restoration of endodontically treated tooth

1. Prepared by :
azheen mohamad

2. Reference
Cohen's pathway of pulp 10 th edition
2010,chapter 22 ,pp777.
www.slide share.com

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 .

13. Components Of Final
Restoration:
 I. Posts
II. Cores
III.Crowns

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.

16. Post selection Factors to be
considered :
Post length
Post diameter
Post design

17. Post length

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

25. Composite resin core

26. Amalgam core

27. Glass Ionomer resin core

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.

30. Advantages
 Durable.
 Good esthetics.
 Restoring dental function.
 Good Form.
 Protection of tooth.

31. Disadvantages
 Loss of tooth structure
 Expensive
 Types:
• Metal-Ceramic Crowns.
• Porcelain Jacket Crown.
• Full Cast Metal Crowns.
• Partial Cast Metal Crowns.
• Temporary Crowns.