Assessing restored teeth with pulp and periapical diseases for the presence of cracks, caries and marginal breakdown

To determine whether clinical examinations and periapical radiographs provide sufficient information to assess the cause of pulp and periapical diseases, the status of teeth when restored and their further treatment needs. Other aims were to determine whether restorations should be removed prior to commencing endodontic treatment, and whether the type and longevity of restorations were related to the presence of disease.

Information was collected regarding 245 restored teeth from 220 consecutive patients referred for endodontic treatment. Teeth were examined before and after the restorations were removed and the findings were compared.

Pre-operative examination revealed 47 (19.2 per cent) teeth had caries, 57 (23.3 per cent) had cracks and 96 (39.2 per cent) had marginal breakdown. After restoration removal, the figures were 211 (86.1 per cent), 147 (60 per cent), and 244 (99.6 per cent) respectively. Almost all teeth (93 per cent) had more than one of these factors and periapical radiographs were unreliable indicators of their presence. There was only a 56.1 per cent chance (with 95 per cent Confidence Interval) of finding caries, cracks or marginal breakdown prior to restoration removal. Composite resins were more often associated with early onset and rapid progression of pulp diseases.

All restorations should be removed prior to endodontic treatment in order to remove the common factors that may have caused the pulp and periapical disease, and to assess the tooth's prognosis and future treatment needs.