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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) 12426500Mannocci/2002Patients who have endodontically treated premolarsRandomized Controlled Trial
Key resultsThe 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: 06/02/2011spacer
E-mail Hoangv@livemail.uthscsa.edu
Author Vi Linh Hoang
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
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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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