Decision Making in the Restoration of Endodontically Treated Teeth: Effect of Biomimetic Dentistry Training

Abstract

The restoration of endodontically treated teeth (ETT) is challenging as these teeth often present with structural deficiencies. Currently, there is no consensus regarding the final restoration choice. Historically, the full coverage crown was the universally selected treatment for endodontically treated teeth. With advances in adhesive and biomimetic dentistry, more minimally invasive treatment modalities have become a viable option. With this study, we aim to understand the restorative decision of the general dentist with or without additional training in biomimetic dentistry. Seventy-eight general dentists, with or without biomimetic training, were surveyed to determine their restorative preferences on five extracted posterior teeth, categorized according to volumetric loss of tooth structure, as indicated by the number of missing walls, the isthmus width, the presence or absence of marginal ridges, and cusps. CAD/CAM reconstructions were made with the teeth to analyze the volume of tooth loss and compare these with the survey results. Data were compared using the chi-squared test and Fisher's exact test. The frequency of responses recommending a crown and the volume of tooth loss were correlated using the Pearson test (p < 0.05). For all five teeth, survey responses showed a statistically significant difference in the restorative decision of full coverage versus alternative restorations, with biomimetic dentists selecting a direct restoration or inlay/onlay in lieu of a full coverage crown (n = 63, p < 0.05). The age of the participant did not have a significant impact on the restorative decision making process for these teeth. The biomimetic trained dentists showed a greater tendency to select a crown option only when the volume of tooth loss was greatest, otherwise their restorative decisions tended towards the conservative treatment options. This study also demonstrates a novel method of digitally developing a volume of tooth loss to compare against the visual interpretation of the volume of tooth loss.

Keywords: biomimetic dentistry; endodontics; evidence-based dentistry; restorative dentistry.

Figure 1

(a) Photographs of the maxillary molar tooth with missing mesial and distal marginal ridge and disto-palatal cusp; (b) the restorative decision of all the participants obtained from this tooth; (c) the rationale behind the choice of the restorative decision; (d) the rationale against the use of a post.

Figure 2

(a) Photograph of the maxillary molar tooth with missing distal marginal ridge and disto-palatal and disto-lingual cusp; (b) the restorative decision of all the participants obtained from this tooth; (c) the rationale behind the choice of the restorative decision; (d) the rationale against the use of a post.

Figure 2

(a) Photograph of the maxillary molar tooth with missing distal marginal ridge and disto-palatal and disto-lingual cusp; (b) the restorative decision of all the participants obtained from this tooth; (c) the rationale behind the choice of the restorative decision; (d) the rationale against the use of a post.

Figure 3

(a) Photograph of the maxillary molar tooth with missing mesial marginal ridge; (b) the restorative decision of all the participants obtained from this tooth; (c) the rationale behind the choice of the restorative decision; (d) the rationale against the use of a post.

Figure 4

(a) Photographs of the maxillary premolar tooth missing mesial and distal marginal ridge; (b) the restorative decision of all the participants obtained from this tooth; (c) the rationale behind the choice of the restorative decision; (d) the rationale against the use of a post.

Figure 5

(a) Photograph of the mandibular molar with missing mesial marginal ridge; (b) the restorative decision of all the participants obtained from this tooth; (c) the rationale behind the choice of the restorative decision; (d) the rationale against the use of a post.

Figure 5

(a) Photograph of the mandibular molar with missing mesial marginal ridge; (b) the restorative decision of all the participants obtained from this tooth; (c) the rationale behind the choice of the restorative decision; (d) the rationale against the use of a post.

Figure 6

Depicts the 3D reconstruction of the maxillary molar acquired by 3Shape Digital Designer, (3Shape Copenhagen, Denmark). (A) Photograph of the extracted tooth; (B) the buccal view; (C) The distal view; (D) the occlusal view; (E) the mesial view; (F) the lingual view of the 3D scan; (G) the 3D reconstruction with an inlay; (H) the inlay proposal of the tooth generated with 3D shaped digital designer.

Figure 7

Depicts the 3D reconstruction of the maxillary molar acquired by 3Shape Digital Designer, (3Shape Copenhagen, Denmark). (A) Photograph of the extracted tooth; (B) the buccal view; (C) the distal view; (D) the occlusal view; (E) the mesial view; (F) the lingual view of the 3D scan; (G) the 3D reconstruction with an inlay; (H) the inlay proposal of the tooth generated with 3D shaped digital designer.

Figure 8

Depicts the 3D reconstruction of the maxillary molar acquired by 3Shape Digital Designer, (3Shape Copenhagen, Denmark). (A) Photograph of the extracted tooth; (B) the buccal view; (C) the distal view; (D) the occlusal view; (E) the mesial view; (F) the lingual view of the 3D scan; (G) the 3D reconstruction with an inlay; (H) the inlay proposal of the tooth generated with 3D shaped digital designer.

Figure 9

Depicts the 3D reconstruction of the maxillary premolar acquired by 3Shape Digital Designer, (3Shape Copenhagen, Denmark). (A) Photograph of the extracted tooth; (B) the buccal view; (C) the distal view; (D) the occlusal view; (E) the mesial view; (F) the lingual view of the 3D scan; (G) the 3D reconstruction with an inlay; (H) the inlay proposal of the tooth generated with 3D shaped digital designer.

Figure 10

Depicts the 3D reconstruction of the mandibular molar acquired by 3Shape Digital Designer, (3Shape Copenhagen, Denmark). (A) Photograph of the extracted tooth; (B) the buccal view; (C) the distal view; (D) the occlusal view; (E) the mesial view; (F) the lingual view of the 3D scan; (G) the 3D reconstruction with an inlay; (H) the inlay proposal of the tooth generated with 3D shaped digital designer.

Figure 11

Correlation analysis for the volume of tooth loss, and frequency of decision for full crown restoration, for dentists trained in biomimetic dentistry. The Pearson correlation value is 0.4563, indicating moderate positive correlation.

Figure 12

Correlation analysis for the volume of tooth loss, and frequency of decision for full crown restoration, for dentists not trained in biomimetic dentistry. The Pearson correlation value is 0.3691, indicating weak correlation.