The restoration of endodontically threated posterior teeth: the full-adhesive strategy

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The radiographic (a) and clinical (b) aspect
10. The radiographic (a) and clinical (b) aspect of the endocrown restoration one week after the luting.

Conclusions

Recently, the restoration of endodontically treated teeth with adhesive techniques has been advocated both in the root and in the crown to prevent further loss of sound tissues as adhesion ensures sufficient material retention without needing an aggressive macroretentive preparation10-12. In particular, the use of bonded overlays like endocrowns for the coronal restoration of an ETT is growing against classical full-crown restorations. Reason for this change of paradigm is a more conservative approach, which preserves tooth tissues and allows re-intervention in case of failure. Furthermore, endocrowns eliminate many technical steps during the fabrication - such as post cementation, core fabrication, temporary crown and potential crown lengthening, which increase treatment time and costs. All these intermediary stages may also favor bacterial infiltration and cause endodontic re-infection. Different materials can be used to fabricate an endocrown like feldsphatic and glass-ceramic, hybrid composite and the newest CAD/CAM ceramic and composite blocks. Scientific literature is still not clear about which material is best indicated for such restorations. The authors prefer micro-hybrid composite resins - lab-made or in the form of CAD/CAM blocks - claiming their stress absorbing properties and their practical benefits like the possibility to modify and repair the surface easily13. Lithium-disilicate reinforced glass-ceramics (e.g. IPS e.max Press and CAD, Ivoclar, Schaan-Liechstenstein) may be alternatives to this concept above all for esthetic reasons. Several in-vitro studies and some in-vivo trials have confirmed the validity of this adhesive approach, especially for molars10,14-19. By relying on adhesion, no radicular posts are necessary any more on molars and at the present moment it is difficult to decide if posts are necessary on premolars and front teeth. If yes, they may only be considered in case of extremely destructed teeth. Consequently, in many instances, restoration of devital teeth may follow the same principles as the restoration of vital teeth20.

Photos copyright:
Figures 1 and 2 with the courtesy of GT. Rocca, I. Krejci, “Restaurations adhésives pour dent dépulpée. L’alternative au tout couronne”. Réalités Cliniques 2011(1)25-31.

References

1. Goldstein GR. The longevity of direct and indirect posterior restorations is uncertain and may be affected by a number of dentist-, patient-, and material-related factors. J Evid Based Dent Pract 2010;10:30-31.

2. Ericson D, Kidd E, McComb D, Mjör I, Noack MJ. Minimally Invasive Dentistry – concepts and techniques in cardiology. Oral Health Prev Dent 2003;1:59-72.

3. Reeh ES, Messer HH, Douglas WH. Reduction in tooth stiffness as a result of endodontic and restorative procedures J Endod 1989;15:512-6.

4. Panitvisai P, Messer HH. Cuspal deflection in molars in relation to endodontic and restorative procedures. J Endod 1995;21:57-61.

5. Pashley DH, Tay FR, Breschi L, Tjäderhane L, Carvalho RM, Carrilho M & Tezvergil-Mutluay. A State of the art etch-and-rinse adhesives. Dent Mater 2011;27:1-16.

6. Dietschi D, Bouillaguet S. Restoration of the Endodontically Treated Tooth In: Cohen S, Hargreaves KM (eds) Pathways of the pulp. St. Louis, Mo : Elsevier Mosby, 2006;777-807.

7. Koth DL. Full crown restorations and gingival inflammation in a controlled population. The Journal of prosthetic dentistry 1982;48:681-685.

8. Rocca GT, Krejci I. Bonded indirect restorations for posterior teeth: from cavity preparation to provisionalization. Quintessence International 2007;38:371-379.

9. Rocca GT, Krejci I. Bonded indirect restorations for posterior teeth: the luting appointment. Quintessence International 2007;38:543-553.

10. Krejci I, Duc O, Dietschi D, de Campos E. Marginal adaptation, retention and fracture resistance of adhesive composite restorations on devital teeth with and without posts. Operative Dentistry 2003;28:127-135.

11. Mohammadi N, Kahnamoii MA, Yeganeh PK, Navimipour EJ. Effect of fiber post and cusp coverage on fracture resistance of endodontically treated maxillary premolars directly restored with composite resin. J Endod 2009;35:1428-1432.

12. Bitter K, Kielbassa AM. Post-endodontic restorations with adhesively luted fiber-reinforced composite post systems: a review. Am J Dent 2006;20:353-60.

13. Rocca GT, Bonnafous F, Rizcalla N, Krejci I. A technique to improve the esthetic aspects of CAD/CAM composite resin restorations. J Prosthet Dent 2010;104:273-275.

14. Lin C, Chang Y, Pai C. Evaluation of failure risks in ceramic restorations for endodontically treated premolar with MOD preparation. Dent Mater 2011;27:431-438.

15. Magne P, Knezevic A. Simulated fatigue resistance of composite resin versus porcelain CAD/CAM overlay restorations on endodontically treated molars. Quintessence International 2009;40:125-133.

16. Magne P, Knezevic A. Thickness of CAD-CAM composite resin overlays influences fatigue resistance of endodontically treated premolars. Dent Mater 2009;25:1264-1268. 17. Lin C, Chang Y, Pa C. Estimation of the risk of failure for an endodontically treated maxillary premolar with MODP preparation and CAD/CAM ceramic restorations. J Endod 2009;35:1391-1395.

18. Bindl A, Mörmann WH. Clinical evaluation of adhesively placed Cerec endo-crowns after 2 years -preliminary results. The Journal of Adhesive Dentistry 1999;1:255-265.

19. Bindl A, Richter B, Mormann WH. Survival of ceramic computer-aided design/manufacturing crowns bonded to preparations with reduced macroretention geometry. The International Journal of Prosthodontics 2005;18:219-224.

20. Rocca GT, Krejci I. Crown- and post-free adhesive restorations for endodontically treated posterior teeth: from direct composite to Endocrowns. Eur J Esthet Dent 2013 ;8(2):156-79.

 

 

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