Top

BMC Oral Health

Published in:

Open Access 01-12-2023 | Denture | Research

Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a systematic review and meta-analysis

Authors: Kholod Khalil Al-Manei, Shuruq Alzaidi, Ghadah Almalki, Khaled Al-Manei, Nabeel Almotairy

Published in: BMC Oral Health | Issue 1/2023

Abstract

Background

Restoring vital teeth with indirect restorations may threaten dental pulp integrity. However, the incidence of and influential factors on pulp necrosis and periapical pathosis in such teeth are still unknown. Therefore, this systematic review and meta-analysis aimed to investigate the incidence of and influential factors on pulp necrosis and periapical pathosis of vital teeth following indirect restorations.

Methods

The search was conducted in five databases, using MEDLINE via PubMed, Web of Science, EMBASE, CINAHL, and Cochrane Library. Eligible clinical trials and cohort studies were included. The risk of bias was assessed using Joanna Briggs Institute’s critical appraisal tool and Newcastle–Ottawa Scale. The overall incidences of pulp necrosis and periapical pathosis following indirect restorations were calculated using a random effects model. Subgroup meta-analyses were also performed to determine the potential influencing factors for pulp necrosis and periapical pathosis. The certainty of the evidence was assessed using the GRADE tool.

Results

A total of 5,814 studies were identified, of which 37 were included in the meta-analysis. The overall incidences of pulp necrosis and periapical pathosis following indirect restorations were determined to be 5.02% and 3.63%, respectively. All studies were assessed as having a moderate-low risk of bias. The incidence of pulp necrosis following indirect restorations increased when the pulp status was objectively assessed (thermal/electrical testing). The presence of pre-operative caries or restorations, treatment of anterior teeth, temporization for more than two weeks, and cementation with eugenol-free temporary cement, all increased this incidence. Final impression with polyether and permanent cementation with glass ionomer cement both increased the incidence of pulp necrosis. Longer follow-up periods (> 10 years) and treatment provided by undergraduate students or general practitioners were also factors that increased this incidence. On the other hand, the incidence of periapical pathosis increased when teeth were restored with fixed partial dentures, the bone level was < 35%, and the follow-up was > 10 years. The certainty of the evidence overall was assessed as low.

Conclusions

Although the incidences of pulp necrosis and periapical pathosis following indirect restorations remain low, many factors affect these incidences that should thus be considered when planning indirect restorations on vital teeth.

Database registration

PROSPERO (CRD42020218378).

Available only for authorised users

Cheung GS, Lai SC, Ng RP. Fate of vital pulps beneath a metal-ceramic crown or a bridge retainer. Int Endod J. 2005;38(8):521–30.PubMedCrossRef

Yavorek A, Bhagavatula P, Patel K, Szabo A, Ibrahim M. The Incidence of Root Canal Therapy after Full-Coverage Restorations: A 10-Year Retrospective Study. J Endodontics. 2020;46(5):605–10.CrossRef

Brunton PA, Ratnayake J, Loch C, Veerasamy A, Cathro P, Lee R. Indirect Restorations and Fixed Prosthodontics: Materials and Techniques Used by General Dentists of New Zealand. Int J Dentistry. 2019;2019:5210162.CrossRef

Olley RC, Andiappan M, Frost PM. An up to 50-year follow-up of crown and veneer survival in a dental practice. J Prosthet Dent. 2018;119(6):935–41.PubMedCrossRef

Lynch CD, Hale R, Chestnutt IG, Wilson NHF. Reasons for placement and replacement of crowns in general dental practice. Br Dent J. 2018;225(3):229–34.PubMedCrossRef

Kontakiotis EG, Filippatos CG, Stefopoulos S, Tzanetakis GN. A prospective study of the incidence of asymptomatic pulp necrosis following crown preparation. Int Endod J. 2015;48(6):512–7.PubMedCrossRef

Al-Manei KK, Ban Owaiwid A, AlDhafiri R, Al-Manei K, AlHarran S, Alsulaimani R. Shear Bond Strength of E. Max Ceramic Restoration to Hydraulic Calcium Silicate Based Cement (Biodentine): An In Vitro Study. Eur Endod J. 2020;5(3):288–94.PubMedPubMedCentral

Galler KM, Weber M, Korkmaz Y, Widbiller M, Feuerer M: Inflammatory Response Mechanisms of the Dentine-Pulp Complex and the Periapical Tissues. Int J Mol Sci 2021:22(3):1480.

Kawashima N, Okiji T. Odontoblasts: Specialized hard-tissue-forming cells in the dentin-pulp complex. Congenit Anom (Kyoto). 2016;56(4):144–53.PubMedCrossRef

10.

Cavalcanti BN, Otani C, Rode SM. High-speed cavity preparation techniques with different water flows. J Prosthet Dent. 2002;87(2):158–61.PubMedCrossRef

11.

Pashley DH. Dentin-predentin complex and its permeability: physiologic overview. J Dental Res. 1985;64 Spec No:613–20.CrossRef

12.

Bergenholtz G, Cox CF, Loesche WJ, Syed SA. Bacterial leakage around dental restorations: its effect on the dental pulp. J Oral Pathol. 1982;11(6):439–50.PubMedCrossRef

13.

Cotton WR. Pulp response to an airstream directed into human cavity preparations. Oral Surg Oral Med Oral Pathol. 1967;24(1):78–88.PubMedCrossRef

14.

Manoil D, Al-Manei K, Belibasakis GN. A Systematic Review of the Root Canal Microbiota Associated with Apical Periodontitis: Lessons from Next-Generation Sequencing. Proteomics Clin Appl. 2020;14(3):e1900060.PubMedCrossRef

15.

Gomes B, Herrera DR. Etiologic role of root canal infection in apical periodontitis and its relationship with clinical symptomatology. Braz Oral Res. 2018;32(suppl 1): e69.PubMedCrossRef

16.

Al-Manei K, Ghorbani M, Naud S, Al-Manei KK, Sobkowiak MJ, Lund B, Hazirolan G, Sällberg Chen M, Özenci V. Clinical Microbial Identification of Severe Oral Infections by MALDI-TOF Mass Spectrometry in Stockholm County: an 11-Year (2010 to 2020) Epidemiological Investigation. Microbiol Spectr. 2022;10(6):e0248722.PubMedCrossRef

17.

Valderhaug J, Jokstad A, Ambjørnsen E, Norheim PW. Assessment of the periapical and clinical status of crowned teeth over 25 years. J Dent. 1997;25(2):97–105.PubMedCrossRef

18.

Kohli S, Bhatia S, Al-Haddad A, Pulikkotil SJ, Jamayet NB: Pulpal and Periapical Status of the Vital Teeth Used as Abutment for Fixed Prosthesis-A Systematic Review and Meta-Analysis. J Prosthodont. 2022;31(2):102–114.

19.

Javed F, Haji Z, Khan FR: Comments on Pulpal and Periapical Status of the Vital Teeth Used as Abutment for Fixed Prosthesis: A Systematic Review and Meta-Analysis. J Prosthodont 2022;31(2):93.

20.

Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.PubMedPubMedCentralCrossRef

21.

Aziz AM, El-Mowafy O, Tenenbaum HC, Lawrence HP. Clinical performance of CAD-CAM crowns provided by predoctoral students at the University of Toronto. J Prosthet Dent. 2022;127(5):729–36.PubMedCrossRef

22.

Bergenholtz G, Nyman S. Endodontic complications following periodontal and prosthetic treatment of patients with advanced periodontal disease. J Periodontol. 1984;55(2):63–8.PubMedCrossRef

23.

Chaar MS, Passia N, Kern M. Long-term clinical outcome of posterior metal-ceramic crowns fabricated with direct metal laser-sintering technology. J Prosthodont Res. 2020;64(3):354–7.PubMedCrossRef

24.

Cheung GS. A preliminary investigation into the longevity and causes of failure of single unit extracoronal restorations. J Dent. 1991;19(3):160–3.PubMedCrossRef

25.

Denner N, Heydecke G, Gerds T, Strub JR. Clinical comparison of postoperative sensitivity for an adhesive resin cement containing 4-META and a conventional glass-lonomer cement. Int J Prosthodont. 2007;20(1):73–8.PubMed

26.

Derchi G, Marchio V, Borgia V, Özcan M, Giuca MR, Barone A. Twelve-year longitudinal clinical evaluation of bonded indirect composite resin inlays. Quintessence Int. 2019;50(6):448–54.PubMed

27.

Encke BS, Heydecke G, Wolkewitz M, Strub JR. Results of a prospective randomized controlled trial of posterior ZrSiO(4)-ceramic crowns. J Oral Rehabil. 2009;36(3):226–35.PubMedCrossRef

28.

Ericson S, Hedegård B, Wennström A. Roentgenographic study of vital abutment teeth. J Prosthet Dent. 1966;16(5):981–7.PubMedCrossRef

29.

Fayyad MA. al-Rafee MA: Failure of dental bridges: III–Effect of some technical factors. J Oral Rehabil. 1996;23(10):675–8.PubMed

30.

Forrer FA, Schnider N, Brägger U, Yilmaz B, Hicklin SP. Clinical performance and patient satisfaction obtained with tooth-supported ceramic crowns and fixed partial dentures. J Prosthet Dent. 2020;124(4):446–53.PubMedCrossRef

31.

Hämmerle CH, Ungerer MC, Fantoni PC, Brägger U, Bürgin W, Lang NP. Long-term analysis of biologic and technical aspects of fixed partial dentures with cantilevers. Int J Prosthodont. 2000;13(5):409–15.PubMed

32.

Ioannidis A, Bindl A. Clinical prospective evaluation of zirconia-based three-unit posterior fixed dental prostheses: Up-to ten-year results. J Dent. 2016;47:80–5.PubMedCrossRef

33.

Johnson GH, Powell LV, DeRouen TA. Evaluation and control of post-cementation pulpal sensitivity: zinc phosphate and glass ionomer luting cements. J Am Dent Assoc. 1993;124(11):38–46.PubMedCrossRef

34.

Jokstad A, Mjör IA. Ten years’ clinical evaluation of three luting cements. J Dent. 1996;24(5):309–15.PubMedCrossRef

35.

Karlsson S. A clinical evaluation of fixed bridges, 10 years following insertion. J Oral Rehabil. 1986;13(5):423–32.PubMedCrossRef

36.

Mohamed Khazin S, Abdullah D, Liew AKC, Soo E, Ahmad Tarib N: Pulpal and periapical disease in crowned vital teeth: A prospective matched cohort study. Aust Endod J 2022;48(1):8–19.

37.

Lockard MW. A retrospective study of pulpal response in vital adult teeth prepared for complete coverage restorations at ultrahigh speed using only air coolant. J Prosthet Dent. 2002;88(5):473–8.PubMedCrossRef

38.

Lundgren GP, Vestlund GM, Dahllöf G. Crown therapy in young individuals with amelogenesis imperfecta: Long term follow-up of a randomized controlled trial. J Dent. 2018;76:102–8.PubMedCrossRef

39.

Lundqvist P, Nilson H. A clinical re-examination of patients treated with pinledge-crowns. J Oral Rehabil. 1982;9(5):373–87.PubMedCrossRef

40.

Piemjai M, Adunphichet N. Impact of hybrid layer formation on the 15-year survival, complications, and failures of full-coverage retainers. J Prosthodont Res. 2022;66(1):131–40.PubMedCrossRef

41.

Rauch A, Reich S, Schierz O. Chair-side generated posterior monolithic lithium disilicate crowns: clinical survival after 6 years. Clin Oral Investig. 2017;21(6):2083–9.PubMedCrossRef

42.

Reich S, Schierz O. Chair-side generated posterior lithium disilicate crowns after 4 years. Clin Oral Investig. 2013;17(7):1765–72.PubMedCrossRef

43.

Reichen-Graden S, Lang NP. Periodontal and pulpal conditions of abutment teeth. Status after four to eight years following the incorporation of fixed reconstructions. Schweiz Monatsschr Zahnmed. 1989;99(12):1381–5.PubMed

44.

Rinke S, Gersdorff N, Lange K, Roediger M. Prospective evaluation of zirconia posterior fixed partial dentures: 7-year clinical results. Int J Prosthodont. 2013;26(2):164–71.PubMedCrossRef

45.

Rinke S, Lange K, Roediger M, Gersdorff N. Risk factors for technical and biological complications with zirconia single crowns. Clin Oral Investig. 2015;19(8):1999–2006.PubMedCrossRef

46.

Rinke S, Pfitzenreuter T, Leha A, Roediger M, Ziebolz D. Clinical evaluation of chairside-fabricated partial crowns composed of zirconia-reinforced lithium silicate ceramics: 3-year results of a prospective practice-based study. J Esthet Restor Dent. 2020;32(2):226–35.PubMedCrossRef

47.

Scheibenbogen A, Manhart J, Kunzelmann KH, Hickel R. One-year clinical evaluation of composite and ceramic inlays in posterior teeth. J Prosthet Dent. 1998;80(4):410–6.PubMedCrossRef

48.

Selz CF, Strub JR, Vach K, Guess PC. Long-term performance of posterior InCeram Alumina crowns cemented with different luting agents: a prospective, randomized clinical split-mouth study over 5 years. Clin Oral Investig. 2014;18(6):1695–703.PubMedCrossRef

49.

Tinschert J, Schulze KA, Natt G, Latzke P, Heussen N, Spiekermann H. Clinical behavior of zirconia-based fixed partial dentures made of DC-Zirkon: 3-year results. Int J Prosthodont. 2008;21(3):217–22.PubMed

50.

Uzgur Z, Uzgur R, Çolak H, Ercan E, Dallı M. Analysis of Endodontic Complications Following Fixed Prosthodontic Rehabilitation. Int J Prosthodont. 2016;29(6):565–9.PubMedCrossRef

51.

Walther W. Risk of endodontic treatment after insertion of conical crown retained dentures: a longitudinal study. Endod Dent Traumatol. 1995;11(1):27–31.PubMedCrossRef

52.

Wolleb K, Sailer I, Thoma A, Menghini G, Hammerle CH. Clinical and radiographic evaluation of patients receiving both tooth- and implant-supported prosthodontic treatment after 5 years of function. Int J Prosthodont. 2012;25(3):252–9.PubMed

53.

Zitzmann NU, Büren AV, Glenz F, Rohr N, Joda T, Zaugg LK. Clinical outcome of metal- and all-ceramic resin-bonded fixed dental prostheses. J Prosthodont Res. 2021;65(2):243–8.PubMedCrossRef

54.

Chmura Kraemer H, Periyakoil VS, Noda A. Kappa coefficients in medical research. Stat Med. 2002;21(14):2109–29.PubMedCrossRef

55.

Roediger M, Gersdorff N, Huels A, Rinke S. Prospective evaluation of zirconia posterior fixed partial dentures: four-year clinical results. Int J Prosthodont. 2010;23(2):141–8.PubMed

56.

Frisk F, Hakeberg M. A 24-year follow-up of root filled teeth and periapical health amongst middle aged and elderly women in Göteborg. Sweden Int Endodontic J. 2005;38(4):246–54.CrossRef

57.

Patel S, Wilson R, Dawood A, Mannocci F. The detection of periapical pathosis using periapical radiography and cone beam computed tomography - part 1: pre-operative status. Int Endod J. 2012;45(8):702–10.PubMedCrossRef

58.

Lo Giudice R, Nicita F, Puleio F, Alibrandi A, Cervino G, Lizio AS, Pantaleo G. Accuracy of Periapical Radiography and CBCT in Endodontic Evaluation. Int J Dentistry. 2018;2018:2514243.CrossRef

59.

Brännström M, Nyborg H. Pulp reaction to a temporary zinc oxide/eugenol cement. J Prosthet Dent. 1976;35(2):185–91.PubMedCrossRef

60.

Baldissara P, Comin G, Martone F, Scotti R. Comparative study of the marginal microleakage of six cements in fixed provisional crowns. J Prosthet Dent. 1998;80(4):417–22.PubMedCrossRef

61.

Bagis B, Atilla P, Cakar N, Hasanreisoglu U. An immunohistochemical evaluation of cell adhesion molecules in human dental pulp after tooth preparation and application of temporary luting cements. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107(1):137–44.PubMedCrossRef

62.

Lewinstein I, Chweidan H, Matalon S, Pilo R. Retention and marginal leakage of provisional crowns cemented with provisional cements enriched with chlorhexidine diacetate. J Prosthet Dent. 2007;98(5):373–8.PubMedCrossRef

63.

Pandey P, Mantri S, Bhasin A, Deogade SC. Mechanical Properties of a New Vinyl Polyether Silicone in Comparison to Vinyl Polysiloxane and Polyether Elastomeric Impression Materials. Contemp Clin Dent. 2019;10(2):203–7.PubMedPubMedCentralCrossRef

64.

Langeland K, Langeland LK. Pulp reactions to crown preparation, impression, temporary crown fixation, and permanent cementation. J Prosthet Dent. 1965;15:129–43.PubMedCrossRef

65.

Rajasimhan NV, Jayaraman S, Ali DJ, Subramanian B. Evaluation of cytotoxicity levels of poly vinyl ether silicone, polyether, and poly vinyl siloxane impression materials: An in vitro study. J Indian Prosthodont Soc. 2019;19(4):332–7.PubMedPubMedCentralCrossRef

66.

Roberta T, Federico M, Federica B, Antonietta CM, Sergio B, Ugo C. Study of the potential cytotoxicity of dental impression materials. Toxicol In Vitro. 2003;17(5–6):657–62.PubMedCrossRef

67.

Sydiskis RJ, Gerhardt DE. Cytotoxicity of impression materials. J Prosthet Dent. 1993;69(4):431–5.PubMedCrossRef

68.

Boraldi F, Coppi C, Bortolini S, Consolo U, Tiozzo R. Cytotoxic Evaluation of Elastomeric Dental Impression Materials on a Permanent Mouse Cell Line and on a Primary Human Gingival Fibroblast Culture. Materials (Basel). 2009;2(3):934–44.CrossRef

69.

Murray PE, Smith AJ, Windsor LJ, Mjör IA. Remaining dentine thickness and human pulp responses. Int Endod J. 2003;36(1):33–43.PubMedCrossRef

70.

Schmalz G. Pulp Reactions to Dental Materials. In: The Dental Pulp: Biology, Pathology, and Regenerative Therapies. edn. Edited by Goldberg M. Berlin, Heidelberg: Springer Berlin Heidelberg; 2014. p. 169–83.CrossRef

71.

Pameijer CH: 6 - Biocompatibility of luting cements for dental applications. In: Biocompatibility of Dental Biomaterials. edn. Edited by Shelton R: Woodhead Publishing; Sawston. 2017: 77–94.

72.

Hill EE, Lott J. A clinically focused discussion of luting materials. Aust Dent J. 2011;56(Suppl 1):67–76.PubMedCrossRef

73.

Smith DC, Ruse ND. Acidity of glass ionomer cements during setting and its relation to pulp sensitivity. J Am Dent Assoc. 1986;112(5):654–7.PubMedCrossRef

74.

McCabe PS, Dummer PM. Pulp canal obliteration: an endodontic diagnosis and treatment challenge. Int Endod J. 2012;45(2):177–97.PubMedCrossRef

75.

Zilinskaite-Petrauskiene I, Haug SR: A Comparison of Endodontic Treatment Factors, Operator Difficulties and perceived Oral Health-Related Quality of Life between Elderly and Young Patients. J Endodontics 2021;47(12):1844–1853.

76.

Cushen SE, Turkyilmaz I. Impact of operator experience on the accuracy of implant placement with stereolithographic surgical templates: an in vitro study. J Prosthet Dent. 2013;109(4):248–54.PubMedCrossRef

77.

Kozlovsky A, Rapaport A, Artzi Z. Influence of operator skill level on the clinical outcome of non-surgical periodontal treatment: a retrospective study. Clin Oral Investig. 2018;22(8):2927–32.PubMedCrossRef

78.

Sonkar J, Maney P, Yu Q, Palaiologou A. Retrospective study to identify associations between clinician training and dental implant outcome and to compare the use of MATLAB with SAS. Int J Implant Dent. 2019;5(1):28.PubMedPubMedCentralCrossRef

79.

Alsulaimani RS, Al-Manei KK. S AA, AlAqeely RS, S AMA-S, E MA-M: Effects of Clinical Training and Case Difficulty on the Radiographic Quality of Root Canal Fillings Performed by Dental Students in Saudi Arabia. Iran Endod J. 2015;10(4):268–73.PubMedPubMedCentral

80.

Frankenberger R, Reinelt C, Petschelt A, Krämer N. Operator vs. material influence on clinical outcome of bonded ceramic inlays. Dent Mater. 2009;25(8):960–8.PubMedCrossRef

81.

Wisithphrom K, Murray PE, About I, Windsor LJ. Interactions between cavity preparation and restoration events and their effects on pulp vitality. Int J Periodontics Restorative Dent. 2006;26(6):596–605.PubMed

82.

Whitworth JM, Walls AW, Wassell RW. Crowns and extra-coronal restorations: endodontic considerations: the pulp, the root-treated tooth and the crown. Br Dent J. 2002;192(6):315–20 323–317.PubMedCrossRef

83.

Li X, Hu L, Ma L, Chang S, Wang W, Feng Y, Xu Y, Hu J, Zhang C, Wang S. Severe periodontitis may influence cementum and dental pulp through inflammation, oxidative stress, and apoptosis. J Periodontol. 2019;90(11):1297–306.PubMedCrossRef

84.

Wan L, Lu HB, Xuan DY, Yan YX, Zhang JC. Histological changes within dental pulps in teeth with moderate-to-severe chronic periodontitis. Int Endod J. 2015;48(1):95–102.PubMedCrossRef

Title: Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a systematic review and meta-analysis
Authors: Kholod Khalil Al-Manei
Shuruq Alzaidi
Ghadah Almalki
Khaled Al-Manei
Nabeel Almotairy
Publication date: 01-12-2023
Publisher: BioMed Central
Keyword: Denture
Published in: BMC Oral Health / Issue 1/2023
Electronic ISSN: 1472-6831
DOI: https://doi.org/10.1186/s12903-023-02826-1

2024 ASCO Annual Meeting

Springer Medicine

Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a systematic review and meta-analysis

Abstract

Background

Methods

Results

Conclusions

Database registration

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Database registration

Please log in to get access to this content

Other articles of this Issue 1/2023

Psoriasis and oral health in adult United States population: a cross-sectional study

Application of computer-aided design and 3D-printed template for accurate bone augmentation in the aesthetic region of anterior teeth

Coexpression network analysis identified MT3 as a hub gene that promotes the chemoresistance of oral cancer by regulating the expression of YAP1

Three-dimensional positional relationship between impacted mandibular third molars and the mandibular canal

A scoping review on the association of early childhood caries and maternal gender inequality

Postoperative pain of single-visit endodontic treatment with gutta-percha versus MTA filling: a randomized superiority trial