DO ENDODONTICALLY-TREATED TEETH REALLY BENEFIT FROM CROWN PLACEMENT?
Traditionally, it has been accepted that the best treatment for a posterior, endodontically-treated tooth is some form of coronal coverage. This may take the form of a gold, ceramic, resin composite, or amalgam restoration that covers the occlusal aspect of the tooth to prevent it from fracture. The purpose of this retrospective study was to evaluate the hypothesis that crown placement improves the long-term survivability of endodontically-treated teeth. The researchers used a dental school database to identify 280 patients (400 teeth) that had received endodontic during a two-year period. Patient records, radiographs, and a computer database were used to select from this number those who met the inclusion criteria of the study. Kaplan-Meier survival estimates were then generated for those 203 teeth. Results indicated that endodontically- treated teeth that had not received a crown were lost at a rate six times greater than those that had. The authors concluded there was a strong association between placement of a crown and survival of an endodontically-treated teeth.
Quite a number of previously published articles and scientific papers have voiced the opinion that endodontically-treated posterior teeth (as well as anterior teeth with loss of significant coronal tooth structure) should receive crowns to protect them from fracture and extend their longevity. At least one study has shown that crowned endodontically-treated teeth survive longer than those that were not crowned. As the authors of the current study indicated, crowns are not the only viable option to protect teeth following obturation. Cuspal coverage may also be provided by complex amalgams and by gold, ceramic, and resin composite onlays. Unfortunately, although one would expect that these treatments would function for this purpose at least as well as full coronal coverage, no reports exist in the literature to support this contention. Regardless of the specific treatment employed, the evidence does seem to indicate that obturated teeth benefit from restorative coverage of their fracture-prone occlusal surfaces.
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