Review Article
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

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Abstract

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 investigators. 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 restoration (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.

Section snippets

Literature Search

A search was undertaken to identify all clinical studies that reported coassociation of the quality of root canal treatment and the quality of coronal restoration with endodontic treatment outcome. The MEDLINE (Ovid) database was searched for retrospective studies published between 1966 and 2010 (last accessed November 2, 2010) using key words “root filling” OR “coronal restoration” OR “quality” OR “periapical status.” A Cochrane Library search was also conducted. A similar search was also

Results

Of the 31 articles examined, 20 studies containing information on some aspects of coronal restorations 31, 45, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71 were excluded for various reasons (Table 1). Two studies were further excluded from the remaining 11 studies, yielding 9 30, 72, 73, 74, 75, 76, 77, 78, 79 for meta-analysis. One study was excluded based on comments by the authors that the quality of root canal treatment was very poor in the region in which the

Discussion

Endodontic treatment outcome has been the subject of investigation for many years with studies examining success rates using different protocols. The lack of standardization of study protocols and endpoints for determining success make comparisons difficult. Despite the presence of a host of factors that contribute to success or failure of root canal treatment, the fundamental biologic principle that determines clinical success remains unchanged. Kakahashi et al (86) showed that apical

Acknowledgments

We thank Peter Shipman for his literature search, Courtney McCracken for her assistance in developing the data collection forms, Kelly Miller and Lifang Zhang for their assistance in constructing the graphs, and Michelle Burnside for her secretarial support.

The authors deny any conflicts of interest related to this study.

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    Drs Gillen and Looney contributed equally to this work.

    Supported by grants R01 DE015306-06 (D.H.P.) and R21 DE019213-02 (F.R.T.) from the National Institute of Dental and Craniofacial Research.

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    Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.