Download - 1st Prostho Group Journal Club
-
7/30/2019 1st Prostho Group Journal Club
1/30
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
-
7/30/2019 1st Prostho Group Journal Club
2/30
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
-
7/30/2019 1st Prostho Group Journal Club
3/30
PURPOSE
Evaluate clinical success rate of
endodontically treated premolars restored
with fiber posts and direct CR snd compare
similar treatment with MCC
-
7/30/2019 1st Prostho Group Journal Club
4/30
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
-
7/30/2019 1st Prostho Group Journal Club
5/30
117 subjects
Cointossed
GROUP 1 : GROUP 2
RCT +
Composite
RCT +
Composite
Metal
Ceramic
Crown
All procedures done by one operator
After 1 week
-
7/30/2019 1st Prostho Group Journal Club
6/30
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)
-
7/30/2019 1st Prostho Group Journal Club
7/30
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)
-
7/30/2019 1st Prostho Group Journal Club
8/30
RESULTS
-
7/30/2019 1st Prostho Group Journal Club
9/30
SUMMARY OF RESULTS
Year 1
No Failurereported
Recall for Group1=55
Recall for Group2= 57
Year 2
Recall for Group1= 48
Recall for Group2=57
Failure due to:
Post
decementation Marginal gaps
formation
Year 3
Recall for Group1=50
Recall for Group2=54
Failure due to :
Marginal gaps
formation
-
7/30/2019 1st Prostho Group Journal Club
10/30
-
7/30/2019 1st Prostho Group Journal Club
11/30
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
-
7/30/2019 1st Prostho Group Journal Club
12/30
Failures might be correlate due to fiber post
become flexible
Wear rate not included
Planned to continue until year 6
-
7/30/2019 1st Prostho Group Journal Club
13/30
CONCLUSION
Ceramo-metal crown coverage did not
enhance clinical performance of
endodontically treated and restored teeth
compared to composite
-
7/30/2019 1st Prostho Group Journal Club
14/30
CRITICAL APPRAISAL
Tom and Ryan
-
7/30/2019 1st Prostho Group Journal Club
15/30
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!
-
7/30/2019 1st Prostho Group Journal Club
16/30
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
-
7/30/2019 1st Prostho Group Journal Club
17/30
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)
-
7/30/2019 1st Prostho Group Journal Club
18/30
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
-
7/30/2019 1st Prostho Group Journal Club
19/30
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?
-
7/30/2019 1st Prostho Group Journal Club
20/30
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?
-
7/30/2019 1st Prostho Group Journal Club
21/30
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!
-
7/30/2019 1st Prostho Group Journal Club
22/30
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
-
7/30/2019 1st Prostho Group Journal Club
23/30
-
7/30/2019 1st Prostho Group Journal Club
24/30
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
-
7/30/2019 1st Prostho Group Journal Club
25/30
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
-
7/30/2019 1st Prostho Group Journal Club
26/30
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?
-
7/30/2019 1st Prostho Group Journal Club
27/30
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?
-
7/30/2019 1st Prostho Group Journal Club
28/30
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
-
7/30/2019 1st Prostho Group Journal Club
29/30
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
-
7/30/2019 1st Prostho Group Journal Club
30/30
QUESTIONS??