ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Full Cuspal Coverage Restorations Improve the Long-Term Survivability of Endodontically Treated Posterior Teeth
Clinical Question For adult patients with an endodontically treated posterior tooth, does a full cuspal coverage restoration, compared to a restoration that doesn’t provide full cuspal coverage, increase survivability of the treated tooth?
Clinical Bottom Line Endodontically treated posterior teeth with full cuspal coverage restorations have increased long-term survivability compared to treated teeth without full cuspal coverage restorations.
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) 17822823Stavropoulou/200710 studiesSystematic review of non-randomized trials
Key resultsThe survivability curves for teeth with and without full cuspal coverage restorations following endodontic treatment were calculated from the pooled data of 5 and 8 studies, respectively. Endodontically treated teeth with full coverage restorations had a combined survivability curve of 81 ± 12% after 10 years. Conversely, endodontically treated teeth lacking full cuspal coverage restorations had a survivability curve of 63 ± 15% after 10 years. The short-term survivability of endodontically treated teeth without full coverage restorations (84 ± 9%) is not different from that of teeth with full cuspal coverage. Therefore, the lack of full cuspal coverage restorations in posterior teeth results in decreased long-term survival (3-10 years).
#2) 15564861Salehrabi/20041.4 million endodontically treated teethEpidemiological
Key resultsEndodontically treated posterior teeth that lacked full cuspal coverage restorations were 6 times more likely to require extraction. During the study’s 8-year observation period, 85% of the extracted endodontically treated posterior teeth lacked full cuspal coverage restorations (p<0.001).
#3) 25043331Winward/20143,455 endodontically treated posterior teethRadiographic survey
Key resultsFull cuspal restorations were missing in 97.5% of the endodontically treated posterior teeth determined non-restorable requiring extraction. Two board-certified endodontists determined restorability. No raw data or criteria for restorability were reported.
Evidence Search systematic[sb] AND (dental[All Fields] AND restorations[All Fields] AND ("root canal therapy"[MeSH Terms] OR ("root"[All Fields] AND "canal"[All Fields] AND "therapy"[All Fields]) OR "root canal therapy"[All Fields]))
Comments on
The Evidence
Validity: The systematic review consisted of mainly retrospective clinical studies with varying treatment and reporting protocols. The inclusion criteria required a minimum follow-up period of 2 years. The conclusions were based on survivability curves constructed (estimated) from the pooled data. The epidemiological study by Salehrabi et al. included a large sample size (n=1.4 million) and long follow-up period (8 years). The results indicate a strong association between endodontically treated posterior teeth without full cuspal coverage restorations and subsequent extractions. The radiographic survey by Winward et al. had a large sample size (n=3,455). No randomized clinical trials were found on this topic. Perspective: Endodontic treatment of posterior teeth has been associated with an increased risk of fracture (Sorensen, 1984). Endodontically treated teeth have frequently lost significant coronal tooth structure from previous caries, trauma, and pre-existing restorations. The increased risk of fracture is mainly due to the loss of coronal tooth structure with a small increase attributed by the incorporated endodontic access preparation (Reeh, 1989). To reduce the risk of fracture and increase long-term survivability, full cuspal coverage restorations should be considered necessary on endodontically treated posterior teeth.
Applicability Applicable to providers restoring endodontically treated posterior teeth. Clinicians should consider timely placement of a full cuspal coverage restoration on treated teeth as a necessary clinical procedure.
Specialty/Discipline (Endodontics) (General Dentistry) (Prosthodontics)
Keywords Endodontics, Posterior teeth, Long-term survival, Restorations, Crowns, Fractures
ID# 2782
Date of submission: 11/19/2014spacer
E-mail rameyk@livemail.uthscsa.edu
Author Kelly Ramey, DDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Anibal Diogenes, DDS, PhD
Faculty mentor/Co-author e-mail diogenes@uthscsa.edu
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