A new classification system for the restoration of root filled teeth.

The aim of this report is to (i) review the current literature on the status of root filled teeth, (ii) analyse the most important factors in decision-making, (iii) discuss the current restorative concepts, and (iv) classify both the evidence and clinical practice in a way that seeks to be clear, understandable and helpful for clinicians. Restoration of root filled teeth represents a challenge for the clinician and remains a controversial subject. The guidelines describe a new classification that is drawn from evidence presented in the literature and also from clinical expertise-based reviews. It describes five categories of teeth.

Classification and treatment of the anterior maxillary dentition affected by dental erosion: the ACE classification.

Erosive tooth wear is a serious problem with very costly consequences. Intercepting patients at the initial stages of the disease is critical to avoid significant irreversible damages to their dentition and to benefit from still favorable conditions when it comes to clinical performance of the restorative measures proposed. In this article, a new classification is proposed to quantify the severity of the dental destruction and to guide clinicians and patients in the therapeutic decision-making process. The classification is based on several parameters relevant for both the selection of treatment and the assessment of the prognosis, such as dentin exposure in the palatal tooth contact areas, alterations at the level of the incisal edges, and ultimately, loss of pulp vitality.

Restoring endodontically treated teeth with posts and cores--a review.

OBJECTIVE: The prognosis of endodontically treated teeth depends not only on the success of the endodontic treatment, but also on the type of reconstruction. These considerations include the decision of whether or not to use posts. METHODS AND MATERIALS: A literature review has been performed to create guidelines for the reconstruction of endodontically treated teeth by posts and cores. RESULTS: Posts should only be used for the retention of core material in cases where little dental substance remains, ie, one or no cavity walls. A ferrule of 2 mm has to be provided, by surgical means if necessary. The post length is limited by the necessary apical seal of 4 to 6 mm. In cases of short posts, adhesive fixation is preferred. Ceramic posts show a higher risk of fracture than fiber posts which are retrievable. Composites have proven to be a good core material. Posts should be inserted if endodontically treated teeth are used as abutments for removable partial dentures. CONCLUSION: These guidelines are based mainly on in vitro studies with an evidence level of II a or II b, as there is a lack of randomized clinical studies available. The remaining tooth structure is an important factor influencing the indication of posts and cores, yet it is not sufficiently recognized in clinical studies and in vitro. Therefore, further prospective clinical studies are needed.

Developing a tooth restorability index.

UNLABELLED: It is generally agreed that the inherent strength of a tooth is dependent on the remaining dentine. It therefore seems logical that preservation of coronal dentine is important to the survival of intra- and extra-coronal restorations. The clinical assessment of the amount of dentine needed for functional requirements and the strategic value of remaining tooth structure is currently based on clinical opinion. This paper discusses what recommendations have been published and proposes an index that may be useful in assessing the restorability of a tooth. CLINICAL RELEVANCE: An index used to assess the amount and contribution of remaining coronal dentine to resistance and retention form could be of value in treatment planning.

Effect of Post Placement on the Restoration of Endodontically Treated Teeth: A Systematic Review.

PURPOSE: The aim of this study was to assess the effect of root canal post placement on the restoration of endodontically treated teeth. MATERIALS AND METHODS: PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and two Chinese databases (China National Knowledge Internet and the Wan-fang database) were searched to identify randomized or quasi-randomized clinical trials related to post-and-core systems for the restoration of endodontically treated teeth. Studies published prior to August 2013, performed on humans, and written in English or Chinese were considered for inclusion. Two of the authors independently extracted data and assessed the quality of the selected studies. RESULTS: Three studies involving 317 participants were included in the review. Meta-analysis revealed that the risk of overall failure was greater with nonpost (104/271) than with post (78/377) restorations, irrespective of the number of remaining coronal walls (risk ratio [RR] = 0.41; 95% confidence interval [CI], 0.23 to 0.74). The risk of catastrophic failure was greater with nonpost (24/227) than with post (4/329) restorations, irrespective of the remaining coronal walls in restored teeth (RR = 0.11; 95% CI, 0.04 to 0.31). When three or four coronal walls remained, no catastrophic failure occurred in either the post group or the nonpost group. The difference in noncatastrophic failure between the two groups had no statistical significance no matter how many coronal walls remained (P > .05). CONCLUSIONS: Post placement appears to have a significant influence on reducing the catastrophic failure rate of endodontically treated teeth. When three or four coronal walls remain, post placement seems to have no influence on the restoration of endodontically treated teeth.

The Impact of the Crown-Root Ratio on Survival of Abutment Teeth for Dentures.

Crown-root ratio (CRR) is commonly recorded when planning prosthodontic procedures. However, there is a lack of longitudinal clinical data evaluating the association between CRR and tooth survival. The aim of this longitudinal practice-based study was to assess the impact of CRR on the survival of abutment teeth for removable partial dentures (RPDs). Data were collected from 147 patients provided with RPDs at a dental hospital in Japan. In total, 236 clasp-retained RPDs and 856 abutment teeth were analyzed. Survival of abutment teeth was assessed using Kaplan-Meier methods and Cox's proportional hazard (PH) regression. The Cox PH regression was used to assess the prognostic significance of initial CRR value with adjustments for clinically relevant factors, including age, sex, frequency of periodontal maintenance programs, occlusal support area, type of abutment tooth, status of endodontic treatment, and probing pocket depth. Abutment teeth were divided into 1 of 5 risk groups according to CRR: A (≤0.75), B (0.76-1.00), C (1.01-1.25), D (1.26-1.50) and E (≥1.51). The 7-year survival rate was 89.1% for group A, 85.9% for group B, 86.5% for group C, 76.9% for group D, and 46.7% for group E. The survival curves of groups A, B, and C were illustrated to be quite similar and favorable. The multivariable analysis treating CRR as a continuous variable allowed estimation of the hazard ratio at any specific CRR value. When CRR = 0.80 was set as a reference, the estimated hazard ratio was 0.58 for CRR = 0.50 (95% confidence interval [CI], 0.36-0.91), 1.13 for CRR = 1.00 (95% CI, 0.93-1.37), 1.35 for CRR = 1.25 (95% CI, 1.02-1.80), 1.53 for CRR = 1.50 (95% CI, 1.15-2.08), or 1.95 for CRR = 2.00 (95% CI, 1.44-2.65). These practice-based longitudinal data provide information to improve the evidence-based prognosis of teeth in providing prosthodontic procedures.

Restoration of endodontically treated teeth: review, classification, and post design.

Restoration of endodontically treated teeth requires knowledge of material science, defect analysis, force analysis, and mechanical engineering principles of preparation and design. This article reviews the basic principles of the restorative concepts and presents an approach to restoration of teeth, based on a new classification. The component strength, component interface strength, and analysis of force intensity, frequency, and direction are discussed; the restoration design is reviewed, including post selection and passive engagement posts. A new post of a "segmentally parallel" design is introduced.

Case series: tooth retention 5 years after irretrievable separation of LightSpeedLSX instruments.

INTRODUCTION: Of 3,216 root canals treated endodontically at the Creighton University School of Dentistry from September 1, 2005, to August 31, 2007, with LightSpeedLSX instruments (LightSpeed Technology, Inc, San Antonio, TX), there were 12 cases of irretrievable instrument separation. More than 5 years after the separations, an attempt was made to contact the patients and assess for healing and tooth retention. METHODS: Third- and fourth-year dental students performed root canal procedures according to protocol from September 1, 2005, to August 31, 2007. A database was collected during the 24-month period recording cases with irretrievable LightspeedLSX separation. Efforts were made from July 2011 to December 2011 to contact the 12 patients for endodontic follow-up. Clinical and radiographic evaluations of healing were performed. RESULTS: Of the 12 patients with irretrievable separations, 8 patients were contacted and 5 returned to Creighton University School of Dentistry for follow-up. All 8 contacted patients confirmed the presence of the root canal-treated tooth in question, and the teeth of the 5 evaluated patients were determined to be asymptomatic and functional. Radiographic analysis resulted in 2 teeth being classified as complete healing, 2 as uncertain healing, and 1 as no healing. CONCLUSIONS: The 100% tooth retention rate and the lack of symptoms in 8 contacted (5 evaluated) patients 5 years after treatment suggests that long-term retention and functionality can occur after irretrievable instrument separation. Although tooth retention and functionality are desirable outcomes, radiographic findings may be indicative of inadequate periapical healing, thus requiring the clinician to evaluate whether additional treatment is necessary.

A novel diagnostic and prognostic classification for the clinical management of endodontically treated single anterior teeth.

The restoration of endodontically treated anterior teeth (ETAT) may pose a significant clinical challenge given the wide variety of therapeutic options available. Accurate analysis of the remaining tooth structure is critical in the diagnostic process, leading to selection of the proper treatment option. A novel, simple, and precise classification that allows the evaluation of ETAT is presented. Important factors related to the crown or abutment such as height, wall thickness, and circumferential integrity and root-related factors such as diameter of the canal, depth of the preparation, and canal shape are discussed. This classification may serve to establish a comprehensive diagnosis and assign prognosis to ETAT, which may be helpful for interclinician communication and standardized comparisons in clinical research.

Tobacco smoking and radiographic periapical status: a retrospective case-control study.

INTRODUCTION: The aim of this study was to investigate radiographically the relationship of tobacco smoking and periapical status by using a retrospective case-control study design. METHODS: The records of 79 controls and 79 age- and sex-matched cases were examined. Case was defined as a patient who has at least 1 radiographically detectable periapical lesion in a tooth. Control was defined as a patient who has no radiographically detectable periapical lesion in any teeth. Periapical status was assessed by using panoramic radiographs and the periapical index score. The history of smoking and diabetes, the number of teeth and root-filled teeth, and the quality of root fillings were recorded. Statistical analyses were conducted by using the Cohen kappa test, χ(2) test, Student's t test, and logistic regression analysis. RESULTS: Among the case subjects, 75% had antecedents of smoking, whereas in the control group only 13% had been smokers (odds ratio, 20.4; 95% confidence interval, 8.8-46.9; P = .0000). After multivariate logistic regression analysis adjusting for covariates (age, gender, number of teeth, root-filled teeth, root-filled teeth with a root filling technically unsatisfactory, and diabetes), a strong association was observed between the presence of at least 1 radiographically detectable periapical lesion and antecedents of smoking (odds ratio, 32.4; 95% confidence interval, 11.7-89.8; P = .0000). CONCLUSIONS: After adjusting for age, gender, number of teeth, endodontic status, quality of root filling, and diabetic status, tobacco smoking is strongly associated with the presence of radiographically diagnosed periapical lesions.

Assessment of endodontically treated teeth adjacent to proposed implant sites.

Many partially dentate dentitions are now being restored using dental implants; but assessment of endodontically treated teeth adjacent to the proposed implant sites has seldom been reported. Assessment criteria are given for sound- and endodontically compromised teeth to ensure adequate preimplant preventive and restorative treatment and to minimize the chances of failure of dental implants adjacent to these teeth. Cases are used to illustrate pitfalls in the treatment planning process.

Esthetic restoration of endodontically treated teeth: factors that affect prognosis.

Restoration of endodontically treated teeth involves a complex system of components and component interfaces designed to resist force. Dental materials, forces on teeth, clinical circumstances, and restorative design determine restoration success. A new classification evaluates number of canals, amount of remaining tooth surface, chamber space, canal quality, and canal orientation.

Procesos endoperiodontales. II. Lesiones endoperiodontales / No disponible

Analiza una clasificación clínica de las lesiones endoperiodontales, la historia clínica para alcanzar un diagnóstico así como las opiniones terapéuticas de las mismas (AU)

Analysis of clinical classification for the endoperiodontal lesions, of the clinical history required to achieve a diagnosis and of their therapeutic options (AU)