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Devon M. Ptak, DMD, MPH publishes new Clinical Research in the Journal of Endodontics

The Pulpal Response to Crown Preparation and Cementation

Devon M. Ptak, DMD, MPH, Anika Solanki, DMD, Lauren Andler, DMD, Deborah Tung, DMD, Shruti Jain, BDS MPH, Elinor Alon, DMD

Published: March 08, 2023, Journal of Endodontics



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).


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’.


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.


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.

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