CLINICAL

RESEARCH
A Retrospective Study on the Success,
Survival, and Incidence of Complications of
Post-Retained Restorations in Premolars
Supporting Fixed Dental Prostheses with a
Mean of 7 Years in Function
Zi Ying Phang, BDS, MDS
Sheralyn Hui Qi Quek, BDS, MDS
Khim Hean Teoh, BDS, MDS
Department of Restorative Dentistry (Prosthodontics), National Dental Center Singapore.

Keson Beng Choon Tan, BDS, MSD

Faculty of Dentistry, National University of Singapore, Singapore.

Ken Tan, BDS, MSc, Dr Med Dent

Department of Restorative Dentistry (Prosthodontics), National Dental Center Singapore.

Purpose: To evaluate the survival and success rates of post-and-core restorations supporting fixed dental
prostheses (FDPs) after a mean time in function of 7 years and to assess the incidences of biologic and technical
complications. Materials and Methods: Patients from the National Dental Center Singapore (NDCS) with
endodontically treated premolars restored with post-retained FDPs from 2007 to 2009 were recruited from
the Endodontic Registry and evaluated by three clinicians. A total of 265 patients with 329 treated premolars
were examined clinically. Digital radiographs were also obtained. Complications were classified as tooth- or
prosthesis-related. Failure and complication rates were calculated based on person-time-at-risk. Results: The
mean time in function was 7.1 years. A total of 25 teeth in 23 patients were lost, resulting in a 7-year survival
rate of 92.7% (95% CI: 89.5%, 95.0%). The corresponding success rate was 75.1% (95% CI: 70.5%, 79.1%).
A total of 40 FDPs failed, resulting in a 7-year prosthetic survival rate of 88.6% (95% CI: 84.8%, 91.5%).
Common complications observed were recurrent periodontal disease (3.9%), periapical pathology (7.3%),
caries (3.9%), porcelain chipping (9.9%), and tooth fractures (5.0%). For the incidence of tooth fracture, a
risk analysis yielded significant associations with the number of occluding teeth (odds ratio: 4.2; 95% CI:
1.1, 16.7) and the number of adjacent teeth (odds ratio: 4.0, 95% CI: 1.5, 10.9). Conclusion: Restoration of
premolar teeth requiring root canal treatment with a post and core and crown is a viable treatment when
premolar teeth have adjacent teeth. Int J Prosthodont 2020;33:176–183. doi: 10.11607/ijp.6090

P
reservation of the natural dentition has always been a key therapeutic goal in
dentistry. Endodontic treatment has a documented long-term history of success
and allows for the preservation of teeth with treated root canal infections.1,2 In
addition, a systematic review revealed that nonvital teeth restored with crowns had
a higher long-term survival than those without crown coverage.3 However, in the
absence of sufficient coronal tooth structure, the use of intraradicular posts and cores
may be necessary to retain the definitive prosthesis.4 Various prosthetic parameters
Correspondence to: have been investigated in in vitro studies on extracted teeth,5–7 as well as in pho-
Dr Zi Ying Phang
toelastic studies8 and finite element analyses,9 to determine the optimal design for
Department of Restorative
Dentistry (Prosthodontics) restoration of such teeth.
National Dental Center Singapore More recently, clinical outcome studies have focused on the longevity of such post-
5 Second Hospital Avenue
retained restorations. Published studies range from short-term10 to long-term11,12
Singapore 168938
Email: [email protected] follow-ups and across different prosthetic materials, such as cast post cores13,14 and
prefabricated post cores.15,16 The traditional cast gold post-and-core technique is more
Submitted January 24, 2019;
time-consuming, as it requires additional clinical visits and incurs additional laborato-
accepted August 30, 2019.
©2020 by Quintessence ry and material costs. In contrast, prefabricated posts are easier to use, allow for more
Publishing Co Inc. conservative post preparations, and may have better esthetic outcomes. As the use of

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 Phang et al

prefabricated post cores became increasingly common, the dentition only when teeth are missing or could not
more comparison studies were published contrasting be maintained with reasonable efforts.29
the outcomes of cast and prefabricated post cores.17,18 The aim of the present study, therefore, was to evalu-
A prospective study with a mean observation period ate the survival and success rates of post-and-core
of more than 4 years18 reported high survival rates of reconstructions supporting FDPs of premolars in pa-
92.5% for teeth restored with prefabricated posts and tients treated at the National Dental Centre, Singapore
97.1% for teeth restored with cast post cores. Com- (NDCS), and to assess the incidences of biologic and
monly reported complications included root fractures, technical complications. The secondary objective was to
recurrent caries, periradicular disease, and loss of reten- assess any differences in the survival of reconstructions
tion. However, the observation periods of the teeth in- based on the types of post-and-core systems applied.
cluded in the study ranged from 2 to 11.5 years. Cast
post cores were also exclusively used for the restoration MATERIALS AND METHODS
of anterior teeth, whereas molars were predominantly
restored with prefabricated titanium posts. Studies by This study was designed and conducted as a retrospec-
a Dutch group17,19 found survival rates of 83% to 92% tive evaluation of endodontically treated and restored
and 71% to 80% at the tooth and restoration levels, premolar teeth with an observation period of at least
respectively, after 17 years. There were no differences 5 years. Patients treated from 2007 to 2009 were iden-
in survival probabilities among the different post-and- tified through the NDCS Endodontics Registry. Eligible
core restorations. A significant influence of the amount patients were sequentially contacted and recruited for
of remaining dentin was found for the survival of pre- the study. Clinical examinations were conducted by
fabricated post cores; however, survival data at 17 years three standardized examiners. To reduce interexaminer
were based on only 28% of the original sample size. variability, the first five subjects were seen jointly by two
These studies also included a large number of operators examiners (P.Z.Y. and K.T. or S.Q. and K.T.). Digital peri-
and had difficulties ensuring operator compliance with apical radiographs were taken with the paralleling tech-
study protocols. nique using a device (XCP, Rinn) to minimize deviation
The advent of successful dental implant therapy has of the x-ray beam from the long axis of the tooth.30,31
led some clinicians to reconsider the role of conven- Two examiners evaluated all radiographs. The research
tional endodontics and posts and cores and crowns in protocol was submitted to and approved by the Sing-
the restoration of severely broken-down teeth. Instead, Health Centralized Institutional Review Board (IRB Ref-
the option of extracting these teeth and replacing them erence No: 2015/3027).
with dental implants has recently been propagated. The
biophysiologic differences between natural teeth and Inclusion and Exclusion Criteria
dental implants are well known. Although it has been Only subjects that met the following inclusion criteria
postulated that endodontically treated teeth may have a were enrolled:
poorer longevity than vital abutments,20 maintaining an
endodontically compromised tooth may also preserve • Endodontic treatment, posts and cores, and FDPs
the biologic function of the periodontal ligaments. Nu- done on at least one premolar at NDCS
merous studies have shown increased tactile thresholds • Above the age of 21 years
with implants compared to natural teeth.21–23 Others • Identified through the Endodontics Registry (2007
have demonstrated impaired force control with implant- to 2009)
supported prostheses.24,25 • Contactable by telephone or mail
Many clinicians continue to be of the opinion that • Medically fit
the restoration of an endodontically treated tooth with
post-retained fixed dental prostheses (FDPs) remains a Subjects with failed endodontic treatment and re-
viable treatment option. Systematic reviews comparing treatment of premolar teeth done at NDCS were ex-
outcomes of root canal treatment and restoration with cluded from this study.
or without posts and cores, implant-supported single
crowns, FDPs, and extraction without replacement26,27 Clinical Examination
concluded that there were no significant differences in Biologic parameters recorded at the clinical review in-
survival outcomes between root canal–treated teeth and cluded the loss of teeth, presence of caries, and peri-
single-tooth implants after 5 years. In another review, it odontal parameters such as probing depths, presence or
was observed that the success of root canal treatment absence of bleeding on probing, tooth mobility, fremi-
increased over time due to the potential of late healing. tus, and suppuration. Patients’ subjective complaints
In contrast, the success of implant treatment decreased about pain or discomfort were also recorded. Technical
over time.28 Dental implants should be used to extend parameters recorded at review were prosthesis survival

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 Clinical Research

Table 1   Summary Table of Eligible Patients • Exposure time of FDPs that
Recruited Uncontactable Subjects who could be followed for the whole
Patient subjects subjects declined participation observation period
demographics (n = 265) (n = 168) (n = 158)
• Exposure time up to a failure/
Gender, n (%) complication of the FDPs that
Male 110 (41.5) 62 (36.9) 46 (29.1)
Female 155 (58.5) 106 (63.1) 112 (70.9) were lost due to failure during
Age, y
the observation period
Mean 58.3 54.7 55.3
Minimum 27 24 24 Given that some patients had
Maximum 90 82 87
more than one tooth eligible for this
Tooth location, n (%) study, robust confidence intervals
Maxilla 221 (67.2) 132 (69.1) 121 (68.0)
Mandible 108 (32.8) 59 (30.9) 57 (32.0) were used to account for clustering
within patients when a patient con-
Restored teeth, n (%)
1 207 (78.1) 145 (86.3) 139 (88.0) tributed more than one tooth to the
2 52 (19.6) 23 (13.7) 18 (11.4) study. Statistical analyses were done
≥3 6 (2.3) 0 1 (0.63) using Statistical Analysis Software
9.4 (SAS Institute).

and/or success (absence of any complications). Complications relating to RESULTS

the tooth or restoration included fractures, porcelain veneer chippings,
loss of retention of the crown or post, and need for endodontic retreat- The interexaminer agreement was
ment. In addition, details pertaining to the nature of the occlusal contacts determined to be 95.6% based on
(tested with shim stock foil), opposing dentition (natural, fixed, removable, repeated radiographic evaluation of
or unopposed), proximal contacts (open, light, or normal contacts), and 329 cases.
crown design (full metal, porcelain fused to metal [PFM], all-ceramic) were A total of 659 eligible patients
recorded. In the event of porcelain veneer chippings, clinical photographs were identified. Eleven were de-
were taken. ceased at the time of recall. A total
Wherever possible, the time in function until a complication occurred of 605 patients were contacted, and
was noted. When the exact time of occurrence could not be determined, a 266 subjects were finally enrolled in
range was used to represent the time-in-function up to the occurrence of the study. As the time in function of
the complication. The lower limit of this range was calculated from the last the FDP did not reach the minimum
complication-free patient visit, and the upper limit was calculated using the of 5 years, the data from one sub-
date of discovery of the complication. ject were eliminated; hence, 265 pa-
tients (110 men, 155 women) with
Outcome Definitions a median age of 58.3 years (range:
Outcomes were defined at both the prosthesis level and the tooth level. 27 to 90 years), accounting for 329
Success was defined as presence in function and absence of any compli- restored premolars, were included.
cations or interventions in the time period from the restoration to the date A total of 207 (78.1%) patients had
of the review, inclusive (observation period). Survival was defined as the only one restored premolar, while
prostheses or teeth remaining in situ with or without modifications for the 52 (19.6%) had 2 restored premo-
observation period. Failure was defined as the loss of the prosthesis or tooth lars and 6 (2.3%) had 3 restored
or requiring replacement with a new prosthesis or extraction of the tooth. premolars. Of 329 restored pre-
Prosthesis outcomes were limited to complications or failures directly re- molars, two-thirds (67.2%) were
lated to the restoration and included caries related to prosthesis margins, maxillary premolars and one-third
tooth fractures, loss of retention, porcelain chipping, and other FDP compli- (32.8%) were mandibular premo-
cations. Tooth outcomes were limited to complications or failures affecting lars. Demographics of all enrolled
the tooth but independent of the prostheses, such as progressive periodon- subjects for the study are presented
tal disease and periapical pathology. in Table 1. The demographics of un-
contactable subjects and those re-
Statistical Calculations fusing to participate are included for
Failure and complication rates were calculated based on the person-time- comparison.
at-risk.32,33 These rates were calculated by dividing the number of events Post space preparations for all
(failures or complications) in the numerator by the total exposure time (of teeth were done with the Parapost
FDPs) in the denominator. The total exposure time was calculated by taking XP System (Coltene Whaledent).
the sum of the following: Clinical documentation showed that

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 Phang et al

all posts and cores engaged 2 to 3 mm of parallel walls Table 2   Summary of Survival, Failure, and
apically. Out of the 329 teeth assessed, 232 (70.5%) Complication Rates
were restored with a cast gold post and core, and 97 7-year risk 95% confidence
(%) interval (%)
(29.5%) were restored with a prefabricated post and
direct restorative core. The mean time in function for di- Failure 7.3 4.97, 10.55
rect posts was 6.7 years (standard deviation [SD] 1.49), Failure and complication 24.9 20.88, 29.54
and for cast posts and cores it was 7.2 years (SD 1.42). Success 75.1 70.46, 79.12
The majority of posts (58.4%) were cemented with Prosthesis survival 88.6 84.84, 91.53
zinc phosphate cement (Hy-bond, Shofu). There was a
Prosthesis success 81.2 76.85, 84.85
near equal distribution between resin-modified glass-
Biologic complications
ionomer cements (Fuji Plus, GC) (12.8%) and resin ce- Caries 3.9 2.26, 6.56
ment (Panavia F, Kuraray Dental) (13.1%). A proportion Periapical pathology 7.3 4.97, 10.73
of the sample (15.8%) did not reveal the type of cement Progressive attachment loss 3.9 2.29, 6.63
used. Technical complications
A total of 315 (95.7%) teeth were definitively restored Fracture 5.0 3.13, 7.91
Loss of retention 0.9 0.29, 2.77
with single-unit FDPs, while 14 (4.3%) teeth were part Porcelain chipping 9.9 7.21, 13.63
of 3- to 5-unit multi-unit FDPs. Of the 329 FDPs, 326
(99.1%) were PFM prostheses, and only 3 (0.9%) were
full-metal prostheses.
and were considered prosthetic failures, but survived
Survival and Complication Data at the tooth level. The 7-year rate for caries was 0.56
The time in function and complication data were ex- per 100 FDP years, resulting in a risk of 3.9% (95% CI:
amined for 329 teeth (Table 2). The 7-year risk for fail- 2.26%, 6.56%) after 7 years.
ure was 7.3% (95% confidence interval [CI]: 4.97%,
10.55%). The rate of failure was 1.08 per 100 FDP years Technical Complications
(95% CI: 0.73, 1.59). Therefore, the overall 7-year sur- Tooth Fractures. Seventeen teeth fractured at vary-
vival rate was 92.7% (95% CI: 89.45%, 95.03%). ing time points after the prostheses had been incorpo-
The overall 7-year risk for failure and complication rated. All fractured teeth were extracted and deemed
was 24.9% (95% CI: 20.88%, 29.54%). The rate of fail- as failures. The 7-year fracture rate was 0.73 per 100
ure and complication was 4.1 per 100 FDP years (95% FDP years, resulting in a risk of 5.0% (95% CI: 3.13%,
CI: 3.35, 5.00). Consequently, the overall 7-year risk for 7.91%) after 7 years.
complication-free teeth was 75.1% (95% CI: 70.46%, Loss of Retention. Three teeth were found to have
79.12%). decementation of the prosthesis not related to other
complications such as fracture or caries. In all cases,
Prosthesis-Related Complications prostheses were recemented, and the teeth were
Five categories of complications were defined as being deemed to have survived. The rate for loss of retention
prosthesis-related: without loss of the reconstruction was 0.13 per 100
FDP years, resulting in a risk of 0.9% (95% CI: 0.29%,
• Caries involving margins of the FDPs 2.77%) after 7 years.
• Fractures (including vertical root fractures and Porcelain Chipping. Prostheses with ceramic chip-
coronal fractures) ping were scored according to the modified US Public
• Loss of retention Health Service (USPHS) criteria as proposed by Sailer et
• Porcelain chipping al (2009).34 Thirty-four teeth were found to have vary-
• FDP complications ing degrees of porcelain chipping. Twelve prostheses
were classified as Grade B, which allowed polishing of
The 7-year risk for prosthesis survival was 88.6% the chipped veneering porcelain. Fourteen prostheses
(95% CI: 84.84%, 91.53%), and the 7-year risk for pros- were classified as Grade C, indicating porcelain chip-
thesis success was 81.2% (95% CI: 76.85%, 84.85%). ping with exposure of the underlying framework. Eight
prostheses showed extensive porcelain fracture requir-
Biologic Complications ing a new prosthesis.
Caries. Thirteen teeth were found to have caries re- The eight FDPs were considered as failed, whereas
lated to prosthesis margins, 2 of which were treated the remaining 26 prostheses were classified as surviv-
with intraoral repairs and survived. Four teeth required ing. The 7-year rate for porcelain chipping was 1.50
extraction and were deemed as failures. The remaining per 100 FDP years, resulting in a risk of 9.9% (95% CI:
7 teeth required replacement of the existing prostheses 7.21%, 13.63%) after 7 years.

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 Clinical Research

Table 3   Risk Factors for Prosthetic Complications teeth were identified as having
Effect Outcome Odds ratio 95% CI P value radio­graphic evidence of peri­apical
No. of occluding pairs Overall outcome 2.6 1.30, 5.05 .007 pathology (PAI score ≥ 3). Two of
(≤ 5 vs ≥ 10) Tooth fracture 4.2 1.07, 16.65 .040 these teeth were deemed to have
No. of adjacent teeth Technical complications 2.6 1.38, 4.81 .003 failed due to endodontic reasons
Tooth fracture 4.0 1.50, 10.86 .006 (pain). One tooth failed due to con-
tinued root resorption, whereas
another failed due to a persistent
If prostheses with minor porcelain chipping that do not require any form and enlarged periapical lesion after
of clinical intervention were excluded from the analysis (n = 11), a total of 23 apicoectomy.
prostheses would require either polishing or refabrication of the prostheses. The rate of periapical pathology
This accounted for a revised 7-year rate for porcelain chipping of 1.01 per 100 was 1.09 per 100 FDP years, re-
FDP years, resulting in a risk of 6.8% (95% CI: 4.57%, 10.04%) after 7 years. sulting in a risk of 7.3% (95% CI:
4.97%, 10.73%) after 7 years.
FDP Complications Progressive Periodontal Dis-
Two prostheses had complications related to multi-unit FDPs. Both prosthe- ease (Attachment Loss). Thirteen
ses were three-unit FDPs involving a premolar and a molar abutment. One teeth were found to have progres-
prosthesis had to be sectioned and the molar abutment removed due to sive attachment loss as indicated by
a vertical root fracture. The second prosthesis had recurrent caries on the increased probing depths of 5 mm
molar abutment. Rate and risk for multi-unit FDP complications were not or more. Of these 13 teeth, 3 were
calculated due to the small number of such units included in this study. documented to have severe pro-
Risk Factors for Prosthesis-Related Complications. Odds ratio analy- gressive attachment loss and had
sis was used to identify potential associations of tooth fracture, technical been removed.
complications, and overall outcomes (Table 3). The rate of progressive attach-
Number of Occluding Antagonistic Pairs. The total number of oc- ment loss was 0.57 per 100 FDP
cluding antagonistic pairs was found to have a statistically significant years, resulting in a risk of 3.9%
association with the risk of tooth fractures and overall outcomes. When (95% CI: 2.29%, 6.63%) after 7
comparing between 1 and 5 antagonistic pairs of occlusal contacts vs 10 years.
or more, odds ratio estimates of 4.2 (95% CI: 1.07, 16.65) for fractures
and 2.6 (95% CI: 1.30, 5.05) for overall outcomes were determined. DISCUSSION
However, data on the distribution of antagonistic pairs of occlusal con-
tacts in the dentition were not captured. The results of the present study in-
Number of Adjacent Teeth. The number of teeth adjacent to an end- dicate that a high number of bio-
odontically restored premolar was found to have a statistically significant logic and technical complications
association with the risk for tooth fracture and technical complications. may occur in endodontically treated
When comparing two adjacent teeth vs one adjacent tooth, odds ratio es- premolars reconstructed with posts
timates of 4.0 (95% CI: 1.50, 10.86) for tooth fracture and 2.6 (95% CI: and cores. Moreover, the total num-
1.38, 4.81) for technical complications were calculated, respectively. Due ber of complications amounted to
to the lack of lone-standing premolars, the odds ratio comparison for two 24.9% after 7 years. This proportion
adjacent teeth vs no adjacent tooth could not be determined. falls within the outcomes of previ-
Other Factors. Other factors such as type of cement, secondary use of ous studies of a similar nature but
the restored tooth as an FDP or removable dental prosthesis (RDP) abut- other treatment modalities. As an
ment, location of restored tooth, type of post-and-core restoration, and example, the success rate of 75.1%
type of opposing dentition did not show any statistically significant associa- in the present study compares fa-
tions with survival. vorably to that reported in a recent
systematic review,36 where the suc-
Tooth-Related Complications cess rate after 5 years of implant
Two categories of biologic complications were identified at the tooth level: reconstructions in function was
periapical pathology and progressive periodontal disease. 72.9%. In other words, post-and-
The 7-year rate of biologic complications was 2.37 per 100 FDP years, core–reconstructed, endodontically
resulting in a risk of 15.3% (95% CI: 11.95%, 19.42%) after 7 years. treated premolar teeth appear to
yield success rates similar to those
Biologic Complications reported for implant-supported re-
Periapical Pathology. The Periapical Index (PAI)35 was used in the radio- constructions. This, in turn, means
graphic evaluation of the periapical status of treated teeth. Twenty-four that reconstruction of a nonvital

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 Phang et al

tooth with a post and core represents a treatment that In the present study, premolar teeth were selected
is as equally effective as an implant reconstruction. for examination. The decision to restrict the study to
In interpreting the outcomes of the present study, a only premolar teeth reduced variability in the study pa-
few limitations of the study design must be discussed. rameters associated with tooth configuration. Hence,
The current clinical analysis was retrospective in nature. the results of the present study are limited to treatment
Due to the inherent problems with retrospective studies, outcomes for premolar teeth.
the impact of varying amounts of coronal tooth struc- Most studies reporting on endodontically treated
ture on survival outcomes could not be determined. premolars were restricted to in vitro studies.39,40 Con-
Previous studies, both in vitro8,37 and clinical,17,38 have sequently, there are few clinical trials focusing on pre-
indicated the importance of remaining coronal tooth molars alone.
structure on the outcomes of endodontically treated As opposed to the results of the present study, Fer-
teeth. In the present study, the best available treatment rari et al38 reported an overall success rate of only 60%
at the time was performed. This often included surgical and a survival rate of 94.1% for endodontically treated
crown lengthening (84 out of 329 cases) to achieve a premolars over a period of 6 years. In this study, success
ferrule effect. was defined as absence of absolute and relative failures,
Out of a total of 659 patients eligible for this study, whereas survival was defined as absence of absolute
604 were contacted and 266 were recruited. This ac- failure. Even lower survival rates were reported41 with
counted for a recall rate of 44.0%. Uncontactable pa- success rates of 63.3% to 90.0% and survival rates of
tients accounted for 27.8% of patients eligible, and 86.6% to 100% over a period of only 4 years. Both
26.2% of patients refused to participate. A compari- studies focused on the use of fiber posts with com-
son of the patients who did not participate in the study posite cores and included the restoration of severely
with those who did revealed no major differences in the compromised teeth, such as those with an absence of
demographic parameters between these two groups. ferrule. These could have contributed to the lower sur-
Hence, the cohort examined may indeed be representa- vival rates.
tive of NDCS patients treated with post-and-core resto- In the present study, both prefabricated posts (30%)
rations supporting FDPs. A sample of 47 patients who and cast posts and cores (70%) were applied. In an
declined to participate were interviewed over the phone older study,42 success rates of 89.3% to 93.9% for end-
for their reasons for refusal. Commonly cited reasons odontically treated and restored premolars were report-
were busy schedules (n = 33), immobility (n = 3), and ed, although it was not clear whether these teeth were
prior bad experiences (n = 2). Most patients interviewed restored with both posts and cores and with crowns.
(n = 33) reported no problems with their treated tooth, The present study reported a 7-year overall success rate
3 patients claimed to have their tooth extracted prior to of 75.1% and a survival rate of 92.7%. However, direct
the telephone call, 2 patients had endodontic treatment comparisons with the studies mentioned may be limit-
redone, and 9 were unsure of the current status of their ed, as differences in types of restoration and definitions
treated teeth. of outcomes are evident.
Assuming that patients who were unsure of the condi- The most frequent biologic complication of the post-
tion of their previously treated teeth had experienced no and-core–treated nonvital teeth in the present study
problems or minor problems that had gone unnoticed was periapical pathology (7.3%). Comparing this pro-
by the patient, this results in a survival rate of 89.3%, portion to studies on endodontic success, the endodon-
which is comparable to the survival rate (88.6%) re- tic success rate of the present study was higher than
ported in the examined cohort. However, self-reported previously reported success rates of 68% to 85%2 and
outcomes from phone interviews should be interpreted 74% to 98%.1
with caution, especially as results are skewed toward It should be noted that results from the present study
patients’ perceptions and because complications that were based on periapical radiographs taken at the point
have occurred may have gone unnoticed by the patient. of review, and no comparisons with previous treatment
As opposed to previously published retrospective co- or postoperative radiographs were made. Due to the
hort studies, all the subjects participating in the pres- retrospective nature of the study, standardized radio-
ent study were recalled and physically examined by graphs were not performed for examination of the peri-
three standardized examiners. No data were obtained apical status of the teeth. In addition, no distinction was
through telephone interviews or on the basis of insur- made between development or regression of previously
ance claims, apart from the sample survey for reasons healed or persistent lesions.
for refusal mentioned, and the results of which were not The most common prosthesis-related complications
used for analysis. Hence, a calculation of time in func- in the present study were porcelain veneer chipping,
tion for all the reconstructions was possible and renders with 34 teeth (10.3%) found to have this in varying de-
the results able to be compared with each other. grees. Although this figure was higher compared to the

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 Clinical Research

risk of 2.6% reported for single crowns,43 a previous CONCLUSIONS

study on implant-supported single crowns performed in
the same institution30 showed similar results. The results of the present study indicate that endodon-
Significantly higher odds for tooth fracture were re- tically treated teeth with post-and-core reconstructions
ported in the present study for the number of adjacent yielded a success rate of 75.1% after 7 years in function.
teeth, indicating that the loss of one or both adjacent Such success is comparable to or even surpasses suc-
teeth next to the incorporated restoration represents cess rates presented in systematic reviews for implant-
an increased risk for tooth fracture. This is in line with reconstructed single crowns. Hence, preservation of
results from previously published clinical studies.44–48 endodontically treated teeth remains one of the most
Raedel et al44 found a statistically significant decrease important paradigms in clinical dentistry.
in survival times for teeth with no adjacent neighbor-
ing teeth (10.6 years) compared to teeth with at least ACKNOWLEDGMENTS
one adjacent proximal contact (13.8 years). A retrospec-
tive review46 of clinical records for 203 teeth found that The authors report no conflicts of interest.
teeth with 2 proximal contacts had better survival esti-
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Literature Abstract

Single Crowns on Tooth Toot-Resected Molars: A Retrospective Multicentric Study

Data regarding single-tooth restorations on molars treated with root resection and separation are limited. The purpose of this retrospective
study was therefore to evaluate the clinical success and survival rates of single crowns on root-resected molars. A total of 86 molars were
treated with root resection or hemisection, prepared with feather-edge margins, and restored with single crowns in 73 patients. The
patients were clinically evaluated during regular recall appointments in 2018. Data were analyzed using descriptive statistics. The mean
follow-up time was 88.7 months (standard deviation 70.6; range 6 to 284). Six failures were recorded during the observation period for
a cumulative survival rate of 93%. In this retrospective evaluation, single crowns on root-resected molars with feather-edge margins had
clinical outcomes similar to those reported for single crowns on implants in the molar area. First molars and molars with two retained roots
showed better survival rates than second molars.
Schmitz JH, Granata S, Magheri P, Noè G. J Prosthet Dent 2019, Epub ahead of print. References: 61. Reprints: Johannes H. Schmitz,
[email protected] —Terry Walton, Australia

Volume 33, Number 2, 2020 183

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NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.