Pulpal Deterioration Following Restorative Procedures: A Case – Control Study
Bibliographic record
Abstract
INTRODUCTION: While restorative procedures aim to preserve tooth structure and function, they may contribute to pulpal deterioration, potentially necessitating endodontic intervention. This matched case-control study examined the time lapse from the most recent definitive (terminal) restoration to the onset of pulpal deterioration. METHODS: A computerized search of dental records (1999-2023) at the University of Toronto identified 1,360 permanent teeth that received terminal restorations followed by endodontic therapy (cases), matched 1:1 with 1,360 teeth that received terminal restorations without subsequent endodontic therapy (controls). Matching criteria included age at the time of restoration, tooth type, and number of prior restorations. Data were analyzed using descriptive statistics, chi-square tests, and multivariable Cox regression. RESULTS: The median time lapse to pulpal deterioration among cases was 14.3 months. Crowns and bridge retainers had the longest interval (28 months), followed by amalgam (17.4), composite resin (11.9), and glass ionomer (11.4). Earlier deterioration was observed in teeth with restorations involving more than two surfaces (11.5), with more than 2 prior restorations (13.9), and with pulp exposure (6.6). In adjusted analyses, glass ionomer (hazard ratio = 1.6; 95% confidence interval: 1.2-2.2) and multisurface restorations (hazard ratio = 1.5; 95% confidence interval: 1.2-1.7) were statistically significant associated variables. CONCLUSIONS: Pulpal deterioration may occur after a median time lapse of 14.3 months following terminal restoration placement. Crowns/bridge retainers and amalgam restorations were associated with slower progression of pulpal deterioration, whereas composite resin, glass ionomer, multisurface restorations, and pulp exposure were linked to an increased likelihood or earlier onset of pulpal deterioration.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.002 | 0.003 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".