Sir, the decision to place a full coverage crown can be difficult. An operator needs to be aware of the potential complications of crown placement, as well as the risks of not providing treatment.

There is little consensus as to how frequently endodontic complications arise in previously vital teeth. Certain cohort studies1 suggest that 98% of vital pulps will remain free from signs or symptoms of pulpal deterioration after five years, whilst other research suggests a far higher complication rate. One seminal study found that 19% of vital preparations (of unknown age) show evidence of peri-radicular disease.2

I would like to present the results of an internal audit in which I have looked at complications arising in crowns over the first five years following placement. The restorations in question were all single unit, full coverage crowns placed in adult patients by an experienced operator between 2003 and 2006 in a general dental practice. I was able to gather data for 510 teeth where the patient had regularly attended routine examination appointments for a minium of five years following crown placement.

In this cohort, only 6 teeth out of 411 which had not previously been endodontically treated (1.5%) went on to show signs or symptoms of pulpal deterioration within five years.

With adequate water cooling, a good knowledge of pulpal anatomy and conservative preparations the evidence from this cohort suggests that it is possible to place crowns with minimal risk of pulpal complications within five years.