Clinical Parameter-based Evaluation of Restorative Treatment Difficulty in Endodontically Treated Teeth

To evaluate the difficulty levels of restoring endodontically treated teeth across the entire dental arch using a comprehensive multidimensional scoring system.

A total of 1000 teeth (incisors, premolars, and molars) from 654 patients were evaluated through clinical and radiographic examinations. Teeth were scored (1-6) based on the eight parameters of the Restorative Difficulty Evaluation System, which includes endodontic complexity, residual vertical and horizontal structures, marginal seal, interdisciplinary conditions, treatment complexity, and functional/esthetic requirements. Restorative difficulty was categorized into minor, moderate, or high levels. Data were analyzed using the Kruskal-Wallis, Dunn, Pearson's Chi-square, and Fisher-Freeman-Halton tests (P < .05).

The sample distribution comprised 10.8% incisors, 39.7% premolars, and 49.5% molars, with 13.7% classified as minor, 36.5% moderate, and 49.8% high difficulty. Statistical analysis revealed significant differences among tooth types for all parameters except horizontal residual structure and interdisciplinary conditions (P > .05). Furthermore, a significant correlation was found between tooth types and parameter difficulty levels across all categories, with the sole exception of interdisciplinary conditions.

Restorative difficulty in endodontically treated teeth depends on diverse clinical factors beyond traditional anatomical classification. Endodontic complexity and marginal seal serve as the primary determinants of difficulty. While molars pose higher technical risks, incisors exhibit a distinct multidimensional difficulty profile, with higher scores on specific parameters such as esthetic and wear demands. This 8-parameter index provides a standardized, reliable tool for preoperative assessment, enhancing treatment predictability and clinical outcomes across the entire dental arch.