Retrospective evaluation of perforation repairs in 6 private practices.

INTRODUCTION: The purpose of this study was to investigate retrospectively the clinical outcome of 70 perforation repairs performed by 6 endodontic specialists. METHODS: Endodontic specialists performed a total of 70 perforation repairs (69 patients) between 1998 and 2010 using a nonsurgical or combined nonsurgical/surgical approach. Treatments were performed with the aid of a dental operating microscope. Recalls of at least 6 months were obtained on 49 patients (50 teeth). Two calibrated observers evaluated the radiographic results on recalls up to 116 months, with a mean of 37 months. Pre-, intra-, and postoperative data were evaluated with respect to treatment outcomes and possible prognostic factors. RESULTS: Successful results were obtained in 45 of 50 perforation repairs, a success rate of 90%. Significant prognostic factors included the location of the perforation, sex of the patient, and restorative status of the tooth before perforation repair. The overall success rate of this study was higher than reported in other studies. CONCLUSIONS: Perforation repairs can be performed with a high level of success at least in the short- to medium-term.

Restoring the fractured root-canal-treated maxillary lateral incisor: in search of an evidence-based approach.

OBJECTIVE: To demonstrate the existing difficulties and variability in the application of evidence-based dentistry by comparing the recommendations made by 4 dental experts for the treatment of a fractured tooth. METHOD AND MATERIALS: A case presentation was given to 4 specialists, who were asked to independently develop and explain their personal favorite treatment strategy, based on the best available external evidence and their clinical expertise. The entire case was then reviewed by an expert in evidence-based medicine and discussed with the first author. RESULTS: Each of the 4 experts relied on different articles in justifying their clinical decisions. The minimal overlap in the literature they cited largely explains the different treatment suggestions: While the endodontist preferred a metal post-and-core and a porcelain-fused-to-metal (PFM) crown, both the operative dentist and the prosthodontist opted for a glass-fiber post/fiber-reinforced resin composite post. The perio-prosthodontist recommended a PFM crown with either a direct or indirect post and core. The citation analysis revealed that little high-quality information is available about what would be the best therapy for horizontal fractures of root-canal-treated anterior teeth. CONCLUSIONS: This article illustrates that, although it is now common practice in dentistry to base clinical decision making on external evidence from the literature, search strategies and the resulting clinical recommendations still vary greatly.

Survival rate and fracture strength of incisors restored with different post and core systems and endodontically treated incisors without coronoradicular reinforcement.

This in vitro study evaluated the survival rate and fracture resistance of maxillary central incisors restored with different post and core systems. The post and core systems investigated were a prefabricated high precious metal post with cast core (group A), zirconia post with a prefabricated bonded ceramic core (group B), and a resin-ceramic interpenetrating phase composite post (experimental) with a prefabricated bonded ceramic core (group C). The all-ceramic copings were cemented using Panavia 21 TC. In the group without coronoradicular reinforcement, the access cavity was closed with a light-cured composite in combination with a dentine-bonding agent (group D). Each specimen was intermittently loaded and thermocycled before final stress tests in a Zwick machine. The survival rates after 1,200,000 cycles in the artificial mouth were 90% (group A), 80% (group B), 60% (group C), and 100% (group D). Statistically significant differences were found between all groups with the exception of A and B, when failure during cyclic loading was included (Kruskal-Wallis multiple comparisons test). Samples restored with a cast post and core demonstrated more vertical root fractures. It was concluded that the preservation of both internal and external tooth structure is of utmost importance when restoring endodontically treated teeth.