Clinical Outcomes of Endodontic Treatments and Restorations with and without Posts Up to 18 Years

Denise Irene Karin Pontoriero; Simone Grandini; Gianrico Spagnuolo; Nicola Discepoli; Stefano Benedicenti; Valerio Maccagnola; Alberto Mosca; Edoardo Ferrari Cagidiaco; Marco Ferrari

doi:10.3390/jcm10050908

Clinical Outcomes of Endodontic Treatments and Restorations with and without Posts Up to 18 Years

J Clin Med. 2021 Feb 25;10(5):908. doi: 10.3390/jcm10050908.

Authors

Denise Irene Karin Pontoriero¹, Simone Grandini², Gianrico Spagnuolo³, Nicola Discepoli⁴, Stefano Benedicenti⁵, Valerio Maccagnola⁶, Alberto Mosca⁷, Edoardo Ferrari Cagidiaco¹, Marco Ferrari¹

Affiliations

¹ Department of Prosthodontics and Dental Materials, University of Siena, 53100 Siena, Italy.
² Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Siena, 53100 Siena, Italy.
³ Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", 80131 Naples, Italy.
⁴ Department of Periodontology, School of Dental Medicine, University of Siena, 53100 Siena, Italy.
⁵ Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Genoa, 16121 Genoa, Italy.
⁶ Department of Orthodontics, University of Padua, 35122 Padua, Italy.
⁷ Private Practitioner, 25025 Brescia, Italy.

Abstract

Background: The aim of this study was to collect long-term restorative and endodontic outcomes of endodontically treated teeth (ETT).

Methods: 298 teeth were included in the study and were recalled up to 18 years with a media of 10.2 years. At baseline, 198 sample teeth (66.44%) showed symptoms and 164 (55%) had periapical radiolucency. The most frequently used obturation techniques were warm gutta-percha in 80% of cases, and by carrier in 20%. A total of 192 ETT were restored by direct resin composite restorations, and 106 posts were luted. Moreover, 75 (25.16%) direct restorations remained as final restorations, 137 single crowns (45.97%), 42 (14.09%) partial adhesive crowns, and 42 (14.09%) abutments of fixed bridges were the final treatments. Descriptive and inferential statistics were performed (α = 0.05). A Cox regression model was made.

Results: results showed success for 92.6% of ETT up to 18 years, 2.68% (8 ETT) showed irreversible failures, and 14 (4.69%) reversible complications. Four ETT (1.34%) failed because of root fracture and the other four (1.34%) because of endodontic complications. Eight ETT (2.69%) showed non-irreversible periodontal complications and the other six (2.01%) prosthodontic complications. Accordingly, with Kaplan-Meier analysis, the survival rate after 18 years was 97.3% (Interval of Confidence (IC) 95.1-98.3). The presence of a short or long (at least 1 mm related to radiographic apex) quality endodontic filling displayed a statistically significant higher risk of complication (hazard ratio (HR) = 17.00 (IC 5.68-56.84). Furthermore, a clinically detectable not precise coronal margins predicts the presence of any clinical complication with a hazard ratio almost seven times higher than endodontically treated teeth with a proper margin (HR = 6.89 (IC 2.03-23.38), while the presence of lucency at the baseline did not affect the risk of complication (HR = 0.575 (IC 0.205-1.61). The presence of post, tooth position in the arch, and the type of it did not show a high-risk rate (HR = 1.85, 1.98, and 2.24, respectively).

Conclusions: a correct filling (at the apex) of root canals combined with proper coronal margins allow obtaining a long-term high success rate in teeth with a periapical lesion at the baseline. The use of a post or not, when its placement is related to the residual amount of the crown, does not change the final outcome of the ETT.

Keywords: build-up; clinical trial; endodontic outcomes; endodontic retreatments; posts.