Georgiana-Andreea Frumuzache, Simona Stoleriu, Sorin Andrian, Alice-Teodora Rotaru-Costin, Andrei Sălceanu, Eugenia-Larisa Ţarevici, Claudiu Topoliceanu, Mihaela Sălceanu
ABSTRACT
Background: The success of endodontic treatment depends not only on the quality of root canal obturation, but also on the integrity and sealing capacity of the coronal restoration. Clinical studies have shown that a defective coronal restoration can allow reinfection of the root canal system and compromise the apical seal, ultimately leading to treatment failure. In the current context, technological advancements in adhesive materials and CAD/CAM systems have transformed the paradigm of post-endodontic restoration, steering clinical practice toward more conservative and long-lasting solutions. Objective: The aim of this narrative review is to analyze the role of coronal restoration in the success or failure of endodontic treatment, by synthesizing data from recent literature and identifying future clinical and technological directions in post-endodontic rehabilitation. Methods: A critical analysis of the literature published between 1987 and 2024 was conducted by consulting the PubMed, Scopus, and Web of Science databases. The selection included clinical studies, systematic reviews, and meta-analyses that evaluated the relationship between coronal restoration quality, marginal sealing integrity, and the long-term success of endodontic treatment. Results: The synthesized data confirm that coronal sealing integrity directly influences the clinical outcome of endodontic treatment. Endodontically treated teeth with inadequate coronal restorations show a significantly higher incidence of periapical lesions. In contrast, modern adhesive restorations, fabricated using CAD/CAM technology or bioactive materials, provide superior marginal adaptation and optimal stress distribution. Conclusions: A timely, hermetic, and biomechanically stable coronal restoration is essential for the long-term success of endodontic treatment. The evolution of adhesive materials, digital technologies, and the interdisciplinary collaboration between the endodontist and the prosthodontist define the new standard of post-endodontic rehabilitation. The future of clinical practice lies in an integrated, digital, and bioactive approach that regards the restored endodontic tooth as a unified biological and functional system.
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