Clinical Research|Articles in Press

The Pulpal Response to Crown Preparation and Cementation

Published:March 08, 2023DOI:



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


      A retrospective chart review identified 2177 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 noncrown group than the full-coverage group (9.05% vs 7.54%, respectively). For patients who received large fillings, there was not a statistically significant difference based on operative material (amalgam vs composite: odds ratio = 1.32 [95% confidence interval, 0.94–1.85], P > .05) or the number of surfaces involved (3 vs 4: odds ratio = 0.78 [95% confidence interval, 0.54–1.12], P > .05). The association between the restoration type and the pulpal disease treatment performed was statistically significant (P < .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 with 5.68% (n = 101) in the large noncrown 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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