Survival Rates of Unrestorable Fracture of Endodontically Treated Anterior Teeth Restored with Resin Composites or Crowns: A Retrospective Cohort Study

Introduction: Current guidelines for the restoration of endodontically treated anterior teeth (ETT) are based on laboratory results and insufficient clinical findings. This retrospective cohort study aimed to compare the survival rates of ETT with unrestorable fracture restored with direct resin composite (DRC) or full coverage crown (FCC), and identify predisposing factors. Methods and Materials: Dental records and radiographs of ETT restored with DRC or FCC were collected from the dental charts of patients who received endodontic treatments and attended recall(s) from 2007 to 2019. Clinical/radiographic data and incidence of unrestorable fracture were recorded. Survival rates of ETT with unrestorable fracture treated with DRC and FCC were analyzed using Kaplan-Meier survival analysis and log-rank test, whereas predisposing factors were identified using Cox proportional-hazard model. Moreover, the survival rates of maxillary ETT with different sites of remaining cervical tooth structure were analyzed. Results: A total of 263 ETT with 157 DRC and 106 FCC were recruited. At an average recall period of 38 months, the survival rate of ETT restored with FCC was significantly higher (99.1%) than DRC (90.4%) (P<0.05). The predisposing factors of ETT with FCC were not identified; however, the identified predisposing factors of ETT with DRC were: (i) considered less than three walls of remaining cervical tooth structure, (ii) the ratio between root dentin thickness and root canal width at the cervical region was less than 1:1:1, (iii) loss of posterior-teeth support, and (iv) parafunctional habits. Maxillary ETT with complete or palatal structure had a significantly higher survival rate than those without the palatal structure (P<0.05). Conclusion: Based on the findings of the current cohort study, the survival rate of ETT with unrestorable fracture restored with FCC was significantly higher than DRC. However, ETT without predisposing factors were not susceptible to fracture and could be successfully restored with DRC.