Restorative outcomes for endodontically treated teeth in the practitioners engaged in applied research and learning network

Background. The authors aimed to determine the outcome of and factors associated with success and failure of restorations in endodontically treated teeth in patients in practices participating in the Practitioners Engaged in Applied Research and Learning (PEARL) Network. Methods. Practitioner- investigators (P-Is) invited the enrollment of all patients seeking care at participating practices who had undergone primary endodontic therapy and restoration in a permanent tooth three to five years earlier. P-Is classified endodontically reated teeth as restorative failures if the restoration was replaced, the restoration needed replacement or the tooth was cracked or fractured. Results. P-Is from 64 practices enrolled in the study 1,295 eligible patients who had endodontically treated teeth that had been restored. The mean (standard deviation) time to follow-up was 3.9 (0.6) years. Of the 1,298 enrolled teeth, P-Is classified 181 (13.9 percent; 95 percent confidence interval [CI], 12.1-15.8 percent) as restorative failures: 44 (3.4 percent) due to cracks or fractures, 57 (4.4 percent) due to replacement of the original restoration for reasons other than fracture and 80 (6.2 percent) due to need for a new restoration. When analyzing the results by means of multivariate logistic regression, the authors found a greater risk of restorative failure to be associated with canines or incisors and premolars (P =.04), intracoronal restorations (P <.01), lack of preoperative proximal contacts (P <.01), presence of periodontal connective-tissue attachment loss (P <.01), younger age (P =.01), Hispanic/Latino ethnicity (P =.04) and endodontic therapy not having been performed by a specialist (P =.04). Conclusions. These results suggest that molars (as opposed to other types of teeth), full-coverage restorations, preoperative proximal contacts, good periodontal health, non-Hispanic/Latino ethnicity, endodontic therapy performed by a specialist and older patient age are associated with restorative success for endodontically treated teeth in general practice. Clinical Implications. These results contribute to the clinical evidence base to help guide practitioners when planning the restoration of endodontically treated teeth.