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Introduction Thorough cleaning and shaping of root canals are essential for periapical healing. Restoration of endodontically-treated teeth is also required for them to function and prevent coronal leakage. This study compared the impact of the quality of root canal treatment versus the quality of coronal restoration in treatment outcomes. Methods Literature search was conducted using the search terms “coronal restoration”, “root canal”, “periapical status” and “quality”. Articles that evaluated the effect of the quality of root filling and coronal restoration or both on the success of root canal treatment were selected. Nine articles were identified and were reviewed by three investigators. Data were collected based on pre-determined criteria. Percentages of teeth without apical periodontitis were recorded for each category: Adequate Root Canal Treatment (AE), Inadequate Root Canal Treatment (IE), Adequate Restoration (AR), Inadequate Restoration (IR). Data were analyzed using meta-analysis for odds ratios (ORs). Results After adjusting for significant covariates to reduce heterogeneity, the results were combined to obtain pooled estimates of the common OR for the comparison of AR/AE vs AR/IE (OR 2.734; 95% CI 2.61–2.88; p<0.001) and AR/AE vs IR/AE (OR 2.808; 95% CI 2.64–2.97; p<0.001). Conclusion On the basis of the current best available evidence, the odds for healing of apical periodontitis increase with both adequate root canal treatment and adequate restorative treatment. Although poorer clinical outcomes may be expected with adequate root filling-inadequate coronal restoration and inadequate root filling-adequate coronal restoration, there is no significant difference in the odds of healing between these two combinations.

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