectively, at 24 months.

Conclusions

PRF could be used as a suitable biological and economic alternative to MTA in pulpotomy procedures of permanent teeth with incomplete root development.     

Does the Etiology of Pulp Necrosis Affect Regenerative Endodontic Treatment Outcomes? A Systematic Review and Meta-analyses

ObjectiveTo evaluate if there is a connection between the causes of pulp necrosis (eg, caries, trauma, dental anomaly) and the success of regenerative endodontic treatment.MethodsElectronic databases (PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Embase) were searched for studies on regenerative endodontic treatment, which used both clinical and radiographic evaluation of root maturation after at least 6 months of follow-up. The search terms “necrotic pulp”, “regenerative endodontic treatment”, “revascularization”, and “revitalization” were combined using Boolean operators. The main journals on endodontics and dental traumatology were additionally hand-searched. Studies were included if they specified the causes of pulp necrosis. The primary question under review was, “Does the cause of pulp necrosis affect the outcome of regenerative endodontic treatment?” Other factors such as tooth type, intracanal medicament, irrigation protocol, use of a collagen matrix, and the type of scaffold were evaluated for possible relation with the outcome. The risk-of-bias assessment for randomized and nonrandomized studies was performed separately, using a modified Cochrane Collaboration's tool and risk of bias in non-randomized studies of interventions-I tool, respectively. Meta-analysis was performed, when possible, between studies comparing treatment outcomes of teeth whose pulp necrosis had different etiology. The search strategy yielded 1197 items. After screening, 18 studies reporting 445 regenerative endodontic treatment cases were included.ResultsThe overall success rate for 274 teeth with trauma etiology was 94.8%, for 95 teeth with dens evaginatus etiology was 93.1%, and for 24 teeth with caries etiology was 96%. No significant difference was found between the results of regenerative endodontic treatment among teeth with trauma, dens evaginatus, and caries etiology (P = .055). Meta-analysis of studies comparing teeth with caries vs dens evaginatus and those with trauma vs caries confirmed that there was no evidence for difference in outcomes.ConclusionFurther randomized studies specifically testing such hypothesis are needed to confirm the preliminary results of this review.     

Microleakage of different types of temporary restorative materials used in endodontics

A temporary filling should seal the endodontic access cavity to avoid reinfection of the root canal system during endodontic treatment. The aim of this study was to evaluate the marginal seal of four temporary filling materials in endodontic access cavities in vitro, using the dye penetration method. Endodontic access cavity preparations were in 50 incisor and 50 molar noncarious nonrestored crowns of extracted human teeth. The coronal access of 10 teeth per group were filled with Coltosol, Algenol, IRM, Fermit or Fermit-N. After storing the teeth in demineralized water for 48 hours, they were immersed in 2% methylene blue dye for 24 hours. All the teeth were sectioned longitudinally and the linear depth of dye penetration was evaluated under a stereomicroscope. There was no significant difference in the microleakage observed in the high elasticity light-cured resin composite (Fermit) versus the low elasticity light-cured resin composite (Fermit-N) groups (p > 0.05).     

Treatment Outcomes of Permanent Immature Teeth with Crown Fracture: A Retrospective Cohort Study

IntroductionCrown fractures are a common type of traumatic dental injury. Various factors may affect the outcome of crown fractures. This study aimed to evaluate the treatment outcomes of immature teeth with a crown fracture.MethodsThis retrospective cohort study included patients who presented to a dental trauma center from 2008–2018 with a history of a crown fracture of immature teeth and at least 6 months of follow-up. Outcomes of primary endodontic or restorative interventions as well as reinterventions were evaluated. Kaplan-Meier curves were used to compare the unadjusted differences in survival time. Logistic and Cox regression analyses were performed to identify potential predictors for complication and survival time, respectively.ResultsThe success rates of the primary interventions for 99 teeth (72 patients) after a median follow-up of 22 months were as follows: cervical pulpotomy (90.4%), partial pulpotomy (85.2%), mineral trioxide aggregate apical barrier (80.0%), root canal treatment (66.6%), and only restoration (47.2%). Teeth that received vital pulp therapy were less prone to complications (adjusted hazard ratio = 0.21; 95% confidence interval, 0.09–0.53; P < .05), whereas those with concomitant luxation injuries were more susceptible to complications (adjusted odds ratio = 2.90; 95% confidence interval, 1.01–8.29; P < .05).ConclusionsCrown fractures had a relatively high favorable prognosis. Vital pulp therapy (partial or cervical pulpotomy) had the highest success rate, whereas cases that received only restoration had the lowest success rate. Teeth with concomitant luxation injuries had more odds and hazards of complications.     

The Incidence of Root Canal Therapy after Full-Coverage Restorations: A 10-Year Retrospective Study

IntroductionThe process of restoring a tooth with a crown leaves many opportunities for pulpal irritation. The objective of this study was to identify and analyze the factors that contribute to the incidence of nonsurgical root canal therapy (NS-RCT) after the delivery of single-unit full-coverage restorations.MethodsInsurance claims from 88,409 crown placements in the Delta Dental of Wisconsin insurance database were analyzed from the years 2008–2017. The Cox regression model was used to analyze the effect of the predictor variables on the survival of the tooth. Untoward events were defined as NS-RCT, tooth extraction, retreatment of root canal, or apicoectomy as defined by the Code on Dental Procedures and Nomenclature.ResultsOf 88,409 crowns placed, 8.97% were complete metal, 41.40% were all ceramic, and 49.64% were porcelain fused to metal (PFM). The probability of survival of all teeth with crowns placed was 90.41% after 9 years. NS-RCT was the most common untoward event. PFM crowns exhibited a higher rate of untoward events than complete metal crowns and a lower rate than all-ceramic crowns. Crowns placed on individuals 50 years of age and younger had higher rates of untoward events than those placed on individuals ages 51 years and older.ConclusionsThe risk of endodontic treatment after the placement of crowns is low. This risk increases with the placement of all-ceramic or PFM crowns and as the age of the patient decreases.     

A 5-year retrospective study of survival of zirconia single crowns fitted in a private clinical setting

ObjectivesThe aim of this report was to evaluate the 5-year clinical performance and survival of zirconia (NobelProcera?) single crowns.MethodsAll patients treated with porcelain-veneered zirconia single crowns in a private practice during the period October 2004 to November 2005 were included. The records were scrutinized for clinical data. Information was available for 162 patients and 205 crowns.ResultsMost crowns (78%) were placed on premolars and molars. Out of the 143 crowns that were followed for 5 years, 126 (88%) did not have any complications. Of those with complications, the most common were: extraction of abutment tooth (7; 3%), loss of retention (15; 7%), need of endodontic treatment (9; 4%) and porcelain veneer fracture (6; 3%). No zirconia cores fractured. In total 19 restorations (9%) were recorded as failures: abutment tooth extraction (7), remake of crown due to lost retention (6), veneer fracture (4), persistent pain (1) and caries (1). The 5-year cumulative survival rate (CSR) was 88.8%.ConclusionsAccording to the present 5-year results zirconia crowns (NobelProcera?) are a promising prosthodontic alternative also in the premolar and molar regions. Out of the 143 crowns followed for 5 years, 126 (88%) did not have any complications. However, 9% of the restorations were judged as failures. Further studies are necessary to evaluate the long-term success.