Does quality of the final restoration or root canal filling have greatest impact on final outcome?

iStock_000013123590XSmall root canal x-ray

This review looked whether the quality of the final restoration or the quality of the root canal filling had the greatest impact on the outcome of the root canal filling.

Medline, Embase, the Cochrane Library, the Wiley online database, four journals; (Journal of Endodontics, International Endodontic Journal, Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology, and Endodontics and Dental Traumatology) and the references of all relevant articles were searched. There were no language restrictions. Articles that evaluated the effect of the quality of root filling and coronal restoration or both on the success of root canal treatment were selected.

Nine articles were identified and were reviewed by 3 investigators. Data were collected based on predetermined criteria. Percentages of teeth without apical periodontitis were recorded for each category: adequate root canal treatment (AE), inadequate root canal treatment (IE), adequate restoration (AR), and inadequate restoration (IR). Data were analyzed using meta-analysis for odds ratios (ORs).

They found:

  • AR/AE versus AR/IE (OR = 2.734;  95%CI, 2.61–2.88; P < .001)
  • AR/AE versus IR/AE (OR =2.808;  95% CI, 2.64-2.97; P < .001)

They concluded:

On the basis of the current best available evidence, the odds for healing of apical periodontitis increase with both adequate root canal treatment and adequate restorative treatment. Although poorer clinical outcomes may be expected with adequate root filling–inadequate coronal restoration and inadequate root filling–adequate coronal restoration, there is no significant difference in the odds of healing between these two  combinations.

Gillen BM, Looney SW, Gu LS, Loushine BA, Weller RN, Loushine RJ, Pashley DH, Tay FR. 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. 2011 Jul;37(7):895-902. Epub 2

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Derek Richards

Derek Richards
Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. In 2013 the Centre for Evidence-based Dentistry moved to the Dental Health Services Research Unit in Dundee. Derek has been involved with teaching EBD and a wide range of evidence-based initiatives both nationally and internationally since 1994.

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