12 December 2023

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Prosthetic preparation and cementation: how does the pulp react?

Simona Chirico

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A comprehensive pulpal health assessment should be completed prior to the placement of new restorations, as several studies have shown that vital teeth have a 9% chance of becoming necrotic after preparation to accommodate a crown and between 5% and 16% of incurring a pulp pathology within 10 years of its cementation. This is mainly caused by the different temperature degrees that can be reached without adequate refrigeration during the preparation phase (it can increase by approximately 10° C) and during the cementation temperatures can reach up to approximately 52°C.

Materials and methods

In a study published in the Journal of Endodontics, the authors evaluated the risk factors and onset of pulp disease in patients who received a crown compared to those who received direct fillings or inlays as restorations. The authors conducted a retrospective analysis of the clinical records of 2177 cases of large restorations performed on vital teeth. Based on the type of restoration, patients were classified into various groups for statistical analysis.

After restoration placement, cases requiring endodontic intervention or extraction were classified as “having pulp disease.”

Results

8.77% (n = 191) of patients developed pulp disease. Pulp disease was slightly more common in the extensive reconstruction but no crown group than in the full coverage group (9.05% vs 7.54%, respectively). For patients who received large fillings, there was no statistically significant difference between the filling materials used (amalgam vs composite: odds ratio 51.32 [95% confidence interval, 0.94-1.85], P >.05) or based on the number of surfaces affected (3 vs 4: odds ratio 0.78 [95% confidence interval, 0.54-1.12], P >.0.05). The association between the type of restoration and the treatment of pulp disease performed was statistically significant (P < .001). The full coverage group more frequently underwent endodontic treatment than extraction (5.78% vs 3.37%, respectively). Only 1.76% (n = 7) of teeth in the full coverage group were extracted compared to 5.68% (n = 101) in the no-crown group (extractions likely due to fractures).

Conclusions

9% of patients who receive large restorations will develop pulp disease. The risk of pulp disease tends to be higher in older patients who receive large (4-surface) amalgam restorations.