Restoring the fractured root-canal-treated maxillary lateral incisor: In search of an evidence-based approach

Objective: To demonstrate the existing difficulties and variability in the application of evidence-based dentistry by comparing the recommendations made by 4 dental experts for the treatment of a fractured tooth. Method and Materials: A case presentation was given to 4 specialists, who were asked to independently develop and explain their personal favorite treatment strategy, based on the best available external evidence and their clinical expertise. The entire case was then reviewed by an expert in evidence-based medicine and discussed with the first author. Results: Each of the 4 experts relied on different articles in justifying their clinical decisions. The minimal overlap in the literature they cited largely explains the different treatment suggestions: While the endodontist preferred a metal post-and-core and a porcelain-fused-to-metal (PFM) crown, both the operative dentist and the prosthodontist opted for a glass-fiber post/fiber-reinforced resin composite post. The perio-prosthodontist recommended a PFM crown with either a direct or indirect post and core. The citation analysis revealed that little high-quality information is available about what would be the best therapy for horizontal fractures of root-canal-treated anterior teeth. Conclusions: This article illustrates that, although it is now common practice in dentistry to base clinical decision making on external evidence from the literature, search strategies and the resulting clinical recommendations still vary greatly. Keywords: dental abutments, evidence-based dentistry, fixed partial denture, post-and-core technique, resin cements, root canal therapy, tooth fractures, tooth-root injuries, treatment outcome, treatment planning