Skip to main content
SpringerLink
Log in

Radiographic periapical healing associated with root-treated teeth accessed through existing crowns: a historical controlled cohort study

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

The aim of this study was to determine the periapical healing rate and complications arising from non-surgical root canal treatment (NSRCT) conducted through the existing and retained restoration, compared to that conducted after removal of restoration (direct or indirect) with subsequent placement of a new crown.

Materials and methods

Two-hundred-and-forty-five teeth met the inclusion criteria and were followed up for 2 years. One-hundred-and-six teeth had NSRCT completed through existing cast restorations, and 57 and 82 had the existing crowns and direct restorations removed (respectively) and received a new crown after NSRCT. Periapical healing was assessed radiographically using strict (complete healing) and loose (complete and incomplete healing) criteria. Multivariable logistic regression models were used to investigate the effect of prior restoration removal on periapical healing following NSRCT, adjusting for potential confounding (p < 0.05).

Results

There was no significant (p > 0.05) difference in the periapical healing rates amongst teeth accessed through existing crowns (72%, 90%) versus those where crowns (79%, 93%) or direct restorations (77%, 90%) were removed for NSRCT. The findings were adjusted for the significant influencing factor: size of pre-operative radiolucency (p < 0.05). Of the 109 teeth that were initially accessed through existing crowns, 9 (8%) displayed porcelain fracture or crown de-cementation.

Conclusion

Performing root canal treatment through an existing full coverage restoration did not compromise periapical healing and was associated with a low incidence of associated complications.

Clinical relevance

Crown removal before NSRCT is not mandatory for periapical healing but requires a judicious pre-assessment of current and future marginal and restorative integrity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. (2006) Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology. Int Endod J 39(12):921–930. https://doi.org/10.1111/j.1365-2591.2006.01180.x

  2. Ng YL, Mann V, Gulabivala K (2011) A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: part 1: periapical health. Int Endod J 44(7):583–609. https://doi.org/10.1111/j.1365-2591.2011.01872.x

    Article  PubMed  Google Scholar 

  3. Gillen BM, Looney SW, Gu LS, Loushine BA, Weller RN, Loushine RJ, Pashley DH, Tay FR (2011) Impact of the quality of coronal restoration versus the quality of root canal fillings on success of root canal treatment: a systematic review and meta-analysis. J Endod 37(7):895–902. https://doi.org/10.1016/j.joen.2011.04.002

    Article  PubMed  Google Scholar 

  4. Ng YL, Mann V, Gulabivala K (2010) Tooth survival following non-surgical root canal treatment: a systematic review of the literature. Int Endod J 43(3):171–189. https://doi.org/10.1111/j.1365-2591.2009.01671.x

    Article  PubMed  Google Scholar 

  5. Burke FJ, Lucarotti PS (2009) Ten-year outcome of crowns placed within the General Dental Services in England and Wales. J Dent 37(1):12–24. https://doi.org/10.1016/j.jdent.2008.03.017

    Article  PubMed  Google Scholar 

  6. Christensen GJ (2013) Too many crowns? J Am Dent Assoc 144(10):1174–1176. https://doi.org/10.14219/jada.archive.2013.0037

    Article  PubMed  Google Scholar 

  7. Suzuki S, Cox CF, White KC (1994) Pulpal response after complete crown preparation, dentinal sealing, and provisional restoration. Quintessence Int 25(7):477–485

    PubMed  Google Scholar 

  8. Goodacre CJ, Bernal G, Rungcharassaeng K, Kan JY (2003) Clinical complications in fixed prosthodontics. J Prosthet Dent 90(1):31–41. https://doi.org/10.1016/s0022-3913(03)00214-2

    Article  PubMed  Google Scholar 

  9. Pjetursson BE, Sailer I, Makarov NA, Zwahlen M, Thoma DS (2015) All-ceramic or metal-ceramic tooth-supported fixed dental prostheses (FDPs)? A systematic review of the survival and complication rates. Part II: Multiple-unit FDPs. Dent Mater 31(6):624–639. https://doi.org/10.1016/j.dental.2015.02.013

    Article  PubMed  Google Scholar 

  10. Sailer I, Makarov NA, Thoma DS, Zwahlen M, Pjetursson BE (2015) All-ceramic or metal-ceramic tooth-supported fixed dental prostheses (FDPs)? A systematic review of the survival and complication rates. Part I: Single crowns (SCs). Dent Mater 31(6):603–623. https://doi.org/10.1016/j.dental.2015.02.011

    Article  PubMed  Google Scholar 

  11. Bergenholtz G, Nyman S (1984) Endodontic complications following periodontal and prosthetic treatment of patients with advanced periodontal disease. J Periodontol 55(2):63–68. https://doi.org/10.1902/jop.1984.55.2.63

    Article  PubMed  Google Scholar 

  12. Kirkevang LL, Horsted-Bindslev P, Orstavik D, Wenzel A (2001) Frequency and distribution of endodontically treated teeth and apical periodontitis in an urban Danish population. Int Endod J 34(3):198–205. https://doi.org/10.1046/j.1365-2591.2001.00370.x

    Article  PubMed  Google Scholar 

  13. Goldman M, Laosonthorn P, White RR (1992) Microleakage--full crowns and the dental pulp. J Endod 18(10):473–475. https://doi.org/10.1016/s0099-2399(06)81345-2

    Article  PubMed  Google Scholar 

  14. Mulvay PG, Abbott PV (1996) The effect of endodontic access cavity preparation and subsequent restorative procedures on molar crown retention. Aust Dent J 41(2):134–139. https://doi.org/10.1111/j.1834-7819.1996.tb05927.x

    Article  PubMed  Google Scholar 

  15. Whitworth JM, Walls AW, Wassell RW (2002) Crowns and extra-coronal restorations: endodontic considerations: the pulp, the root-treated tooth and the crown. Br Dent J 192(6):315–320, 323-317. https://doi.org/10.1038/sj.bdj.4801365

    Article  PubMed  Google Scholar 

  16. Abbott PV (2004) Assessing restored teeth with pulp and periapical diseases for the presence of cracks, caries and marginal breakdown. Aust Dent J 49(1):33–39; quiz 45. https://doi.org/10.1111/j.1834-7819.2004.tb00047.x

    Article  PubMed  Google Scholar 

  17. Trautmann G, Gutmann JL, Nunn ME, Witherspoon DE, Shulman JD (2000) Restoring teeth that are endodontically treated through existing crowns. Part I: Survey of pulpal status on access. Quintessence Int 31(10):713–718

    PubMed  Google Scholar 

  18. Bystrom A, Happonen RP, Sjogren U, Sundqvist G (1987) Healing of periapical lesions of pulpless teeth after endodontic treatment with controlled asepsis. Endod Dent Traumatol 3(2):58–63. https://doi.org/10.1111/j.1600-9657.1987.tb00543.x

    Article  PubMed  Google Scholar 

  19. Ruiz XF, Duran-Sindreu F, Shemesh H, García Font M, Vallés M, Roig Cayón M, Olivieri JG (2017) Development of periapical lesions in endodontically treated teeth with and without periodontal involvement: a retrospective cohort study. J Endod 43(8):1246–1249. https://doi.org/10.1016/j.joen.2017.03.037

    Article  PubMed  Google Scholar 

  20. Sim IG, Lim TS, Krishnaswamy G, Chen NN (2016) Decision making for retention of endodontically treated posterior cracked teeth: a 5-year follow-up study. J Endod 42(2):225–229. https://doi.org/10.1016/j.joen.2015.11.011

    Article  PubMed  Google Scholar 

  21. Gorni FG, Gagliani MM (2004) The outcome of endodontic retreatment: a 2-yr follow-up. J Endod 30(1):1–4. https://doi.org/10.1097/00004770-200401000-00001

    Article  PubMed  Google Scholar 

  22. Ng YL, Mann V, Rahbaran S, Lewsey J, Gulabivala K (2008) Outcome of primary root canal treatment: systematic review of the literature--Part 2. Influence of clinical factors. Int Endod J 41(1):6–31. https://doi.org/10.1111/j.1365-2591.2007.01323.x

    Article  PubMed  Google Scholar 

  23. Petrie A, Watson P (1999) Statistics for veterinary and animal science, 1st edn. Blackwell Science, Oxford

    Google Scholar 

  24. He J, White RK, White CA, Schweitzer JL, Woodmansey KF (2017) Clinical and patient-centered outcomes of nonsurgical root canal retreatment in first molars using contemporary techniques. J Endod 43(2):231–237. https://doi.org/10.1016/j.joen.2016.10.029

    Article  PubMed  Google Scholar 

  25. Hoskinson SE, Ng YL, Hoskinson AE, Moles DR, Gulabivala K (2002) A retrospective comparison of outcome of root canal treatment using two different protocols. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 93(6):705–715. https://doi.org/10.1067/moe.2001.122822

    Article  PubMed  Google Scholar 

  26. de Chevigny C, Dao TT, Basrani BR, Marquis V, Farzaneh M, Abitbol S, Friedman S (2008) Treatment outcome in endodontics: the Toronto study--phase 4: initial treatment. J Endod 34(3):258–263. https://doi.org/10.1016/j.joen.2007.10.017

    Article  PubMed  Google Scholar 

  27. Chailertvanitkul P, Saunders WP, Saunders EM, MacKenzie D (1997) An evaluation of microbial coronal leakage in the restored pulp chamber of root-canal treated multirooted teeth. Int Endod J 30(5):318–322. https://doi.org/10.1046/j.1365-2591.1997.00089.x

    Article  PubMed  Google Scholar 

  28. Ricucci D, Bergenholtz G (2003) Bacterial status in root-filled teeth exposed to the oral environment by loss of restoration and fracture or caries--a histobacteriological study of treated cases. Int Endod J 36(11):787–802. https://doi.org/10.1046/j.1365-2591.2003.00721.x

    Article  PubMed  Google Scholar 

  29. Al-Maqtari AA, Lui JL (2010) Effect of aging on coronal microleakage in access cavities through metal ceramic crowns restored with resin composites. J Prosthodont 19(5):347–356. https://doi.org/10.1111/j.1532-849X.2010.00593.x

    Article  PubMed  Google Scholar 

  30. Ng YL, Mann V, Gulabivala K (2008) Outcome of secondary root canal treatment: a systematic review of the literature. Int Endod J 41(12):1026–1046. https://doi.org/10.1111/j.1365-2591.2008.01484.x

    Article  PubMed  Google Scholar 

  31. Bergenholtz G (2000) Evidence for bacterial causation of adverse pulpal responses in resin-based dental restorations. Crit Rev Oral Biol Med 11(4):467–480. https://doi.org/10.1177/10454411000110040501

    Article  PubMed  Google Scholar 

  32. Whitworth JM, Myers PM, Smith J, Walls AW, McCabe JF (2005) Endodontic complications after plastic restorations in general practice. Int Endod J 38(6):409–416. https://doi.org/10.1111/j.1365-2591.2005.00962.x

    Article  PubMed  Google Scholar 

  33. Browne RM, Tobias RS (1986) Microbial microleakage and pulpal inflammation: a review. Endod Dent Traumatol 2(5):177–183. https://doi.org/10.1111/j.1600-9657.1986.tb00141.x

    Article  PubMed  Google Scholar 

  34. Moraschini V, Fai CK, Alto RM, Dos Santos GO (2015) Amalgam and resin composite longevity of posterior restorations: a systematic review and meta-analysis. J Dent 43(9):1043–1050. https://doi.org/10.1016/j.jdent.2015.06.005

    Article  PubMed  Google Scholar 

  35. Mjör IA (2005) Clinical diagnosis of recurrent caries. J Am Dent Assoc 136(10):1426–1433. https://doi.org/10.14219/jada.archive.2005.0057

    Article  PubMed  Google Scholar 

  36. Nagasiri R, Chitmongkolsuk S (2005) Long-term survival of endodontically treated molars without crown coverage: a retrospective cohort study. J Prosthet Dent 93:164–170. https://doi.org/10.1016/j.prosdent.2004.11.001

    Article  PubMed  Google Scholar 

  37. Gorman CM, Ray NJ, Burke FM (2016) The effect of endodontic access on all-ceramic crowns: a systematic review of in vitro studies. J Dent 53:22–29. https://doi.org/10.1016/j.jdent.2016.08.005

    Article  PubMed  Google Scholar 

  38. Gerogianni P, Lien W, Bompolaki D, Verrett R, Haney S, Mattie P, Johnson R (2019) Fracture resistance of pressed and milled lithium disilicate anterior complete coverage restorations following endodontic access preparation. J Prosthodont 28(2):163–170. https://doi.org/10.1111/jopr.12798

    Article  PubMed  Google Scholar 

  39. Bompolaki D, Kontogiorgos E, Wilson JB, Nagy WW (2015) Fracture resistance of lithium disilicate restorations after endodontic access preparation: an in vitro study. J Prosthet Dent 114(4):580–586. https://doi.org/10.1016/j.prosdent.2015.04.013

    Article  PubMed  Google Scholar 

  40. Wood KC, Berzins DW, Luo Q, Thompson GA, Toth JM, Nagy WW (2006) Resistance to fracture of two all-ceramic crown materials following endodontic access. J Prosthet Dent 95(1):33–41. https://doi.org/10.1016/j.prosdent.2005.11.003

    Article  PubMed  Google Scholar 

  41. Sutherland JK, Teplitsky PE, Moulding MB (1989) Endodontic access of all-ceramic crowns. J Prosthet Dent 61(2):146–149. https://doi.org/10.1016/0022-3913(89)90362-4

    Article  PubMed  Google Scholar 

  42. McMullen AF 3rd, Himel VT, Sarkar NK (1989) An in vitro study of the effect endodontic access preparation has upon the retention of porcelain fused to metal crowns of maxillary central incisors. J Endod 15(4):154–156. https://doi.org/10.1016/s0099-2399(89)80252-3

    Article  PubMed  Google Scholar 

  43. Yu Y, Abbott P (1994) The effect of endodontic access cavity preparation and subsequent procedures on incisor crown retention. Aust Dent J 39:247–251. https://doi.org/10.1111/j.1834-7819.1994.tb04786.x

    Article  PubMed  Google Scholar 

  44. Skupien JA, Opdam N, Winnen R, Bronkhorst E, Kreulen C, Pereira-Cenci T, Huysmans MC (2013) A practice-based study on the survival of restored endodontically treated teeth. J Endod 39(11):1335–1340. https://doi.org/10.1016/j.joen.2013.06.028

    Article  PubMed  Google Scholar 

  45. Wiegand A, Kanzow P (2020) Effect of repairing endodontic access cavities on survival of single crowns and retainer restorations. J Endod 46(3):376–382. https://doi.org/10.1016/j.joen.2019.11.012

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Endodontic Practice, 15 Penn Hill Avenue, Poole, BH15 1LS, UK

    Luis M. Ferrández & John S. Rhodes

  2. Unit of Endodontology, Division of Restorative Dental Science, University College London Eastman Dental Institute, London, UK

    Yuan-Ling Ng, Sarjoo S. Mistry & Kishor Gulabivala

Authors
  1. Luis M. Ferrández
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yuan-Ling Ng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John S. Rhodes
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sarjoo S. Mistry
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kishor Gulabivala
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luis M. Ferrández.

Ethics declarations

Ethical approval

This non-intervention retrospective cohort study did not require research ethics committee review according to the UK Health Research Authority (http://www.hra-decisiontools.org.uk/research/). This study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

This study did not use identifiable details of patients and treatment data used was gathered anonymously.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ferrández, L.M., Ng, YL., Rhodes, J.S. et al. Radiographic periapical healing associated with root-treated teeth accessed through existing crowns: a historical controlled cohort study. Clin Oral Invest 25, 5807–5814 (2021). https://doi.org/10.1007/s00784-021-03885-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-021-03885-w

Keywords

Search

Navigation