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Pulpal Deterioration Following Restorative Procedures: A Case - Control Study.

S Desai¹, A Tepperman¹, A Ben Suleiman²

¹Faculty of Dentistry, University of Toronto, ON, Canada.

Journal of Endodontics

|June 15, 2025

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This summary is machine-generated.

Restorative dental procedures can lead to pulpal deterioration, with a median onset of 14.3 months after the final restoration. Certain materials like glass ionomer and multisurface restorations increase this risk, while crowns and amalgam show slower progression.

Area of Science:

Dental Restorations
Pulpal Health
Endodontic Outcomes

Background:

Restorative dental procedures aim to preserve tooth structure but can paradoxically lead to pulpal deterioration.
This necessitates understanding the timeline between definitive restorations and subsequent endodontic treatment needs.

Purpose of the Study:

To investigate the time interval from the placement of a definitive (terminal) dental restoration to the onset of pulpal deterioration.
To identify factors influencing the progression of pulpal issues post-restoration.

Main Methods:

A matched case-control study analyzed 1,360 teeth requiring endodontic therapy (cases) against 1,360 control teeth without endodontic intervention.
Data from 1999-2023 were extracted from dental records, with matching based on age, tooth type, and prior restoration history.

Keywords:

Endodontics pulpal deterioration restorations risk factors time lapse

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Statistical analyses included descriptive statistics, chi-square tests, and multivariable Cox regression.

Main Results:

The median time to pulpal deterioration was 14.3 months post-restoration.
Crowns and bridge retainers (28 months) and amalgam (17.4 months) showed longer intervals compared to composite resin (11.9 months) and glass ionomer (11.4 months).
Multisurface restorations and pulp exposure were significantly associated with earlier pulpal deterioration (HR 1.5 and 6.6 months respectively). Glass ionomer restorations also showed a significant association (HR 1.6).

Conclusions:

Pulpal deterioration can occur a median of 14.3 months after definitive restoration placement.
Restorations like crowns and amalgam are associated with slower pulpal deterioration.
Composite resin, glass ionomer, multisurface restorations, and pulp exposure are linked to an increased likelihood or earlier onset of pulpal deterioration, highlighting the need for careful material selection and procedural considerations.