3. Restoration of the Endodontically
Treated Tooth
Endodontic treatment is largely performed on teeth
significantly affected by caries, multiple repeat
restorations and/or fracture.
Already structurally weakened, such teeth are often
further weakened by the endodontic procedures
designed to provide optimal access .
4. Restorations of endodontically
treated teeth are designed to:-
(1) protect the remaining tooth from fracture.
(2) prevent reinfection of the root canal system.
(3) replace the missing tooth structure.
5. What are the objectives of Final
restoration?
1. Maintained coronal and apical seal of the root canal
treatment .
2. Protect and preserve the remaining tooth structure.
3. Provided a supportive and retention ,foundation for
the placement of definitive restoration.
4. Restore the function and esthetics.
6. What are the factors to be considered
while planning the final restoration?
Amount of remaining sound tooth structure.
Occlusal function.
Opposing dentition.
Position of the tooth in the arch.
Length, width and curvature of the roots.
7. Endodontically treated teeth are
weakened due to:-
◆ caries and/or previous restorations.
◆ fracture or trauma.
◆ endodontic access and instrumentation.
◆ decreased moisture.
8. Cusp Fracture Of Endodontically
Treated Teeth:_
endodontically treated teeth with intra-coronal
restorations are at higher risk and the occurrence of
unrestorable sub-gingival cusp fractures is more common.
there was a positive correlation between endodontically
treated teeth and subgingival fracture location.
9. Esthetic Changes in Nonvital and
Endodontically Treated Teeth:
Color change and darkening of nonvital teeth is a
common clinical observation.
Endodontic restoration of teeth in the esthetic zone
require careful control of procedures and materials to
retain a translucent, natural appearance.
Avoid the use of potentially staining endodontic cements
and to clean all material residues in the pulpal chamber
and access cavity.
10. Direct Composite Restorations:
Anterior teeth:-
Anterior teeth with minimal loss of tooth structure can be
restored conservatively with a bonded restoration in the
access opening.
A post is of little or no benefit in a structurally sound
anterior tooth ,Increases the chances of a failure.
11. Posterior teeth:
Endodontically treated posterior teeth are subject to
greater loading than anterior teeth, because of their
position closer to the insertion of the masticatory
muscles.
clinical success rates of endodontically treated premolars
restored with fiber posts and direct composite
restorations or full coverage with metal-ceramic crowns
were highly successful without any failures, even after 3
years of service .
14. POSTS
Characteristics of an ideal post:
1. Minimum preparation.
2. Resistance to fatigue.
3. Non corrosive.
4. Retentive (post & Head).
5. Easy to adjust and fit.
6. Radiopaque.
7. Adequate material
8. Easy Removal
15. Indications of post:-
The remaining coronal tooth structure is inadequate for
the retention of a restoration.
When there is sufficient root length to accommodate the
post while maintaining an adequate apical seal.
18. Post diameter
The diameter of the post is dictated by
the root canal anatomy.
A minimal dentin thickness of 1 mm around the post
should be provided
The post should be wide enough so that it does not
deform under loading.
A post should not be so wide that the root is
unnecessarily weakened, since this increases the risk
of root fracture.
19. Post design:
Posts can be serrated, smooth,
roughened or threaded.
Parallel, serrated posts
are cemented
into the canal passively.
They are retentive and produce less stress in the root
dentine than threaded systems.
20. Ferrule Effect
The ferrule is the circumferential ring of sound tooth
structure that is enveloped by the cervical portion of
the crown restoration. A minimum sound dentine
height of 1.5-2 mm is required between the core and
crown margins.
21. Importance of ferrule
The ferrule provides bracing or casing action to
protect the integrity of the root.
22. CORES:-
Core of the post and core restoration
replaces carious, fractured or missing
tooth structure , It also retains the final
crown.
23. Indications:
Core restorations are indicated if any of the
following clinical conditions exist:-
The replacement of missing coronal tooth
structure is necessary.
When the enhanced retention and resistance
to displacement of the final restoration is
necessary.
24. Materials used for core build up:
DIRECT PLACEMENT:
Composite resin
Amalgam
Glass ionomer resin
INDIRECT PLACEMENT:
Casting
28. So which is the best material for
core buildup???
The modulus of elasticity of amalgam is significantly
higher than all other material tested and is closer to
that of dentin.
Prepared core build-ups in a hybrid composite
material provided the highest fracture resistance.
study showed that the tensile and flexural strengths
of composite are significantly higher than that of
amalgam and glass ionomer.
29. Crowns:
Indications:
Better esthetics.
Situations in which the structural integrity of natural
crown is compromised.
Contraindications:
Anterior teeth have only have conservative access
opening.
