1st prostho group journal club

7/30/2019 1st Prostho Group Journal Club

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THREE-YEAR CLINICAL

COMPARISON OF SURVIVAL OF

ENDODONTICALLY TREATED

TEETH RESTORED WITH EITHER

FULL CAST COVERAGE OR WITH

DIRECT COMPOSITERESTORATION

Fracesco Mannocci MD, DDS, PhD

Egidio Bertelli MD,DDSMarlyn Sheriff BSc, PhD

Timothy Watson BSc, DDS, PhD

T.R Pitt Ford BDS, PhD


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STATEMENT OF PROBLEM

Little information exists regarding outcome of

crown build-ups on endodontically treated

teeth restored with MCC or with only direct

placed CR


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PURPOSE

Evaluate clinical success rate of

endodontically treated premolars restored

with fiber posts and direct CR snd compare

similar treatment with MCC


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MATERIALS & METHODS

117 subjects (54 men, 63 women)

Age: 35 55 years old (mean: 48 years old)

Education level: 61% high school/universitydegree

Teeth included: 24 maxillary first premolars,

57 maxillary second premolars, 3 first

mandibular premolars, 33mandibular second

premolars-----met all the specific

inclusion/exclusion criteria


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117 subjects

Cointossed

GROUP 1 : GROUP 2

RCT +

Composite

RCT +

Composite

Metal

Ceramic

Crown

All procedures done by one operator

After 1 week


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CLINICAL EVALUATION

Success or failure

Perfomed by 2 examiners other than the

operator

1. Visual inspection

-Continuity of margin

-Periodontal probing2. Periapical radiograph

3. Photographic examination (colourslides)


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FAILURE

Root fracture

Post fracture

Post decementationClinical/ radiographic evidence of marginal

gap

Clinical evidence of secondary caries

The 2 groups were compared.

Data analyzed by use of a computer programme

(StatXact-3)


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RESULTS


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SUMMARY OF RESULTS

Year 1

No Failurereported

Recall for Group1=55

Recall for Group2= 57

Year 2

Recall for Group1= 48


Failure due to:

Post

decementation Marginal gaps

formation

Year 3



Failure due to :

Marginal gaps

formation


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DISCUSSION

Equivalent failure rate between Group 1 and

Group 2

Suggest to include matched pairs of teeth to

reduce bias

Results cant be compared to other studies

on post-crown and composite restorations of

endodontically treated teeth


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Failures might be correlate due to fiber post

become flexible

Wear rate not included

Planned to continue until year 6


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CONCLUSION

Ceramo-metal crown coverage did not

enhance clinical performance of

endodontically treated and restored teeth

compared to composite


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CRITICAL APPRAISAL

Tom and Ryan


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OPENING

Must be said that this is an experimental

clinical study and these are often very difficult

to set up but the purpose of today is to

critique the study and see whereimprovements could be made. So we may

seem a bit harsh!


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TITLE

We felt the title does not accurately describe

the method:

- states teeth rather than premolars

- fails to state that it is a direct composite

restoration AND a fibre post


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STATEMENT OF PROBLEM

The study does try and answer an important

question, i.e. what coronal restoration is best

for endodontically treated teeth (albeit only

premolars with intact cusps)


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PURPOSE AND INTRODUCTION

States that MCC most common system for

anterior and premolar crown coverage for

aesthetic reasons function needs to be

considered

Not entirely clear whether posts are being

used with the teeth that are being crowns


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M & M SELECTION CRITERIA

Premolars selected but in differing positions inthe mouth also, one group may havecontained more of one type than the other

Both cusps intact but was access for endominimal to preserve tooth structure was allendo done by the same operator and if so towhat skill level? Students or specialist?

We also felt that both cusps intact could mean asignificant amount of tooth structure left needfor crown or need for post justified?


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M & M SELECTION CRITERIA

Mentions need to be in occlusal function after

treatment but doesnt take into account

parafunction, malocclusion or what tooth is

opposed by can affect outcome

Perio attachment loss of 40% - bit high?!?

As far as subject selection goes we werent

sure why pt education was relevantprevious dental attendance perhaps a better

indicator?


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M & M CLINICAL PROCEDURE(GO TO FLOW CHART)

RCT too generalised. Technique used, skill ofoperator, same operator?

Post placement why 7mm? Surely on basis ofroot formation.

Crown prep 6 degree convergence seemshopeful?!

Crown fabrication one lab but same technicianor different ones?

Standardisation of procedure creates a strongerstudy!


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M & M JADAD SCORES

Procedure to used independantly assessmethodological quality of a clinical trial

Three questions asked:

1. Was it randomised?

2. Was it blind?3. Was there description of withdrawals or

dropouts?

Score +1 for yes, 0 for no

Additional points given if: method of randomisation described and appropriate

method of blinding described and appropriate

Points deducted if either of above points inappropriate


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M & M - BLINDING

Blinding is difficult as the operator knows

what theyre placing and the patient knows

what theyve been given BUT can do blind

analysis of datathis wasnt done however


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M & M - WITHDRAWALS OR DROPOUTS(GO TO CLINICAL EVALUATION SLIDE)

There was drop out exact reasons notstated

Does say that teeth lost due to trauma,

endodontic or periodontal problems wereconsidered missing data but how much was thisand how much was non attendance?

Non attendance could possibly be attributed to

failureCould do intention to treat the patient is

counted even though they have been lost tofollow up


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M & M - CLINICAL EVALUATION

Examiner agreement exceeded 90% - but

what is the relationship of the examiners to

the operator. Colleagues? Juniors?

Marginal gap formation considered failure.

Teeth lost to endo failure not counted how

many endo failures were due to marginal gap

formation but not counted?


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RESULTS AND DISCUSSION

Findings are stated clearly based on theoutcome measurements. There is nodifference between the two groups. But:

No power calculations for this study(explanation?); problematic for ethical approvalnowadays?

Were there differences between the various

types of premolar? They suggest matching pairsof teeth but rightly state this is difficult to do insufficient numbers

Improve tooth selection more broken

down?


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RESULTS AND DISCUSSION (CONTD)

Numbers are small so statistical significance

may not have been picked up (however must

be said numbers are good for a clinical trial)

Tooth wear is mentioned as a factor that

might affect long term clinical performance of

composite crown build ups

Longer study needed6 year review planned


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CONCLUSIONS

Within the limitations of this study

acknowledges that that further scope is

required

It is an experimental clinical trial and these

are often difficult to set up strengths are

that it is in vivo and clinical

Will it change our clinical practice? Not likelyon the strength of this study alone


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QUESTIONS??

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