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.


METHODS
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.
Türp
Jens C
JC
Clinic for Reconstructive Dentistry and Temporomandibular Disorders, Dental School, University of Basel, Basel, Switzerland. jens.tuerp@unibas.ch
Heydecke
Guido
G
Krastl
Gabriel
G
Pontius
Oliver
O
Antes
Gerd
G
Zitzmann
Nicola U
NU
D004708:Endodontics; D019317:Evidence-Based Medicine; D006801:Humans; D007180:Incisor / Q000293:injuries; D008297:Male; D008875:Middle Aged; D011176:Post and Core Technique; D014082:Tooth Fractures / Q000209:etiology / Q000628:therapy*; D014092:Tooth Root / Q000293:injuries; D019553:Tooth, Nonvital / Q000150:complications*