What do systematic reviews say?

Pre-operative caries fillings or crowns vs Intact teeth

One study reported a 13% incidence in teeth with pre-operative caries fillings or crowns.

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Pre-operative caries fillings or crowns
  Proportion 13
  1 study
  GRADE not reported
• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Intact teeth
  Proportion 5
  1 study
  GRADE not reported

Pre-operative bone level < 35% vs Pre-operative bone level ≥ 35%

One study reported a 1.4% incidence with bone level < 35%.

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Bone level < 35%
  Proportion 1.4
  1 study
  GRADE not reported
• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Bone level ≥ 35%
  Proportion 0
  1 study
  GRADE not reported

Eugenol-based temporary cement vs Eugenol-free temporary cement

The pooled incidence with eugenol-based temporary cement was 3.34%.

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Eugenol-based
  Proportion 3.34 [1.66, 5.58]
  7043 participants
  GRADE not reported
• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Eugenol-free
  Proportion 5.77 [3.72, 8.24]
  639 participants
  GRADE not reported

Intervention not reported

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Reversible hydrocolloid impression material
  Proportion 1.19
  1 study
  GRADE not reported

Glass ionomer (GIC) permanent cement vs Glass ionomer cement or zinc phosphate cement

The pooled incidence with GIC permanent cement was 5.33%.

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  GIC
  Proportion 5.33 [2.56, 9.03]
  182 participants
  GRADE not reported

Indirect restorations (crowns, fixed partial dentures, inlays/onlays/veneers) vs None (single-group incidence)

Periapical pathosis incidence among follow-up >5-10 years was 3.88% (subgroup analysis; not GRADE-rated).

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  >5-10 years · University clinics and dental practices, multiple countries · Follow-up >5-10 years
  Proportion 3.88 [1.95, 6.45]
  1864 participants
  GRADE not reported
• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  >10 years · University clinics and dental practices, multiple countries · Follow-up >10 years
  Proportion 4.05 [0.89, 9.36]
  2656 participants
  GRADE not reported
• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Follow-up ≤5 to >10 years · University clinics and dental practices, multiple countries · Fixed partial dentures (FPD)
  Proportion 4.59 [2.28, 7.64]
  9 studies · 2435 participants
  GRADE not reported

Polyether impression material vs Polyvinyl siloxane impression material

The pooled incidence with polyether impression material was 4.02%.

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Polyether
  Proportion 4.02 [2.47, 5.92]
  2985 participants
  GRADE not reported
• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Polyvinyl siloxane
  Proportion 3.17 [1.55, 5.34]
  636 participants
  GRADE not reported

Ceramic restoration material vs Porcelain-fused-to-metal restoration material

The pooled incidence with ceramic restorations was 5.59%.

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Ceramic
  Proportion 5.59 [2.89, 9.12]
  460 participants
  GRADE not reported

Pulp-status assessment method

The pooled incidence with radiographic assessment was 4.95%.

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Radiographic
  Proportion 4.95 [2.43, 8.29]
  5 studies · 1853 participants
  GRADE not reported
• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Objective
  Proportion 5.66 [3.71, 7.99]
  24 studies · 6581 participants
  GRADE not reported

Zinc polycarboxylate cement

One study reported a 1.1% incidence with zinc polycarboxylate permanent cement.

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Zinc polycarboxylate
  Proportion 1.1
  1 study
  GRADE not reported

Intervention not reported

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Compound impression material
  Proportion 3.27
  1 study
  GRADE not reported

Indirect restorations (crowns, fixed partial dentures, inlays/onlays/veneers) vs None (single-group incidence)

The pooled incidence with ≤ 5 years of follow-up was 3.53%.

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  ≤ 5 years · ≤ 5 years
  Proportion 3.53 [2.10, 5.31]
  5532 participants
  Low