|Year : 2021 | Volume
| Issue : 3 | Page : 433-436
Follow-up of endodontically treated teeth without crown coverage in Vidarbha region: A long-term retrospective cohort study
Pradnya Nikhade1, Neelam Bajaj2, Priyanka Paul3, Shweta Sedani1
1 Department of Conservative Dentistry Endodontics, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (M), Wardha, Maharashtra, India
2 Department of PHD, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (M), Wardha, Maharashtra, India
3 Department of Dentistry, AIIMS, Nagpur, Maharashtra, India
|Date of Submission||12-Jul-2021|
|Date of Decision||22-Aug-2021|
|Date of Acceptance||30-Aug-2021|
|Date of Web Publication||12-Mar-2022|
Dr. Pradnya Nikhade
103, Department of Conservative Dentistry, SPDC, DMIMS (Deemed To Be University), Sawangi (Meghe), Wardha - 442 001, Maharashtra
Source of Support: None, Conflict of Interest: None
Statement of Problem: Teeth are weakened after endodontic treatment and should, preferably, be crowned, especially posterior teeth. However, this is not always possible due to certain reasons. Information about the appropriate treatment modalities. This retrospective study was carried out to evaluate the survival of endodontically treated teeth (ETTs) without crown coverage on the basis of various parameters in the region of Vidarbha in Maharashtra, India. 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. Materials and Methods: Relevant data from 300 subjects for 148 ETTs was recorded at the Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College, Wardha, Maharashtra. 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. One hundred and forty-eight teeth restored using glass-ionomer cement (GIC), SF, and composites were considered successful during the observation time of 3 years because no intervention was needed in these teeth were labeled as “survived.” The teeth restored with composite were 90. The teeth restored with GIC were 14. The teeth restored with silver amalgam were 44. Out of 148 teeth were considered successful during the observation time of 3 years because no intervention was needed in these teeth were labeled as “survived.” Follow-up was done at regular intervals after 5, 7, and 10 years, respectively. At the end of 10 years, the number of teeth survived was 26. The teeth restored with composite were 14. The teeth restored with GIC were 4. The teeth restored with silver amalgam were 8. Results: At the end of the observation time period (10 years), 13 teeth had to be extracted at the end of 6 years and 19 restorations were repaired or replaced at 5, 7, and 9 years. Conclusion: Within the limitations of this study, the amount of remaining tooth structure and types of restorative material have a significant association with the longevity of endodontically treated molars without crown coverage. ETTs evaluated after 10 years showed positive survival and success in long time period. Various parameters were significantly seen to influence the outcome and thereby survival of teeth in the arch when no crowns were placed on ETTs.
Keywords: Endodontically treated teeth, noninterventional clinical trial, restorations, retrospective cohort study
|How to cite this article:|
Nikhade P, Bajaj N, Paul P, Sedani S. Follow-up of endodontically treated teeth without crown coverage in Vidarbha region: A long-term retrospective cohort study. J Datta Meghe Inst Med Sci Univ 2021;16:433-6
|How to cite this URL:|
Nikhade P, Bajaj N, Paul P, Sedani S. Follow-up of endodontically treated teeth without crown coverage in Vidarbha region: A long-term retrospective cohort study. J Datta Meghe Inst Med Sci Univ [serial online] 2021 [cited 2022 Jun 30];16:433-6. Available from: http://www.journaldmims.com/text.asp?2021/16/3/433/339448
| Introduction|| |
An occlusal coverage with endodontically treated teeth (ETTs) is considered an optimum treatment. There are multiple reasons of loss of root canal (RC)-treated teeth as reported by Caplan and Weintraub. Two factors are considered for the failure of RC-treated teeth as nonvital condition of teeth and loss of dentin as tooth structure.
Papa et al. reported that there is no significant difference in moisture content of vital and nonvital teeth. Their matched pair study carried out by Sedgley and Messer concluded that teeth post endodontic treatment do not become brittle. The necessity to place a crown on an ETT has been investigated in clinical trials with limited observation time, but a Cochrane review does not reveal any conclusion due to lack of suitable studies.
In the 3-year follow-up of ETTs by Nikhade et al., it was observed that coronal coverage of ETTs presumably reduced the risk of fracture or other failures. The result showed the favorable survival of ETTs and restoration level. The crown restoration has been a suggested protocol to reinforce or strengthen a tooth after endodontic treatment.
The use of various direct restorative materials and techniques in compromised teeth has shown a good prognosis in vitro.
Reeh et al. studied the prospective results for different restorative techniques in nonvital teeth. Standardized MOD cavities were used. The study analyzed that composite resins with etching showed a relative stiffness near to that of the unaltered tooth. Silver amalgam restoration showed little or no resistance to cuspal movement, whereas a gold onlay extended greater resistance to movement than that of the unaltered tooth.
In a 20-year retrospective study, the only prospective study that compared performance between the uncrowned and crowned ETTs was performed by Mannocci et al.
The aims of this study were to evaluate the criteria for survival of ETTs without crown coverage and to identify possible explanations for the differences observed.
For RC-treated teeth, having a large restoration which is not easily replaceable, the survival of restoration and tooth is questionable as in such cases the complications such as failure of RC treatment as well as vertical fractures are common resulting in tooth loss.
The general condition of ETTs is such that they are restored with complex as well as extensive restorations where repair or replacement is difficult to perform, thus long-term follow-ups are mandatory. When retrospective data from the patient files can be retrieved, an analytical study of factors contributing to longevity is possible. Many clinical studies pertaining to ETTs are done to assess the longevity.
The present observational retrospective study aimed to justify the long-term longevity of ETTs without crown coverage in the patients in Vidarbha region of Maharashtra, India. The parameters were added to the previous study carried out and assessed after 3 years. The same patients were evaluated for 10 years to determine the survival of ETTs.
This retrospective study used the records from the routine patients coming to the outpatient department in the dental hospital located in Vidarbha region of Maharashtra, India. This region consists of 26 districts connected with each other. Data were collected from 2010 to 2020. Follow-up of the first 3 years was done till 2013, and the analysis was done for the survival and success of ETTs using Kaplan–Meier statistics and was published.
| Materials and Methods|| |
The status of the patients was updated in terms of patient intent to continue with further observation every year. The status of restoration was updated with consent of patients, and the present condition of the tooth in question was observed. Potential carious lesions, questionable crown or root fractures, loss of restoration, and tooth loss were taken into consideration. All the previous records were reviewed for basic data collected and viewed after 3 years. Recall program was scheduled for every 6 months. Records from patients who regularly visited the dental hospital for the presence of ETTs were as follows:
- A restoration was placed at least 6 months before the last recall visit [Graph 1], [Graph 2]
- A restoration was placed within 6 months after endodontic treatment
- Records contained information on the ETTs and the dentition.
Screening of the patient files yielded 450 ETTs. From these, 300 RC-treated teeth were evaluated which met the inclusion criteria. The following data were collected from the patient's records.
A checklist chart was made according to the guidelines given in the study carried out by Skupien JA et al. to record the characteristics of patient's ETT.
- Characteristics of the involved tooth and the dentition including the number of teeth, its type, presence of caries while entering the hospital, and decayed/missing/filled teeth at the time of endodontic treatment
- The data of endodontic treatment which includes relevant information such as number of canals, number of sessions, and number of filled canals
- The date of placement of the follow-up restoration, the type of restoration, number of surfaces, placement of a post, and core buildup
- The date and the type of all interventions on the ETT in the period after endodontic treatment.
Dental records were assessed for baseline data on the date of endodontic completion, previous changes in tooth condition. The patients were on 6 months, and 1, 2, and 5 years till 10.3 years post endodontic recall program. Though not all continued to attend. Patients were also enquired about any changes in tooth condition. Only permanent teeth which had not received provisional crowns, definitive restorations with cuspal coverage, post and core restorations, and/or crowns at the time of recall were included. Treatment outcome was defined as a failure if there were negative findings in the condition of a tooth that required a restoration, tooth repair, or extraction. Failure characteristics of tooth changes included recurrent caries at the margin of a restoration, crack/fracture line, loss of restoration, fracture of tooth or restoration, and/or vertical root fracture. ETTs that were lost because of endodontic and periodontal reasons were also excluded. The independent variables assessed were age of patient, gender, location of tooth in arch, existence of opposing dentition, adjacent teeth, remaining tooth structure, and type of restorative material.
Three hundred RC-treated teeth in 148 subjects that satisfied the inclusion criteria were included in this study. The age range of the subjects was between 20 and 45 years.
The observation period ranged from 6 months to 10.3 years. At the end of 10 years, 93 teeth were found to be intact with restorations without full coverage. The follow-up began from the date of endodontic therapy completion and ended on the date of negative findings in a tooth condition and/or tooth extraction. For teeth that were not determined a failure, follow-up ended on the date of data collection in the clinic [Table 1], [Table 2], [Table 3], [Table 4].
| Discussion|| |
In the present study, a retrospective observational survival analysis of restored ETTs was made in the Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College, Wardha, Maharashtra.
The study limitations included the fact that the number of teeth in each group of study variables was not well distributed and the observation periods were also unequal. Such survival analysis can be made when complete, accurate, and extensive data are available and patient's follow-up can be possible. Randomization is necessary in the situations where the study is long term.
In this study, 300 (male and female) patients regardless of the sex with a mean age of 53 years were selected. One hundred and forty-eight teeth were treated endodontically, and the data were recorded for these teeth for 10.3 years. During the observation time of 3 years, 148 teeth restored using various means were considered successful because no re-treatment was needed and the restorations were intact (composite restoration: 90, glass-ionomer cement (GIC) restoration: 14, and silver amalgam restoration: 44). Out of the remaining 152 teeth, the restorations failed/replaced or repaired (survival) for 121 teeth and 31 teeth were extracted. The follow-up was taken for long term of 10.3 years. At the commencement, only 93 teeth were found intact with no coverage.
Coronal coverage of ETTs presumably reduced the risk of tooth fractures or other failures. Eckerbom et al. in their study on Swedish population found that the teeth with crowns after RC treatment were lost at the same rate as vital teeth. For the restoration of the teeth limited to the endodontic access opening only, restored with amalgam and/or a bonded restoration, different tooth preparations have shown similar fracture resistance when compared with unaltered teeth, in vitro.
When types of restorations were compared, direct composite restorations show to have best overall performance, followed by silver amalgam and glass-ionomer restorations.
This study classified the types of remaining tooth structure according to the number of surfaces or the intact walls that remained and Type 1 remaining tooth structure was shown to have a good tendency for a long-term survival.
The 3-year result of this study revealed the absence of serious failures like root fractures. The observed failures were the fractured restorations observed clinically and the marginal gaps and post de-cementations seen radiographically.
The follow-up of the same number of teeth was taken, and the data were obtained for the next 7 years.
At the end of 10.3 years, 93 teeth remained.
The statistical analysis of the study reveals that the molars survived more as compared to premolars and anterior teeth. This can be correlated to the size and strength of a tooth. The position of teeth in arch and the gender of patients play a vital role in the survival of restored teeth. As the study has been carried out on random population, the habit of eating betel nut and similar hard food cannot be ruled out. The survived teeth were observed with restorations such as resin composite, silver amalgam, and GIC. More number of teeth restored with resin composite survived, followed by silver amalgam and GIC.
The limitation of this study is the nonrandom allocation of treatments to the teeth. The treatment was decided by the clinician and patient based on the specific clinical case. Another limitation was the fact that the number of teeth in each group of the study variables was not well distributed and the observation periods were not equal. In this study, data were not collected on the quality of endodontic treatment itself based on radiographic information, and it will be a subject of a further study. The advantage of the present study is that the status and survival of the ETTs with various restorations reflect the situation in routine practice and provide information about the future of certain restorative materials. The result of the present study shows that restoration on ETTs showed favorable survival on tooth and restoration level.
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Conflicts of interest
There are no conflicts of interest.
[Table 1], [Table 2], [Table 3], [Table 4]