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08 January 2019

Direct or indirect restorations for endodontically treated teeth?

Lorenzo Breschi


Endodontically treated teeth are more susceptible to biomechanical failure compared to vital teeth, mostly due to the amount of internal tooth structure that is removed during endodontic treatment and the loss of coronal hard tissue. The best way to restore endodontically treated teeth has been extensively discussed but is still controversial concerning the best type of final restoration. A systematic review published on the 2018 Journal of Adhesive Dentistry in March, compared the treatment outcomes of direct and indirect permanent restorations, analysing the survival of tooth-restoration complex and the restorative and endodontic success, aiming to provide clinical suggestions.

The authors reviewed, after an electronic search of published English literature in different databases, 3497 records, of which only 9 met the inclusion criteria.

Traditionally, most clinicians prefer to use posts followed by crown restorations for endodontically treated teeth, however, full-coverage crowns may not be necessary. According to some studies in vital teeth, after an extensive damage by caries or endodontic treatment, crowns are still crucial to provide enough coronal protection in endodontically treated teeth. Direct composite restorations are mainly indicated for teeth with minimal or moderate tooth structure loss. However, the decision on whether to place a crown or a partial-coverage restoration should also depend on functional requirements and the amount of remaining tooth structure. 

Based on current evidence, there is a weak recommendation for direct restorations to restore endodontically treated teeth, especially for teeth with extensive coronal damage.
Indirect restorations consisting mostly of
 crowns have a higher short-term (5-year) and medium-term (10-year) survival than direct restorations. Indirect restorations also showed better aesthetic, functional, and biological properties, but no difference in short-term (≤ 5 years) restorative success or endodontic success.

For additional informations:
Direct and Indirect Restorations for Endodontically Treated Teeth: A Systematic Review and Meta-analysis 

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