The Critical Time-lapse between Various Restoration Placements and Subsequent Endodontic Intervention

The Pulpal Response to Crown Preparation and Cementation

INTRODUCTION

This study aimed to evaluate the risk factors and occurrence of pulpal disease in patients who received either 'full coverage' (crowns) or 'large non-crown' restorations (fillings, inlays, or onlays, involving ≥3 surfaces).

METHODS

A retrospective chart review identified 2,177 cases of large restorations placed on vital teeth. Based on the restoration type, patients were stratified into various groups for statistical analysis. After restoration placement, those who required endodontic intervention or extraction, were classified as having 'pulpal disease'.

RESULTS

Over the course of the study, 8.77% (n=191) of patients developed pulpal disease. Pulpal disease was slightly more common in the 'large non-crown' group than the 'full coverage' group (9.05% vs. 7.54%, respectively). For patients that received large fillings, there was not a statistically significant difference based on operative material (Amalgam vs. Composite: OR = 1.32 [95% CI (0.94, 1.85)], P>0.05) or number of surfaces involved (3 vs. 4: OR = 0.78 [95% CI (0.54, 1.12)], P>0.05). The association between restoration type and pulpal disease treatment performed was statistically significant (P<0.001). The 'full coverage' group more frequently underwent endodontic treatment than extraction (5.78% vs. 3.37%, respectively). Only 1.76% (n=7) of teeth in the 'full coverage' group were extracted, compared to 5.68% (n=101) in the 'large non-crown' group.

CONCLUSIONS

It appears that ∼9% of patients who receive large restorations will go on to develop pulpal disease. The risk of pulpal disease tended to be highest in older patients who receive large (4 surface) amalgam restorations. However, teeth with 'full coverage' restorations were less likely to be extracted.

British Society of Prosthodontics Debate on the Implications of the Minamata Convention on Mercury to Dental Amalgam--Should our Patients be Worried?

In 2013, the Minamata Convention on Mercury called for a global phase-down of amalgam use, with a view to reduce environmental mercury pollution. This will significantly impact UK dentistry, given the still extensive use of amalgam in U.K. general dental practice. However, until now there has been little national discussion or debate. In Spring 2015, The British Society of Prosthodontics dedicated a significant part of its Annual Conference to debating the implications of this issue. Clinical case examples were discussed with audience interaction and voting facilitated using innovative Audience Response System Technology. A remarkable range of concerns and opinions were given. The debate elicited specific concerns amongst clinicians regarding the suitability of mercury-free alternatives to amalgam; particularly where cavities are large and extend beneath the gingival anatomy. There are also anecdotal reports of Dental Foundation (DF) dentists not being adequately taught the use of dental amalgam in undergraduate dental schools. CPD/CLINICAL RELEVANCE: Many clinicians, especially those treating patients for whom moisture control is challenging, feel that amalgam should remain available for clinicians to choose in certain clinical circumstances for the restoration of posterior teeth, even in the event of a complete phase-down.