Failure of single‐unit restorations on root filled posterior teeth: a systematic review

Abstract

Afrashtehfar KI, Ahmadi M, Emami E, Abi-Nader S, Tamimi F. Failure of single-unit restorations on root filled posterior teeth: a systematic review. International Endodontic Journal, 50, 951-966, 2017. This systematic review investigated the failure rate of conventional single-unit restorations in root filled posterior permanent teeth. Two reviewers independently applied eligibility criteria, extracted data and assessed the quality of the evidence of each included study according to the Cochrane Collaboration's procedures for randomized control trials (RCTs) and the STROBE criteria for observational studies. The MEDLINE (via Ovid), EMBASE (via Ovid), Cochrane Oral Health Group Trials Register and CENTRAL (via Cochrane Library) databases were searched electronically (January 1993 to week 1, February 2015). This was complemented by an additional hand search of selected journals and the references of relevant studies. Clinical studies published on root filled single-unit restorative treatments with a mean follow-up period of at least 3 years were selected. The outcome measured was clinical or radiological failure. Overall, the four RCTs and the single observational study included were of low and high quality, respectively. Therefore, a meta-analysis was not possible. The pooled mean failure rates were reported according to the type of treatment and remaining coronal tooth structure. The current evidence suggested that the failure rates of the treatments may depend on the amount of remaining tooth structure and type of treatment. Postretained crowns were associated with the most favourable outcome in teeth with one to two remaining coronal tooth wall(s), whereas post-free crowns were superior when greater tooth structure was available. Restorations in teeth without ferrules had such a high rate of failure that other treatment options should be considered.

Dentists' decisions regarding the need for cuspal coverage for endodontically treated and vital posterior teeth

“…A high percentage of the participants decided the need for cuspal coverage for ETT with a MO/DO cavity and thin axial walls (75% for molar and 96.7% for the premolar). This decision was consistent with a systematic review in which the failure rate was found to be reduced when such clinical situations were managed using cuspal coverage instead of using intracoronal restorations (Afrashtehfar, Ahmadi, et al, ). Scotti et al () found the remaining wall thickness to be a very important clinical parameter in the resistance of fracture in endodontically treated premolars and suggested that an axial wall thickness of less than 2 mm is an indication for cuspal coverage to improve the fracture resistance in maxillary premolars.…”

“…Moreover, uncertainty in decision making were more likely to be reported for clinical situations of VT compared with clinical situations of ETT. This could be due to the lack of knowledge synthesis in the literature for deciding when cuspal coverage is needed for VT (Afrashtehfar, Emami, et al, ), compared with the available knowledge synthesis for ETT (Afrashtehfar, Ahmadi, et al, ; Goodacre & Spolnik, ; Smith & Schuman, ).…”

“…Decision making regarding the best management for endodontically treated teeth (ETT) and vital teeth (VT) can be challenging for dentists (Cheung, ; Morgano, Hashem, Fotoohi, & Rose, ; Robbins, ; Zarow, Devoto, & Saracinelli, ). Determining whether cuspal coverage is needed or not is a common clinical decision faced by dentists in their daily clinical practice (Afrashtehfar, Ahmadi, Emami, Abi‐Nader, & Tamimi, ; Afrashtehfar, Emami, et al, ; Afrashtehfar & Tamimi, ).…”

“…Full cuspal coverage refers to covering all of the posterior tooth cusps with direct or indirect restorative material. Deciding whether a tooth would best be restored with cuspal coverage or an intracoronal restoration will depend on many factors such as whether the tooth is endodontically treated or not (Afrashtehfar & Tamimi, ; Aquilino & Caplan, ), the amount and distribution of tooth structure remaining (Afrashtehfar, Ahmadi, et al, ; Afrashtehfar, Emami, et al, ; Nagasiri & Chitmongkolsuk, ), the type and amount of load applied on the tooth during function (Loney, Moulding, & Ritsco, ; Torbjörner & Fransson, ), the parafunctional habits of the patient (Nishigawa, Bando, & Nakano, ), the esthetic value of the tooth, and the knowledge and experience of the dentist (Burke & Lucarotti, ; Lucarotti, Holder, & Burke, ).…”

Dental Care for Asylum-Seekers in Germany: A Retrospective Hospital-Based Study

“…The treatment depends on the severity of the caries. If the tooth is still in good condition, a filling can be placed [45,46]. A root canal treatment is recommended for deep caries that has reached the pulp.…”