Restorative outcomes for endodontically treated teeth in the Practitioners Engaged in Applied Research and Learning network

BackgroundThe authors aimed to determine the outcome of and factors associated with success and failure of restorations in endodontically treated teeth in patients in practices participating in the Practitioners Engaged in Applied Research and Learning (PEARL) Network.MethodsPractitioner-investigators (P-Is) invited the enrollment of all patients seeking care at participating practices who had undergone primary endodontic therapy and restoration in a permanent tooth three to five years earlier. P-Is classified endodontically reated teeth as restorative failures if the restoration was replaced, the restoration needed replacement or the tooth was cracked or fractured.ResultsP-Is from 64 practices enrolled in the study 1,298 eligible patients who had endodontically treated teeth that had been restored. The mean (standard deviation) time to follow-up was 3.9 (0.6) years. Of the 1,298 enrolled teeth, P-Is classified 181 (13.9 percent; 95 percent confidence interval [CI], 12.1–15.8 percent) as restorative failures: 44 (3.4 percent) due to cracks or fractures, 57 (4.4 percent) due to replacement of the original restoration for reasons other than fracture and 80 (6.2 percent) due to need for a new restoration. When analyzing the results by means of multivariate logistic regression, the authors found a greater risk of restorative failure to be associated with canines or incisors and premolars (P = .04), intracoronal restorations (P < .01), lack of preoperative proximal contacts (P < .01), presence of periodontal connective-tissue attachment loss (P < .01), younger age (P = .01), Hispanic/Latino ethnicity (P = .04) and endodontic therapy not having been performed by a specialist (P = .04).ConclusionsThese results suggest that molars (as opposed to other types of teeth), full-coverage restorations, preoperative proximal contacts, good periodontal health, non-Hispanic/Latino ethnicity, endodontic therapy performed by a specialist and older patient age are associated with restorative success for endodontically treated teeth in general practice.Clinical ImplicationsThese results contribute to the clinical evidence base to help guide practitioners when planning the restoration of endodontically treated teeth.     

Success and Survival of Endodontically Treated Cracked Teeth with Radicular Extensions: A 2- to 4-year Prospective Cohort

IntroductionThere are no long-term, prospective clinical studies assessing outcomes of endodontically treated cracked teeth with radicular extensions. The purpose of this prospective study was to examine the 2- to 4-year success and survival rates of endodontically treated, coronally restored, cracked teeth, specifically where the crack extends beyond the level of the canal orifice internally.MethodsSeventy consecutive teeth requiring endodontic treatment with cracks extending to the level of the canal orifice and up to 5 mm beyond were included in the cohort. Treatment was performed by a single endodontist using current techniques, and cases were followed over time. Specific treatment and posttreatment protocols were used. A tooth was “survived” if it was present, asymptomatic, and functional. The category of “success” was given to a case if strict radiographic and clinical criteria were met.ResultsFifty-nine teeth were eligible for survival analysis, and 53 teeth were available for success analysis. There was a 100% survival rate in the first 2 years and 96.6% survival up to the 4-year period; 90.6% were classified as “success” in the 2- to 4-year term. No significant differences (P < .05) were found for periodontal pocketing (up to 7 mm) at the site of the crack, marginal ridge involvement, crack depth, or pretreatment diagnoses.ConclusionsThis study showed that the success and survival rates for cracked teeth with radicular extensions may be similar to endodontically treated teeth in general and may be higher than previously reported in cracked tooth studies. Treatment outcomes in cracked teeth with radicular extensions may be improved by using the following protocols: microscope-assisted intraorifice barriers placed apical to the extent of the crack, complete occlusal reduction, specific postoperative instructions, and expeditious placement of a full-coverage restoration.     

The influence of indirect bonded restorations on clinical prognosis of endodontically treated teeth: A systematic review and meta-analysis

ObjectiveThe loss of the dental coronal portion following carious lesions or fractures leads to endodontic treatment with subsequent restoration to ensure correct anatomy and function. Recently, partial adhesive restorations have been widely proposed to increase the survival rate of endodontically treated teeth. The primary purpose of this review is to assess the failure rate of indirect partial adhesive restorations on endodontically treated teeth (ETT), considering the follow-up period.MethodsThe indications reported in the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) were used to draft the present review. The study was constructed on PICO questions: population (patients who need indirect adhesive restorative treatment on endodontically treated teeth with onlay and overlay), intervention (onlay and overlay), control (patients with onlay and overlay on endodontically treated teeth) and outcome (failure rate and types of failure for onlay and overlay). The asked scientific question was: what are the failure rate and types of failure for adhesive indirect partial restorations on ETT?ResultsThe overall failure rate that emerges is 0.087 with a ratio of 121/1254, I² 80 % p-value< 0.001. Moreover, by meta-regression with covariates the follow-up period reports a coefficient of 0.013 with a P-value< 0.001. In conclusion, the indirect partial restorations on endodontically treated teeth displayed overall acceptable outcomes in terms of success from 2 to 4 years after their placement with only 4.32 % of failure. Failures increase after 7 years up to 12–30 years with failure rates of approximatively 10.65 % and 20.94 %. The analysis of the included articles reporting the causes of restorations failures showed that 15.51 % of cases were related to the loss of dental element.SignificanceBesides the survival rates of indirect adhesive restorations on endodontically treated posterior teeth, it was highlighted that the majority of failures appeared restorable. Thus, partial restorations seemed able to prevent the ETT tooth loss.     

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.     

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).     

A Practice-based Study on the Survival of Restored Endodontically Treated Teeth

IntroductionThis retrospective study evaluated the survival of endodontically treated teeth (ETTs) and investigated factors influencing restoration and tooth survival.MethodsData from 795 ETTs were recorded, and success (restoration still intact) and survival (restoration intact or failed/repaired/replaced and tooth still in situ) were analyzed using Kaplan-Meier statistics. A multivariate Cox regression analysis was performed to assess the variables influencing success and survival.ResultsAt the end of the observation period (mean observation time = 4.48 years), 45 teeth had been extracted (annual failure rate for survival = 1.9% at 9.6 years) and 114 restorations had received a restorative follow-up treatment (annual failure rate for success = 4.9% at 9.6 years).ConclusionsETTs showed acceptable survival and success in the long-term. Variables showing significant influence on survival were the number of teeth in the dentition and the presence of decay at the moment the patient entered the practice.     

Long-term survival of endodontically treated molars without crown coverage: a retrospective cohort study

STATEMENT OF PROBLEM: 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. PURPOSE: 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. MATERIAL AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.     

Influence of coronal restorations on the periapical health of endodontically treated teeth

The purpose of the study was to evaluate a possible relationship between the quality of the coronal restoration, the root canal obturation and the periapical status of endodontically treated teeth. Full mouth series of radiographs from randomly selected patient charts at the Dental Faculty, University of Oslo were examined. A total of 1001 endodontically treated teeth restored with a permanent restoration were evaluated independently by two examiners. According to a predetermined set of radiographic criteria, the technical quality of the root filling of each tooth was scored as either good (GE) or poor (PE), and the technical quality of the coronal restoration was scored as good (GR) or poor (PR). The root and the surrounding structures were then evaluated and according to the periradicular findings, the treatment was categorized as success or failure. The success rate for all endodontically treated teeth was 67.4% (n = 1001). Teeth with root canal posts had a success rate of 70.7% (n = 527) and teeth without posts had a success rate of 63.6% (n = 472). The two groups with technically good endodontics had the highest success rates. In combination with technically good restorations the success rate was 81% (GE + GR, 81%) and combined with technically poor restorations the success rate was 71% (GE + PR, 71%). The two groups with technically poor endodontics combined with either good restorations or poor restorations had significantly lower success rates (PE + GR, 56% and PE + PR, 57%). The technical quality of the endodontic treatment as judged radiographically was significantly more important than the technical quality of the coronal restoration when the periapical status of endodontically treated teeth was evaluated.     

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.     

Outcome and Survival of Endodontically Treated Cracked Posterior Permanent Teeth: A Systematic Review and Meta-analysis

IntroductionThe aim of the present systematic review and meta-analysis was to evaluate the success and survival rate of endodontically treated cracked posterior teeth and to assess the preoperative factors that affect teeth survival.MethodsThe study protocol was registered on the PROSPERO international prospective database of systematic reviews (CRD42019119091). Electronic search was performed for studies up to November 30, 2018 in the following databases: PubMed, Scopus, and Cochrane. All searches were done following the PRISMA guidelines. Clinical studies evaluating the success and/or the survival rate of cracked teeth that were endodontically treated with at least 1-year follow-up were selected. The Newcastle–Ottawa scale was used to evaluate risk assessment. Publication bias was evaluated with funnel plots, and the Egger's test was performed to test asymmetry.ResultsFrom the 410 studies identified through the initial search, 7 studies qualified for the final analysis, all of which were longitudinal cohort studies. The results of the meta-analysis indicated a survival rate of 88% (confidence interval, 0.81–0.94) and a success rate of 82% (confidence interval, 0.78–0.86) after 1 year of follow-up. The presence of a periodontal pocket associated to a crack (relative risk, 1.11) resulted in a higher risk of tooth loss. Patient sex, tooth type, position, the number of cracks present, and preoperative pulp status did not affect treatment survival rate (P > .05). Most of the included studies did not have an accurate record of many variables that could affect the tooth survival. Plus, studies did not present extended follow-up periods or an adequate dropout rate to properly assess treatment outcome and survival.ConclusionsAccording to the results of the present systematic review and meta-analysis, root canal treatment in cracked posterior teeth can be considered a suitable treatment option. The presence of an associated periodontal pocket results in a lower survival rate.     

Seven-year clinical evaluation of painful cracked teeth restored with a direct composite restoration

The purpose of this study was to investigate long-term clinical effectiveness of treating painful cracked teeth with a direct bonded composite resin restoration. The hypothesis tested was that cracked teeth treated with or without cuspal coverage showed the same performance. Forty-one patients attended a dental practice with a painful cracked tooth that was restored with a direct composite resin restoration. Twenty teeth were restored without and 21 with cuspal coverage. After 7 years, 40 teeth could be evaluated. Three teeth without cuspal coverage needed an endodontic treatment, of which 2 failed as a result of fracture. No significant differences were found for tooth or pulp survival. Three more repairable restoration failures were recorded. Mean annual failure rate of restorations without cuspal coverage was 6%; no failures in restorations with cuspal coverage occurred (P = .009). A direct bonded composite resin restoration can be a successful treatment for a cracked tooth.     

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.     

Restoration of the endodontically treated posterior tooth

ObjectivesTo analyse the key factors of the restoration in the posterior endodontically treated teeth, through a literature review and clinical cases presentation. To focus on the clinical advantages of the adhesive indirect restorations, describing the basic principles for long-term success.Materials and methodsThe biomechanical changes due to the root canal therapy and the degree of healthy dental tissue lost because of pathology and iatrogenic factors are the critical points leading the clinician to the restorative treatment planning. The full crown is considered by the literature as the gold standard and is indicated in case of teeth heavily weakened by dental caries, fractures or previous conservative-prosthetic preparations. The improvement of the adhesion and the composite materials, with mechanical properties close to those of dental tissues, offers to the clinician the option of a conservative restoration, able to seal, reinforce and protect the tooth and to delay the execution of a full crown, with the subsequent sacrifice of dental tissue. Although in the presence of small-sized cavity, direct bonded restoration is considered an effective short and medium-term restoration, cuspal coverage with indirect restoration is the treatment of choice in case of mesio-occlusal-distal cavities. Adhesive overlays preserve coronal structure, avoid contamination of the root canal system, reinforce residual dental tissues, guarantee optimal form, function, aesthetics and offer ergonomic and economic undoubted clinical advantages.Results and conclusionsDirect adhesive restorations, indirect bonded restorations and traditional full crown are three therapeutic options for the single posterior endodontically treated teeth. The amount of remaining sound tooth structure is the most significant factor influencing the therapeutic approach. The clinician's operative skill is a determining aspect for long-term success of adhesive inlays.     

Prognostic Factors after Endodontic Microsurgery: A Retrospective Study of 111 Cases with 5 to 9 Years of Follow-up

IntroductionA study was performed of the healing rate of teeth subjected to endodontic microsurgery after a minimum follow-up of 5 years with an analysis of the influence of different pre- and postoperative factors on the outcome.MethodsThis was a retrospective study of patients subjected to endodontic microsurgery with the use of mineral trioxide aggregate (MTA) for retrograde filling between January 2011 and December 2015. In patients with multiple treated teeth, only 1 random tooth was selected for the statistical analysis. Clinical and radiographic parameters were used to assess healing. Simple binary logistic regression models were used to analyze the influence of patient age and sex, the type of tooth, prior radiographic lesion size, the presence of a post, the type of restoration, and the apical extent of prior filling of the root canal on the endodontic microsurgery success rate. Two calibrated observers evaluated the periapical radiographs on an independent basis.ResultsA total of 111 patients (63.1% women and 36.9% men) were included in the study. Of the 111 teeth analyzed, 90 were classified as healed (mean healing rate = 81.1%). Patient age and sex, the presence of a post, the type of tooth, the type of restoration, and the apical extent of prior filling of the root canal had no significant impact on the outcome. Large lesions (>5 mm) were associated with a lower healing rate than smaller lesions, although the difference was not significant. Anterior teeth had a significantly higher healing rate (93.8% maxillary and 100% mandibular) than molars (70.8% maxillary and 57.1% mandibular) (P < .05). The differences between the anterior teeth and the molars were statistically significant.ConclusionsThe mean healing rate of teeth subjected to endodontic microsurgery was 81% after 5–9 years of follow-up. The success rate was lower for upper and lower molars than for teeth in the anterior zone, although the sample was small and further studies are needed to establish whether the type of tooth influences the treatment outcome.     

Influence of coronal restorations on the periapical health of endodontically treated teeth

Abstract – The purpose of the study was to evaluate a possible relationship between the quality of the coronal restoration, the root canal obturation and the periapical status of endodontically treated teeth. Full mouth series of radiographs from randomly selected patient charts at the Dental Faculty, University of Oslo were examined. A total of 1001 endodontically treated teeth restored with a permanent restoration were evaluated independently by two examiners. According to a predetermined set of radiographic criteria, the technical quality of the root filling of each tooth was scored as either good (GE) or poor (PE), and the technical quality of the coronal restoration was scored as good (GR) or poor (PR). The root and the surrounding structures were then evaluated and according to the periradicular findings, the treatment was categorized as success or failure. The success rate for all endodontically treated teeth was 67.4% ( n =1001). Teeth with root canal posts had a success rate of 70.7% ( n =527) and teeth without posts had a success rate of 63.6% ( n =472). The two groups with technically good endodontics had the highest success rates. In combination with technically good restorations the success rate was 81% (GE+GR, 81%) and combined with technically poor restorations the success rate was 71% (GE+PR, 71%). The two groups with technically poor endodontics combined with either good restorations or poor restorations had significantly lower success rates (PE+GR, 56% and PE+PR, 57%). The technical quality of the endodontic treatment as judged radiographically was significantly more important than the technical quality of the coronal restoration when the periapical status of endodontically treated teeth was evaluated.     

Factors Associated with the Need for a Primary Endodontic Treatment after Single-Unit Crown Cementation: A Retrospective Case-Control Study

IntroductionThis case-control study aimed to identify factors associated with an increased risk for endodontic treatment after single-unit crown cementation and to describe the timeline of such events.MethodsAfter evaluating the electronic records of all single-unit crowns placed on nonendodontically treated teeth between 1999 and 2019 and excluding teeth with preexisting questionable or confirmed endodontic disease, “cases” were identified as teeth requiring primary endodontic treatment after crown cementation. This was not examined in the current study because the cases and controls were matched by tooth type.ResultsOverall, 69 teeth without any suspected or confirmed past endodontic disease required an endodontic intervention after crown cementation. The mean number ± standard deviation of restorations in a tooth before crown cementation was significantly higher among the cases than the matched controls (2.16 ± 0.99 vs 0.78 ± 0.78, P < .05). Teeth with ≥2 and ≥3 previous restorations had an almost 4 (odds ratio = 3.81; 95% confidence interval, 1.56–9.29; P < .05) and almost 6 (odds ratio = 5.97; 95% confidence interval, 1.230–28.95; P < .05) times higher risk, respectively, for endodontic treatment after crown cementation compared with teeth with ≤1 restoration present before crown cementation. The majority (65%, n = 45) of teeth in the cases group required endodontic treatment during the first 3 years after crown cementation.ConclusionsThe presence of multiple restorations at the time of crown cementation was identified as a significant predictive factor for the need for endodontic treatment after crown cementation in teeth with no preexisting questionable or confirmed endodontic disease. Therefore, clinicians should be aware and inform patients about the increased risk of primary endodontic treatment in teeth with a history of more than 1 restoration, especially during the first 3 years after permanent crown cementation.     

Performance of ceramic laminate veneers with immediate dentine sealing: An 11 year prospective clinical trial

ObjectiveIn this prospective clinical trial the survival, success rate and patient satisfaction of ceramic laminate veneers with special interest on existing restorations, immediate dentin sealing and endodontically treated teeth was evaluated.MethodsA total of 104 patients (mean age: 42.1 years old) received 384 feldspathic ceramic laminate veneers on maxillary anterior teeth. Veneer preparations with incisal overlap were performed using a mock up technique. Existing resin composite restorations of acceptable quality were not removed but conditioned using silica coating and silanization. Immediate dentin sealing (IDS) was applied when more than 50% of dentin was exposed during preparation. Endodontically treated teeth were not excluded. After adhesive cementation, restorations were evaluated by calibrated evaluators at baseline and final follow-up using modified USPHS criteria.Results225 Laminate veneers were bonded onto teeth without existing restorations, 159 on teeth with pre-existing resin composite restorations, 87 to teeth with more than 50% of exposed dentin surface and 43 to endodontically-treated teeth. In total, 19 failures were observed in form of debonding (n = 3), fracture (n = 15) and extraction due to endodontic complications (n = 1). In teeth with more than 50% of dentin exposure, a significant increase in survival rate was observed when IDS was used (96.4% versus 81.8%). No significant difference was found between teeth with and without pre-existing composite resin restorations (84.6% versus 95.5%) or between vital and non-vital teeth (95.6% versus 88.1%). Laminate veneers luted to endontically-treated teeth had a significant mis-match in color compared to vital teeth. Patients who smoked presented with significantly more marginal discoloration, but no intervention was needed. Patients scored favorably values on the Oral Health Impact Profile questionnaire and were generally satisfied with the treatment. In this clinical trial, the ceramic laminate veneers had a relatively high survival rate.SignificanceTeeth with more than 50% of dentin exposure significantly benefit from IDS. Pre-existing restorations or endodontic treatments do not have an effect on the survival rate of ceramic laminate veneers. However, smoking habits and previous endodontic treatments negatively affect the success rate due to color changes.Clinical Trial Registration Number: NCT03645551     

Outcomes of endodontic therapy in general practice: a study by the Practitioners Engaged in Applied Research and Learning Network

BackgroundThe authors undertook a study involving members of a dental practice-based research network to determine the outcome and factors associated with success and failure of endodontic therapy.MethodsMembers in participating practices (practitioner-investigators [P-Is]) invited the enrollment of all patients seeking treatment in the practice who had undergone primary endodontic therapy and restoration in a permanent tooth three to five years previously. If a patient had more than one tooth so treated, the P-I selected as the index tooth the tooth treated earliest during the three- to five-year period. The authors excluded from the study any teeth that served as abutments for removable partial dentures or overdentures, third molars and teeth undergoing active orthodontic endodontic therapy. The primary outcome was retention of the index tooth. Secondary outcomes, in addition to extraction, that defined failure included clinical or radiographic evidence (or both) of periapical pathosis, endodontic retreatment or pain on percussion.ResultsP-Is in 64 network practices enrolled 1,312 patients with a mean (standard deviation) time to follow-up of 3.9 (0.6) years. During that period, 3.3 percent of the index teeth were extracted, 2.2 percent underwent retreatment, 3.6 percent had pain on percussion and 10.6 percent had periapical radiolucencies for a combined failure rate of 19.1 percent. The presence of preoperative periapical radiolucency with a diagnosis of either irreversible pulpitis or necrotic pulp was associated with failure after multivariate analysis, as were multiple canals, male sex and Hispanic/Latino ethnicity.ConclusionsThese results suggest that failure rates for endodontic therapy are higher than previously reported in general practices, according to results of studies based on dental insurance claims data.Clinical ImplicationsThe results of this study can help guide the practitioner in deciding the most appropriate course of therapy for teeth with irreversible pulpitis, necrotic pulp or periapical periodontitis.     

Retrospective cross sectional comparison of initial nonsurgical endodontic treatment and single-tooth implants

Initial root canal treatment and the replacement of a single tooth with an implant are both viable treatment options, but various success rates have been reported for each treatment modality. This retrospective study compared 196 implant restorations and 196 matched initial nonsurgical root canal treatment (NSRCT) teeth in patients for four possible outcomes: success, survival, survival with subsequent treatment intervention and failure. Cross classifications/tabulations were analyzed using Pearson's chi2 test for association of the two classifications (endodontic vs implant and outcome). Polytomous regression with likelihood ratio tests were used in testing association with tooth location and outcome. Outcomes were as follows for implants and NSRCT respectively: success 73.5% and 82.1%; survival with no intervention 2.6% and 8.2%; survival with intervention 17.9% and 3.6%; and failure 6.1% and 6.1%. Location of the restoration in the mouth did not affect outcome. This study suggests that restored endodontically treated teeth and single tooth implant restorations have similar failure rates, although the implant group showed a longer average and median time to function and a higher incidence of postoperative complications requiring subsequent treatment intervention.     

Treatment of traumatic dental injuries in a cohort of 16-year-olds in northern Sweden

Abstract – The prevalence and yearly incidence of traumatic tooth injury between 1 and 16 years of age have been studied in a cohort of 16-year-olds, born in 1975, and residing in the County of Västerbotten. The study material comprised 3007 dental records from the Public Dental Health Service. Of these, 1040 contained information on dental injuries. Out of 1000 injured primary teeth, 32% were lost, either avulsed at the time of the accident or extracted due to complications. A majority (92%) of the extractions was performed at the first or second follow-up. A total of 690 tooth injury episodes had occurred in the permanent dentition, involving 981 teeth. In 10% of the teeth more than one diagnosis was recorded for the same tooth. 416 restorations were performed due to crown fractures, the majority at the emergency visit. 44% of the patients had to come back one or more times to revise the composite restoration. Complicated fractures or serious luxation injuries constituted only 5% of the total number of injuries in the permanent dentition. 77 (8%) of the traumatised teeth were treated endodontically. Two percent of the teeth with uncomplicated crown fractures required endodontic treatment due to pulp necrosis, while 28% of teeth with a combination of crown fractures and luxation injury were endodontically treated. Out of 6 avulsed incisors, 4 survived after endodontic treatment. A total of 7 incisors were lost as a consequence of the injuries. A specialist treated 4% of the patients.