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

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


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.


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