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
Brian M. Gillen, DDS,* Stephen W. Looney, PhD,† Li-Sha Gu, DDS, MS, PhD,‡ Bethany A. Loushine, DMD,* Roger N. Weller, DMD, MS,* Robert J. Loushine, DDS,* David H. Pashley, DMD, PhD,§ and Franklin R. Tay, BDSc (Hons), PhD*§
Introduction:
Thorough cleaning and shaping of root canals are essential for periapical healing. Restoration of endodontically treated teeth is also required for them to function and prevent coronal leakage. This study compared the impact of the quality of root canal treatment versus the quality of coronal restoration in treatment outcomes.
Methods:
Literature search was conducted using the search terms ‘‘coronal restoration,’’ ‘‘root canal,’’ ‘‘periapical status,’’ and ‘‘quality.’’ 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 inves- tigators. 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 resto- ration (IR). Data were analyzed using meta-analysis for odds ratios (ORs).
Results:
After adjusting for significant covariates to reduce heterogeneity, the results were combined to obtain pooled estimates of the common OR for the comparison of AR/AE versus AR/IE (OR = 2.734; 95% confidence interval [CI], 2.61–2.88; P < .001) and AR/AE versus IR/AE (OR = 2.808; 95% CI, 2.64␣2.97; P < .001).
Conclusions:
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 2 combinations.
(J Endod 2011;37:895–902)
Key Words
Coronal restoration, meta-analysis, obturation, periapical status, quality, root canal treatment, systematic review
"Despite the limitations of a meta-analysis based predominantly on radiographic interpretation, the unanimous result from the 9 studies that examined root-filled teeth with adequate restorations and root canal treatment produced better treatment outcomes reinforces the fundamental biologic principle of preventing bacteria ingress via the concerted efforts of the endodontist and the restorative dentist in providing the highest quality of care in saving functional teeth."
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