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| Title |
Direct Composite Restoration is Equivalent to Full Cast Coverage for Endodontically Treated Premolars |
| Clinical Question |
In a healthy 47 year old patient with a previous endodontically treated premolar, will placing a full coverage crown versus a resin composite buildup result in greater longevity of the tooth? |
| Clinical Bottom Line |
Clinical success rates are equivalent for fiber posts plus direct composite restorations versus full coverage with metal-ceramic crowns for endodontically treated premolars. (See Comments on the CAT below) |
| Best Evidence |
(you may view more info by clicking on the PubMed ID link) |
| PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
| #1) 12426500 | Mannocci/2002 | Patients who have endodontically treated premolars | Randomized Controlled Trial | | Key results | The results of the 3 year randomized controlled trial showed that there are no significant differences between restoring an endondontically treated premolar with a full coverage crown or a composite restoration in regards to failure frequencies(95% confidence interval, -17.5 to 12.6). | |
| Evidence Search |
Search Limits: Meta-Analysis, Randomized Controlled Trial, Review, EnglishSearch "Crowns"[Mesh] Search "Bicuspid"[Mesh]Search "Tooth, Nonvital"[Mesh] |
Comments on
The Evidence |
Due to the large loss of subjects and short term follow-up interval, further study is needed to support the results of this study. |
| Applicability |
The importance of these results could dictate the future treatment of endodontically treated premolars. If these results are valid, direct composite restorations would not only be the treatment of choice but also the most conservative to both the patient’s tooth and wallet. Due to the limitations within the study, further study is needed to confirm if the results would still be valid for a longer follow-up period. |
| Specialty/Discipline |
(General Dentistry) (Prosthodontics) (Restorative Dentistry) |
| Keywords |
Endodontically treated teeth, Premolar, Crown
|
| ID# |
2061 |
| Date of submission: |
06/02/2011 |
| E-mail |
Hoangv@livemail.uthscsa.edu |
| Author |
Vi Linh Hoang |
| Co-author(s) |
|
| Co-author(s) e-mail |
|
| Faculty mentor/Co-author |
Mark Littlestar, DDS |
| Faculty mentor/Co-author e-mail |
littlestarm@uthscsa.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
|
Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
by Minnie Nguyen Ma (Austin, TX) on 07/23/2011
Yes, placing a crown on an endontically treated premolar will result in greater longevity of a tooth. The biggest risk of not doing full cuspal coverage of any posterior tooth is possible fracture of the buildup or the surrounding tooth structure. Mandibular first pre-molars are probably at the least risk of fracture without full cuspal coverage but all in all, I have seen many cases where patients do not get the crowns placed on their teeth after endodontic treatment that results in tooth fracture, which then needs an extraction. | by Christopher E. Knight, DDS (San Antonio) on 07/01/2011
Clinically speaking...in my 12 years of practice I can’t count the number of premolars that lose the buccal or lingual cusps from occlusal fills being too large. Especially in Max Premolars because of the morphology and the mesial vertical groove cutting thru the marginal ridge. Remember, after a tooth has undergone endo, it will desicate, dry up..lose vital color...and will crack almost every time! It may take 5-7 years to break down...but I have seen it in my clinic. I personally demand full coverage with every endo. Not following this protocol can also lead to unwanted legal liability for not doing everything necessary to ensure the longevity of the tooth! | |
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