Loss of pulp vitality following preparation of vital teeth for crowns/FDPs restorations for at least 5 years of follow up period: A Systematic Review and Meta-Analysis

Abstract

Background: Loss of pulp vitality is a common biological complication after full coverage indirect restorations, and dental practitioners should be aware of the contributing factors to achieve best treatment outcome.

Aim: The aim of current review was to investigate the incidence of loss of pulp vitality in the vital teeth restored with full coverage crown or FPDs (fixed dental prostheses) and the factors that might lead to loss of pulp vitality following crown preparation procedure.

Material and Methods: An electronic PubMed search accompanied with manual searching was conducted for the clinical studies on full coverage single crown or full coverage FPDs of vital teeth were performed from 1960 to November 2021 for at least 5 years of follow up period. Risk of bias was assessed with the Newcastle-Ottawa Scale. Statistical analyses were used to identify instantaneous incidence of loss of pulp vitality for the single crowns and bridge abutments groups, and subgroup of restorations according to the type of restoration material.

Results: The search provided 1964 records, after duplicates removal and screening of titles and abstracts, 27 records were eligible for full text reading resulting in 12 studies being included on full coverage crowns/bridges restorations in initially vital teeth. The instantaneous incidence of loss of pulp vitality in full coverage crowns/bridges group was 5.4% (95% CI,2.3- 12.3) and 7.4% (95% CI,4.4-12) respectively and the mean incidence of both groups was 6.5% (95% CI,4-10.4). The value of z is 3.1486, and the value of p is 0.00164, the result is significant at (p < 0.05) when comparing the loss of pulp vitality incidence of crowns and abutments. A Sub Mata-analysis conducted to identify the incidence in the type of material groups (MetalCeramic, All Ceramic and Zirconia) and yield incidence of pulp vitality loss among all ceramic material with an incidence of 5.3% (95%CI, 1.7-15.1), out of one study, and 6.5% (95%CI, 2.6-15.6) among metal ceramic restorations in three studies, while the incidence was 6.3% (95%CI,0.4-53.9) of zirconia crowns in one study.

Conclusion: Preserving the pulp vitality after cementation of crown or bridge is important for the best treatment outcome. The incidence of loss of pulp vitality in full coverage FDPs abutments is more compared to full coverage single crown in the vital teeth.