EPA Consensus Project Paper: The Relationship Between Prosthodontic Rehabilitations and Temporomandibular Disorders.

AIM: The aim of this systematic review is to evaluate the relationship between prosthodontic treatment and temporomandibular disorders (TMD). MATERIALS AND METHODS: Two clinical questions have been raised. Can prosthodontic treatment be used as a strategy to manage temporomandibular disorders? Is there any causal relationship between prosthodontic rehabilitation and the onset of TMD? A systematic search was performed in four medical databases to identify Clinical Trials (CT) and Randomized Clinical Trials (RCT) that could answer the two clinical questions. RESULTS: Any articles fulfilling the inclusion criteria were found. Therefore, the best available evidence on TMD management and aetiology is discussed in a scoping review with focus on the relationship with prosthodontic treatment. CONCLUSIONS: Based on current scientific evidence, prosthetic rehabilitation cannot be proposed as a treatment option for TMD patients, based on the effectiveness of other more conservative options as well as the absence of association between features of dental occlusion and TMD. Thanks to the high neuro plastic adaptation skills of the stomatognathic system, prosthodontic rehabilitation cannot be identified as a direct cause of TMD, but clinicians should pay caution when performing relevant occlusal modifications.

Posterior partial crowns out of lithium disilicate (LS2) with or without posts: A randomized controlled prospective clinical trial with a 3-year follow up.

OBJECTIVES: The objective of this randomized controlled trial was to assess the influence of use of posts as well as the type of posterior tooth (premolars vs molars) for the treatment with lithium disilicate (LS2) partial crowns. MATERIALS AND METHODS: A total of 60 patients were treated with posterior LS2 partial crowns. Two groups (n = 60) were made based on the type of restored tooth: Group 1, premolars and Group 2, molars. The samples of each group were divided into 2 subgroups (n = 30): Subgroup A restored with fiber posts and Subgroup B without them. Clinical and intraoral radiographic examinations were assessed during each recall (6 months and, 1, 2, and 3 years). Kaplan-Meier log-rank test and Cox regression analysis (Pp < 0.05) were applied. RESULTS: Three subgroups showed 100% of survival while group 2 A exhibited the lowest performance (93.3%). The Cox regression analysis showed that the presence of the post was not a significant factor for survival time (Hazard Ratio HR = 0388; CI95% Confidence Interval for H R = 0,1- to 1,5; pp = 017). Tooth type had an influence on survival time that was at the limit of statistical significance (Hazard Ratio HR = 0123; CI95% Confidence Interval for HR = 0 0015- to 0997; p = 005). Particularly, failure risk was greater for premolars. 'Post by tooth type' interactions were not statistically significant (p = 0126). CONCLUSIONS: over a 3-year observation period, the clinical performance of endodontically treated teeth restored with lithium disilicate partial crowns was not significantly affected by the use of a fiber post and by the type of tooth (premolars or molars).

Post-Retained Single Crowns versus Fixed Dental Prostheses: A 7-Year Prospective Clinical Study.

Biomechanical integrity of endodontically treated teeth (ETT) is often compromised. Degree of hard tissue loss and type of final prosthetic restoration should be carefully considered when making a treatment plan. The objective of this prospective clinical trial was to assess the influence of the type of prosthetic restoration as well as the degree of hard tissue loss on 7-y clinical performance of ETT restored with fiber posts. Two groups ( n = 60) were defined depending on the type of prosthetic restoration needed: 1) single unit porcelain-fused-to-metal (PFM) crowns (SCs) and 2) 3- to 4-unit PFM fixed dental prostheses (FDPs), with 1 healthy and 1 endodontically treated and fiber post-restored abutment. Within each group, samples were divided into 2 subgroups ( n = 30) according to the amount of residual coronal tissues after abutment buildup and final preparation: A) >50% of coronal residual structure or B) equal to or <50% of coronal residual structure. The clinical outcome was assessed based on clinical and intraoral radiographic examinations at the recalls after 6, 12, 24, 36, 48, and 84 mo. Data were analyzed by Kaplan-Meier log-rank test and Cox regression analysis ( P < 0.05). The overall 7-y survival rate of ETT restored with fiber post and either SCs or FDPs was 69.2%. The highest 84-mo survival rate was recorded in group 1A (90%), whereas teeth in group 2B exhibited the lowest performance (56.7% survival rate). The log-rank test detected statistically significant differences in survival rates among the groups ( P = 0.048). Cox regression analysis revealed that the amount of residual coronal structure ( P = 0.041; hazard ratio [HR], 2.026; 95% confidence interval [CI] for HR, 1.031-3.982) and the interaction between the type of prosthetic restoration and the amount of residual coronal structure ( P = 0.024; HR, 1.372; 95% CI for HR, 1.042-1.806) were statistically significant factors for survival ( ClinicalTrials.gov NCT01532947).