Acta Universitatis Dentistriae et Chirurgiae Maxillofacialis

The dentofacial apparatus is a complex morphofunctional system; disruption of the integrity or function of any of its components leads to pathological changes. Dentofacial abnormalities and deformities remain a significant problem in dentistry and maxillofacial surgery, particularly in patients with orofacial clefts. Many adult patients with congenital clefts of the lip, palate, and alveolar process, despite early multi-stage surgical and orthodontic treatment, have pronounced morphological and functional disorders of the dentoalveolar apparatus. These disorders considerably hinder the completion of rehabilitation and full restoration of masticatory function. The main challenges remain dentoalveolar and dentofacial deformities, jaw misalignment, weakening of the maxillary complex, bone deficiency, and significant soft-tissue scarring. We analyzed data from Russian and international publications on the feasibility of restoring masticatory function in adult patients with congenital cleft lip, palate, and alveolar process. Rehabilitation must take into account each patient’s individual characteristics. A comprehensive approach combining orthodontic, surgical, and orthopedic treatment is the cornerstone of successful masticatory function restoration, as well as of improving quality of life, social adaptation, and psychological comfort in this patient group.

BACKGROUND: In the pursuit of profit, private dental facilities often tend to prescribe excessive treatments that are not always justified by objective clinical indications. In particular, endodontic treatment prior to crown placement is frequently performed preemptively, which can lead to iatrogenic complications. The rationale for endodontic treatment before prosthetic treatment remains relevant even with modern dental technologies available.

AIM: This study aimed to conduct a retrospective analysis and evaluate the clinical rationale for endodontic treatment prior to prosthodontic treatment in private dental practice.

METHODS: A retrospective analysis was performed on 420 dental records of patients who received specialized care between January 2024 and December 2025. The inclusion criterion was the vitality of teeth subsequently restored with artificial crowns. Exclusion criteria included: patients over 45 years of age; the need for endodontic treatment due to a diagnosis of pulpitis; and patients with coronal destruction requiring post-and-core restorations. Of the 420 outpatient records analyzed, 185 met the study criteria. The patients were divided into two main groups based on the pulp management strategy during prosthodontic treatment: group I (n = 155) received preemptive endodontic treatment before tooth preparation; in group II (n = 30), tooth vitality was preserved. Subgroups were then created within each group based on the crown material for comparative analysis. The primary outcomes were the frequency and justification of pulp extirpation at various stages of prosthodontic treatment. Additionally, in group II, pulp protection methods and the incidence of iatrogenic pulpitis were evaluated.

RESULTS: In group I, the proportion of preemptive endodontic treatment prior to prosthodontic procedures was 83.8% of all analyzed cases. From the standpoint of documented justification, 81.3% of the cases in group I were clinically unwarranted. In group II, a complete pulp protection protocol was absent in 15.2% of observations; chemical protection was used in 46.7%, followed by combined methods in 33.3%, while temporary crowns were used in only 3.3% of cases. Failure to adhere to pulp protection standards led to traumatic pulpitis in 26.7% of patients, which necessitates a revision of tooth preparation approaches for prosthodontic treatment.

CONCLUSION: In modern dentistry, due to the commercialization of medical institutions, excessive dental procedures are performed, including endodontic treatment prior to prosthodontic care. These interventions are often carried out without clinically justified indications, which requires special attention.

On March 21, 2026, the IX All-Russian Scientific and Practical Conference “Prevention in Dentistry” was held in Saint Petersburg. The event was organized by the North-Western State Medical University named after I.I. Mechnikov. Co-sponsors included the Russian Dental Association and the Scientific Medical Society of Dentists of Saint Petersburg , and the Leningrad Region. The event was attended by over 150 physicians representing the following specialties: Pediatric Dentistry, General Dentistry, Orthopedic Dentistry, Therapeutic Dentistry, Surgical Dentistry, Orthodontics, and Radiology. Presentations were given on the prevention and treatment of caries, periodontal disease, and dentoalveolar anomalies, as well as on the potential of radiological imaging methods in the early diagnosis of dental diseases. Special attention was paid to the prevention of hyperplastic lesions of the oral mucosa during orthopedic appointments and the prevention of complications from orthodontic treatment. Prevention of dental diseases in women during pregnancy and the postpartum period was considered. Developments in new orthodontic implants for treating patients with distal dental relationships are presented. In addition, the prevention of temporomandibular joint dysfunction was discussed.