Restoration of the endodontically treated tooth Amith Babu  Amrita Dora Ganesh O.R Praveen J Ourvind Singh
CONTENTS  <ul><li>Introduction  </li></ul><ul><li>History </li></ul><ul><li>Need for final restoration </li></ul><ul><li>O...
The tooth as a house
INTRODUCTION <ul><li>Endodontic treatment is largely performed on teeth significantly affected by caries, multiple repeat ...
INTRODUCTION <ul><li>Hence require special considerations for the final restoration, particularly where there has been ext...
CONTENTS  <ul><li>Introduction   </li></ul><ul><li>History </li></ul><ul><li>Need for final restoration </li></ul><ul><li>...
HISTORY <ul><li>Various methods of restoring pulpless teeth have been reported for past 200 years. </li></ul><ul><li>In 17...
Is final restoration after endodontic treatment important?
LITERATURE REVIEW <ul><li>1 In this study using radiographs they assessed the following </li></ul><ul><li>Good restoration...
CONTENTS  <ul><li>Introduction   </li></ul><ul><li>History </li></ul><ul><li>Need for final restoration </li></ul><ul><li>...
What are the objectives of Final restoration?
GOALS <ul><li>2 Maintained coronal and apical seal of the root canal treatment  </li></ul><ul><li>Protect and preserve the...
What are the factors to be considered while planning the final restoration?
FACTORS <ul><li>3 Amount of remaining sound tooth structure </li></ul><ul><li>Occlusal function </li></ul><ul><li>Opposing...
CONTENTS  <ul><li>Introduction   </li></ul><ul><li>History </li></ul><ul><li>Need for final restoration </li></ul><ul><li>...
4 Based on the remaining tooth structure 4 Restoring endodontically treated teeth with posts and cores—a review Ingrid per...
6 Restoration of Endodontically Treated Teeth: An Evidence-Based Literature Review University of Toronto, Faculty of Denti...
FERRARI AND OTHERS FOKKINGA & OTHERS SAMPLES 240 endodontically-treated premolars in 210 patients 307 endodontically-treat...
8 Ferrari M. Post placement affects survival of endodontically treated premolars. JDentRes 2007;86(8):729-734. 8 Fokkinga ...
CONTENTS  <ul><li>Introduction   </li></ul><ul><li>History </li></ul><ul><li>Need for final restoration </li></ul><ul><li>...
ANTERIOR TEETH <ul><li>9 Anterior teeth with minimal loss of tooth structure can be restored conservatively with a bonded ...
ANTERIOR TEETH <ul><li>10 A post is of little or no benefit in a structurally sound anterior tooth </li></ul><ul><li>Incre...
ANTERIOR TEETH <ul><li>11 In cases of extensive loss of external tooth structure, a post is usually required for anterior ...
Anterior Teeth 13 Biomechanical considerations for the restoration of endodontically treated teeth: A systematic review of...
Anterior Teeth 14 Biomechanical considerations for the restoration of endodontically treated teeth: A systematic review of...
CONTENTS  <ul><li>Introduction   </li></ul><ul><li>History </li></ul><ul><li>Need for final restoration </li></ul><ul><li>...
Considerations for posterior teeth <ul><li>Endodontically treated posterior teeth are subject to greater loading than ante...
Posterior teeth <ul><li>15 The results showed that the clinical success rates of endodontically treated premolars restored...
<ul><li>CASE REPORT </li></ul><ul><li>Post-endodontic restoration of a deeply decayed tooth - options and limitation Micha...
 
 
Posterior teeth <ul><li>16 Molar teeth rarely require a post unless there has been significant loss of tooth structure. A ...
<ul><li>CASE REPORT </li></ul><ul><li>Reconstruction of Endodontically Treated Posterior Teeth—with or without Post? Macie...
 
 
 
 
<ul><li>Tooth fracture of an endodontically treated maxillary molar restored with a bonded composite restoration. </li></ul>
CONTENTS  <ul><li>Introduction   </li></ul><ul><li>History </li></ul><ul><li>Need for final restoration </li></ul><ul><li>...
COMPONENTS OF FINAL RESTORATION <ul><li>Posts </li></ul><ul><li>Cores </li></ul><ul><li>Crowns  </li></ul>
CONTENTS  <ul><li>Introduction   </li></ul><ul><li>History </li></ul><ul><li>Need for final restoration </li></ul><ul><li>...
<ul><li>Role of posts </li></ul><ul><li>Indications </li></ul><ul><li>Post selection:Factors to be considered  </li></ul><...
The Role of Posts in the Restoration of Endodontically Treated Teeth <ul><li>18 The primary purpose for a post is to retai...
INDICATIONS  <ul><li>19 Post placement is indicated if  both  of the following clinical conditions exist: </li></ul><ul><l...
FACTORS TO CONSIDER <ul><li>Post length </li></ul><ul><li>Post diameter </li></ul><ul><li>Post design </li></ul>20 Stockto...
Post length <ul><li>21 Guidelines: </li></ul><ul><li>1. The post should more than the incisocervical or occlusocervical di...
Ideal tooth preparation for post placement
 
Post Size and Length <ul><li>22 Post length is unique and individualized for each case. The clinician should have a thorou...
Post diameter <ul><li>23 The diameter of the post is dictated by </li></ul><ul><li>the root canal anatomy.  </li></ul><ul>...
The diameter of the post is dictated by the remaining root substance and root canal space: (A) too narrow; (B) optimum siz...
Post design <ul><li>24 Posts can be serrated, smooth, roughened or threaded. </li></ul><ul><li>Parallel, serrated posts ar...
Ferrule Effect <ul><li>25 The ferrule is the circumferential ring of sound tooth structure that is enveloped by the cervic...
Importance of ferrule <ul><li>The ferrule provides bracing or casing action to protect the integrity of the root. </li></ul>
26 Effect of a crown ferrule on the fracture resistance of endodontically treated teeth restored with prefabricated posts ...
<ul><li>27 An incomplete crown ferrule is associated with greater variation in load capacity and, despite high fracture va...
27 CHARACTERISTICS OF AN IDEAL POST: <ul><li>Minimum preparation. </li></ul><ul><li>Resistance to fatigue.  </li></ul><ul>...
28 TYPES OF POSTS METALLIC NON-METALLIC <ul><li>Stainless Steel </li></ul><ul><li>Titanium </li></ul><ul><li>Titanium Allo...
Types of Posts
Prefabricated posts
Custom made posts <ul><li>Direct Technique </li></ul><ul><li>Indirect Technique </li></ul>Wax pattern before casting.
Custom cast post and core <ul><li>Advantages: </li></ul><ul><li>Preservation of maximum tooth structure </li></ul><ul><li>...
29 Prefabricated Tapered Post <ul><li>Advantages: </li></ul><ul><li>Conserves tooth structure </li></ul><ul><li>High stren...
30 Prefabricated Parallel - Sided Smooth Post <ul><li>Advantages: </li></ul><ul><li>Excellent clinical retention </li></ul...
31 Prefabricated Threaded Posts <ul><li>Advantages: </li></ul><ul><li>High retention </li></ul><ul><li>Disadvantages: </li...
32 Carbon Fiber Post <ul><li>Advantages: </li></ul><ul><li>Dentin bonding </li></ul><ul><li>Easy removal </li></ul><ul><li...
33 Fiber Reinforced Post <ul><li>Advantages: </li></ul><ul><li>Esthetic  </li></ul><ul><li>Disadvantages: </li></ul><ul><l...
34 Zirconia Ceramic Post <ul><li>Advantages: </li></ul><ul><li>Esthetics </li></ul><ul><li>High stiffness </li></ul><ul><l...
Procedure  Textbook of Endodontology 2 editions Preben Hørsted-Bindslev  Page no 326
A review of the studies done on the various post systems suggests that the fiber posts are the most reliable!!!
<ul><li>Background:  Post design and material has very important effects on dentinal stress distribution since the post pl...
<ul><li>Purpose.  This in vitro study compared the effect of titanium, quartz fiber, glass fiber, and zirconia posts syste...
<ul><li>Conclusion : The fiber posts evaluated provided an advantage over a conventional post that showed a higher number ...
<ul><li>PURPOSE: This retrospective study evaluated treatment outcome of cast post and core and Composipost systems after ...
<ul><li>PURPOSE: This study aggregated literature data on in vitro failure loads and failure modes of prefabricated fiber-...
MECHANICAL PROPERTIES 40 Evolving Technology in Endodontic Posts.  Pitel M., Hicks N Comp. Of Cont. Educ. in Dent. January...
CONTENTS  <ul><li>Introduction   </li></ul><ul><li>History </li></ul><ul><li>Need for final restoration </li></ul><ul><li>...
<ul><li>Indications </li></ul><ul><li>Principles </li></ul><ul><li>Types of core build up </li></ul><ul><li>Procedure  </l...
INDICATIONS   <ul><li>Core restorations are indicated if  any  of the following clinical conditions exist: </li></ul><ul><...
MATERIALS USED FOR CORE BUILD UP <ul><li>DIRECT PLACEMENT: </li></ul><ul><li>Composite resin </li></ul><ul><li>Amalgam </l...
Composite resin core <ul><li>Advantages: </li></ul><ul><li>Good compressive strength </li></ul><ul><li>Easy to manipulate ...
Amalgam core <ul><li>Advantages: </li></ul><ul><li>Reduced marginal leakage </li></ul><ul><li>Better dimensional stability...
Glass Ionomer resin core <ul><li>Advantages: </li></ul><ul><li>Anticariogenic </li></ul><ul><li>Adhesive </li></ul><ul><li...
So which is the best material for core buildup???
<ul><li>The modulus of elasticity of amalgam is significantly higher than all other material tested and is closer to that ...
<ul><li>This study showed that the tensile and flexural strengths of composite are significantly higher than that of amalg...
<ul><li>Tensile strength and modulus of elasticity of glass ionomer cements are significantly lower than dentin and amalga...
CONTENTS  <ul><li>Introduction   </li></ul><ul><li>History </li></ul><ul><li>Need for final restoration </li></ul><ul><li>...
CROWNS <ul><li>Indications </li></ul><ul><li>Advantages  </li></ul><ul><li>Disadvantages  </li></ul><ul><li>Types  </li></ul>
CROWN PLACEMENT <ul><li>INDICATIONS </li></ul><ul><li>Better esthetics </li></ul><ul><li>Situations in which the structura...
CROWNS <ul><li>Advantages: </li></ul><ul><li>Durable </li></ul><ul><li>Good esthetics </li></ul><ul><li>Restoring dental f...
METAL-CERAMIC CROWNS <ul><li>It consists of a ceramic layer bonded to a thin cast metal coping that fits over the tooth pr...
51 PORCELAIN JACKET CROWN <ul><li>It consists of a crown entirely made up of ceramic. </li></ul><ul><li>Superior esthetics...
52 FULL CAST METAL CROWNS <ul><li>Cast metal crown is a full crown restoration which is cast with dental alloy. </li></ul>...
53 PARTIAL CAST METAL CROWNS <ul><li>Partial cast metal crowns may be used when the buccal surface of the tooth is intact....
54 TEMPORARY CROWNS <ul><li>Temporary crowns are used to protect a tooth that has been prepared for a permanent crown whil...
Conclusion
Anterior Tooth Class IV Class I - III Complete Coverage is required Prefabricated fiber post with composite core  full cer...
Posterior Tooth Class IV Class I-III Conservative Trt Onlay Class V Composite Core Fiber post Metal Ceramic Crown Pre-fabr...
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6.restoration of the endodontically treated tooth

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  • Important to maintain Integrity of tooth
  • Studies pertaining to the clinical performance of post and core and non-post and core retained full coverage crowns. Our aim was to locate research, appraise and communicate the evidence found from scientific studies pertaining to the clinical performance of post and core and non-post and core retained full coverage crowns in order to determine which system would minimize post-operative complications and furnish long term prognoses.
  • Outcome Measures and Rates (1) Re-cementation of crown is not considered a failure (data is censured instead) (2) Extraction due to periodontal reasons is not considered a failure (data is censured instead). Includes tooth loss due to fracture of crown/root, periradicular disease, caries, trauma, or other reasons)
  • Typical configuration allowing conservative treatment of an endodontically treated tooth using an adhesive technique with a post as an additional retentive feature. ( a ) Preoperative view: the maxillary right central incisor is nonvital with a large composite restoration. ( b and c ) After removal of existing restorative materials, the residual tooth structure is judged insufficient (width and height) to assume full retention and strength as a prosthetic foundation.
  • ( d and e ) A white fiber post is used as a retentive feature. ( f and g ) Completed prosthetic treatment with all-ceramic restoration on the right central and veneer on the left central incisor.
  • The inspection of the tooth’s hard tissue after removal of the filling showed a remaining palatal dentine wall so that a post insertion could be indicated. A rubber dam was applied in order to prevent further contamination of the endodont and to not impede the adhesive reconstruction of the crown through saliva penetration. The post bed was first rinsed with a 17% EDTA solution to remove the smear layer and then disinfected with a 5.25% NaOCl solution. After drying the well, the post( uxaPost is a glass fiber reinforced composite post) was seated and checked using a marker and foil pen. For the reconstruction of the coronal portion LuxaCore Z-Dual was used as well and lightcured as described above (figure 15).After the so-called ferrule preparation was completed (figure 16 and 17) a provisional was made and cemented in using a temporary adhesive.
  • The inspection of the tooth’s hard tissue after removal of the filling showed a remaining palatal dentine wall so that a post insertion could be indicated. A rubber dam was applied in order to prevent further contamination of the endodont and to not impede the adhesive reconstruction of the crown through saliva penetration. The post bed was first rinsed with a 17% EDTA solution to remove the smear layer and then disinfected with a 5.25% NaOCl solution. After drying the well, the post( uxaPost is a glass fiber reinforced composite post) was seated and checked using a marker and foil pen. For the reconstruction of the coronal portion LuxaCore Z-Dual was used as well and lightcured as described above (figure 15). After the so-called ferrule preparation was completed (figure 16 and 17) a provisional was made and cemented in using a temporary adhesive.
  • A 36-year-old patient came to the surgery complaining of pressure pain on tooth 16. The tooth had been provisionally restored while on holiday after the partial loss of a restoration in silver amalgam (Fig 1). The radiograph (Fig 2) showed a periapical transparency and it was decided that an endodontic intervention was needed on the tooth in question. It was decided that the inappropriate amalgam restoration on tooth 15 would be eliminated as well and two restorations would be applied in composite.
  • Fig 3 Once the tooth has been treated post-endodontically and after the cavity has been thoroughly cleaned, the healthy residual tissue can be assessed and decisions made on the most appropriate restoration technique. Fig 4 The composite restoration is built up very gradually in order to reduce curing shrinkage that causes stress to the walls.
  • Fig 5 The preparation is now complete and the retractor threads are positioned for a precision impression. Fig 6 The composite inlays are ready for adhesive cementing.
  • Fig 7 Once the first inlay has been cemented, any excess material is carefully eliminated. The inter-proximal can then be finished and the second inlay begun. Fig 8 The finished case. Please note the high level of functional and esthetic integration. Fig 9 The final radiographs show the healing and precision of the inlays: the different radio-transparencies of the materials utilized are clearly shown and this helps to understand the thickness of the buildup, the dentin, and the enamels used.
  • Hence, posts do not serve to strengthen teeth. They only serve to retain the core.In actuality, placing a post can predispose a tooth to fracture.
  • a post is that the minimum length of remaining solid tooth equal the sum of the biologic width (2.5 mm), the ferrule length (2 mm), the apical seal (4 mm) and the post length, or 8.5 mm + post length ( Fig. 1 ).
  • The post should be wide enough so that it does not deform under loading. This will depend on the alloy used for construction. A post should not be so wide that the root is unnecessarily weakened, since this increases the risk of root fracture
  • A serrated parallel-sided post is usually the optimal choice for an anterior root-filled tooth. Smooth-sided cast posts are used in canals that are oval in cross-section or when there has been significant loss of coronal dentine from the root canal. The surface of the cast post can be sandblasted to improve retention. Ceramic posts are smooth and are used with a dentine bonding agent to improve retention.
  • When a crown is placed on a tooth with optimal ferrule, the crown and root function as one integrated unit and occlusal forces are transmitted in normal physiological fashion to the periodontium. Where inadequate ferrule exists, occlusal stresses are transferred directly to the core and/or post with high likelihood of tooth, root or post fracture or post dislodgement. In such cases adequate circumferential tooth structure for the vital tooth can best be gained by a)surgical crown lengthening, b) forced orthodontic eruption or, in selected cases, c) sub-gingival preparation and prolonged temporization to allow reestablishment of the biological width.
  • Antirotation effect 1)Risk of fracture without ferrule 2)with ferrule
  • Posts can be broadly divided into prefabricated and custom made. The prefabricated posts can be further divided into metallic and non metallic.
  • Posts can be made from various materials such as stainless steel (A), aesthetic carbon fiber (B), carbon fiber (C), and ceramic (D)
  • Prefabricated post designs. A , Tapered, smooth. B , Parallel, serrated. C , Tapered, self-threading. D , Parallel, threaded. Note that the post fits into pretapped threads in the dentin. E , Parallel, serrated, tapered end.
  • DIRECT TECHNIQUE:(-pretend the model is patient &apos; s mouth-) Do NOT allow resin to set completely. Loosen and reset it several times while it is still rubbery • Once resin has polymerized, remove the pattern • Inspect for any undercuts in pattern and trim away • Measure and verify pattern post is same as prepared post length • Check that pattern goes in and out of canal without binding • Additional resin is Indirect Technique Any elastomeric material will make An accurate impression of the root canal if a wire reinforcement is placed to prevent distortion
  • Advantages: Preservation of maximum tooth structure, the post is fabricated to fit the radicular space Provision of anti-rotational properties Core retention, since core is an inherent part of the post RECOMMENDED USE: The cast post and core is indicated where the inclination of the canal is significantly different from the alignment of the crown. FIGURE: Cast gold post and core for replacement of an anterior tooth.
  • Recommended Use: Only when maximum retention is essential like in teeth with short roots.
  • Flexural Strength – the max load it can withstand during bending Tensile Strength - maximum load that a material can support without fracture when being stretched Elastic modulous – the deformity under elastic load, low value means that the matrial is flexible so it wont fracture easily
  • Core of the post and core restoration replaces carious, fractured or missing tooth structure It also retains the final crown
  • *Durability; dental crowns can last for up to 10 years if properly cared for *Aspect; the look of the tooth will be natural *Restoring dental function and protecting the tooth *Form; a destroyed tooth will get its initial shape after the placement of the crown
  • Inadequate tooth reduction can lead to a bulky crown and poor aesthetics. It is possible to finish the buccal margins with a porcelain butt shoulder to improve the marginal fit and give excellent appearance
  • Stained dentine and metal posts affect the aesthetic appearance of a porcelain jacket crown; however, they can be placed over cores built up in composite or glass ionomer. Excessive occlusal loading may be a problem and can result in unpredictable fracture. In-ceram crowns have a glass infiltrated aluminium oxide ceramic core covered with conventional porcelain. Greater tooth reduction is required than with a metal-ceramic crown (1.5-2.0 mm for In-ceram crowns).
  • Minimal Coronal damage  *Intact Marginal Ridge, *Intact cingulum, *Intact incisal ridge, (esthetically acceptable) Moderate Coronal Damage  *one or two small proximal lesions Significant Coronal damage  *undermined marginal ridges, *loss of incisal edge, *coronal fracture, (esthetically unacceptable)
  • Minimal Coronal damage  *low risk of fracture, *minimal occlusal forces, Intact buccal and lingual cusps Moderate Coronal Damage  *minimum one sound cusp Significant Coronal damage  little or no remaining coronal tooth structure, High risk of fracture
  • 6.restoration of the endodontically treated tooth

    1. 1. Restoration of the endodontically treated tooth Amith Babu Amrita Dora Ganesh O.R Praveen J Ourvind Singh
    2. 2. CONTENTS <ul><li>Introduction </li></ul><ul><li>History </li></ul><ul><li>Need for final restoration </li></ul><ul><li>Objectives </li></ul><ul><li>Classification </li></ul><ul><li>Anterior teeth </li></ul><ul><li>Posterior teeth </li></ul><ul><li>Components of final restoration: </li></ul><ul><li>Posts </li></ul><ul><li>Cores </li></ul><ul><li>Crowns </li></ul>
    3. 3. The tooth as a house
    4. 4. INTRODUCTION <ul><li>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 and by the restorative procedures necessary to rebuild the tooth. </li></ul><ul><li>It is therefore accepted that endodontically treated teeth are weaker and tend to have a lower lifetime prognosis. </li></ul>
    5. 5. INTRODUCTION <ul><li>Hence require special considerations for the final restoration, particularly where there has been extensive loss of tooth structure. The special needs involve ensuring both adequate retention for the final restoration and maximum resistance to tooth fracture. </li></ul><ul><li>Endodontic success depends not only on the quality of the root canal treatment, but also on timely coronal restoration of the compromised tooth. </li></ul>
    6. 6. CONTENTS <ul><li>Introduction </li></ul><ul><li>History </li></ul><ul><li>Need for final restoration </li></ul><ul><li>Objectives </li></ul><ul><li>Classification </li></ul><ul><li>Anterior teeth </li></ul><ul><li>Posterior teeth </li></ul><ul><li>Components of final restoration: </li></ul><ul><li>Posts </li></ul><ul><li>Cores </li></ul><ul><li>Crowns </li></ul>
    7. 7. HISTORY <ul><li>Various methods of restoring pulpless teeth have been reported for past 200 years. </li></ul><ul><li>In 1747 Pierre Fauchard fabricated gold and silver posts to be placed in root canal space. </li></ul><ul><li>Replacement crowns were made from bone, ivory, animal tooth. </li></ul>
    8. 8. Is final restoration after endodontic treatment important?
    9. 9. LITERATURE REVIEW <ul><li>1 In this study using radiographs they assessed the following </li></ul><ul><li>Good restorations + good endodontic treatments resulted in absence of periapical inflammation in 91.4%. </li></ul><ul><li>Poor restorations + poor endodontic treatments resulted in the absence of periradicular inflammation in only 18.1%. </li></ul><ul><li>Poor endodontic treatment + good restorations yielded a success rate of 67.6%. </li></ul>1 Periapical status of endodontically treated teeth in relation to the technical quality of the root filling and the coronal restoration.H. A. Ray and M. Trope International Endodontic Journal, vol. 28, no. 1, pp. 12–18, 1995. This shows the importance of final restoration in endodontically treated teeth
    10. 10. CONTENTS <ul><li>Introduction </li></ul><ul><li>History </li></ul><ul><li>Need for final restoration </li></ul><ul><li>Objectives </li></ul><ul><li>Classification </li></ul><ul><li>Anterior teeth </li></ul><ul><li>Posterior teeth </li></ul><ul><li>Components of final restoration: </li></ul><ul><li>Posts </li></ul><ul><li>Cores </li></ul><ul><li>Crowns </li></ul>
    11. 11. What are the objectives of Final restoration?
    12. 12. GOALS <ul><li>2 Maintained coronal and apical seal of the root canal treatment </li></ul><ul><li>Protect and preserve the remaining tooth structure </li></ul><ul><li>Provided a supportive and retention foundation for the placement of definitive restoration </li></ul><ul><li>Restore the function and esthetics </li></ul>2 Colour atlas of endodontics 2 edition William T.Johnson DDS MS Page no 130
    13. 13. What are the factors to be considered while planning the final restoration?
    14. 14. FACTORS <ul><li>3 Amount of remaining sound tooth structure </li></ul><ul><li>Occlusal function </li></ul><ul><li>Opposing dentition </li></ul><ul><li>Position of the tooth in the arch </li></ul><ul><li>Length, width and curvature of the roots </li></ul>3 Endodontics : Restoring of Endodontically Treated Teeth American Association of Endodontics.1995 Dec Publication
    15. 15. CONTENTS <ul><li>Introduction </li></ul><ul><li>History </li></ul><ul><li>Need for final restoration </li></ul><ul><li>Objectives </li></ul><ul><li>Classification </li></ul><ul><li>Anterior teeth </li></ul><ul><li>Posterior teeth </li></ul><ul><li>Components of final restoration: </li></ul><ul><li>Posts </li></ul><ul><li>Cores </li></ul><ul><li>Crowns </li></ul>
    16. 16. 4 Based on the remaining tooth structure 4 Restoring endodontically treated teeth with posts and cores—a review Ingrid peroz et al.Quintessence International no.9 volume 36 oct 2005. Classification Description Class I 4 walls Class II 3 walls Class III 2 walls Class IV 1 wall Class V No wall
    17. 17. 6 Restoration of Endodontically Treated Teeth: An Evidence-Based Literature Review University of Toronto, Faculty of Dentistry. Int J Prosthodont 2008;18(1):40-1.
    18. 18. FERRARI AND OTHERS FOKKINGA & OTHERS SAMPLES 240 endodontically-treated premolars in 210 patients 307 endodontically-treated teeth in 257 patients TEST TREATMENT Fiber posts Cast post and core Pre-fab metal post and composite core CONTROL TREATMENT No post Post-free composite core DURATION (YRS) 2 Up to 17 CONCLUSIONS 4 coronal wall remaining: no difference in complication rates ≤ 3 coronal walls remaining: post placement increases survival rates Where “substantial remaining dentin” is available, a post and core does not perform better than a post-free core
    19. 19. 8 Ferrari M. Post placement affects survival of endodontically treated premolars. JDentRes 2007;86(8):729-734. 8 Fokkinga W. Up to 17-year controlled clinical study on post-and-cores and covering crowns. J Dent 2007;35(10):778-786.
    20. 20. CONTENTS <ul><li>Introduction </li></ul><ul><li>History </li></ul><ul><li>Need for final restoration </li></ul><ul><li>Objectives </li></ul><ul><li>Classification </li></ul><ul><li>Anterior teeth </li></ul><ul><li>Posterior teeth </li></ul><ul><li>Components of final restoration: </li></ul><ul><li>Posts </li></ul><ul><li>Cores </li></ul><ul><li>Crowns </li></ul>
    21. 21. ANTERIOR TEETH <ul><li>9 Anterior teeth with minimal loss of tooth structure can be restored conservatively with a bonded restoration in the access opening </li></ul>9 Intracoronal reinforcement & coronal coverage:a study of endodontically treated teeth. Sorensen JA, Martinoff JT. J Prosthet Dent 1984;51:780–4.
    22. 22. ANTERIOR TEETH <ul><li>10 A post is of little or no benefit in a structurally sound anterior tooth </li></ul><ul><li>Increases the chances of a failure </li></ul>10 Fracture strength and survival rate of endodontically treated maxillary incisors with approximal cavities after restoration with different post and core systems: an in-vitro study. Heydecke G, Butz F, Strub JR. J Dent 2001; 29:427–33.
    23. 23. ANTERIOR TEETH <ul><li>11 In cases of extensive loss of external tooth structure, a post is usually required for anterior teeth, due to the predominantly shearing forces present and the narrow tooth dimensions. </li></ul><ul><li>Extra-coronal crown preparation combined with endodontic access preparation significantly weakens the cervical area of anterior teeth. </li></ul>11 Post Placement and Restoration of Endodontically Treated Teeth: A Literature Review. Richard S. Schwartz, et al. Journal of Endodontics:VOL. 30, NO. 5, MAY 2004
    24. 24. Anterior Teeth 13 Biomechanical considerations for the restoration of endodontically treated teeth: A systematic review of the literature. Didier Dietschi,, Ivo Krejci, Quintessence international Volume 39 number 2 february 2008
    25. 25. Anterior Teeth 14 Biomechanical considerations for the restoration of endodontically treated teeth: A systematic review of the literature. Didier Dietschi,, Ivo Krejci, Quintessence international Volume 39 number 2 february 2008
    26. 26. CONTENTS <ul><li>Introduction </li></ul><ul><li>History </li></ul><ul><li>Need for final restoration </li></ul><ul><li>Objectives </li></ul><ul><li>Classification </li></ul><ul><li>Anterior teeth </li></ul><ul><li>Posterior teeth </li></ul><ul><li>Components of final restoration: </li></ul><ul><li>Posts </li></ul><ul><li>Cores </li></ul><ul><li>Crowns </li></ul>
    27. 27. Considerations for posterior teeth <ul><li>Endodontically treated posterior teeth are subject to greater loading than anterior teeth, because of their position closer to the insertion of the masticatory mus­cles. This, combined with their morphologic character­istics, makes them more susceptible to fracture. </li></ul>
    28. 28. Posterior teeth <ul><li>15 The results showed that the 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 . </li></ul><ul><li>15 J Prosthet Dent 2002 Sep;88(3):297-301. Three-year clinical survival of endodontically treated premolars restored with either full cast coverage or with direct composite restoration. Mannocci F, Bertelli E, Sherriff M, Watson TF, Ford TR </li></ul>
    29. 29. <ul><li>CASE REPORT </li></ul><ul><li>Post-endodontic restoration of a deeply decayed tooth - options and limitation Michael Bruder, DDS. Jounal of oral science,11: 2;2007. </li></ul>
    30. 32. Posterior teeth <ul><li>16 Molar teeth rarely require a post unless there has been significant loss of tooth structure. A coronal-radicular core buildup with silver amalgam utilizing the pulp chamber, and possible 2 mm canal extensions, has proved very effective in vitro and in vivo. </li></ul><ul><li>16 Nayyar, A., An amalgam coronal-radicular dowel and core technique for endodontically treated posterior teeth. J Prosthet Dent, 1980. 43 : p. 511. </li></ul>
    31. 33. <ul><li>CASE REPORT </li></ul><ul><li>Reconstruction of Endodontically Treated Posterior Teeth—with or without Post? Maciej Zarow, Walter Devoto. The European Journal Of Esthetic Dentistry. Volume 4,number 4,december 2009. </li></ul>
    32. 38. <ul><li>Tooth fracture of an endodontically treated maxillary molar restored with a bonded composite restoration. </li></ul>
    33. 39. CONTENTS <ul><li>Introduction </li></ul><ul><li>History </li></ul><ul><li>Need for final restoration </li></ul><ul><li>Objectives </li></ul><ul><li>Classification </li></ul><ul><li>Anterior teeth </li></ul><ul><li>Posterior teeth </li></ul><ul><li>Components of final restoration : </li></ul><ul><li>Posts </li></ul><ul><li>Cores </li></ul><ul><li>Crowns </li></ul>
    34. 40. COMPONENTS OF FINAL RESTORATION <ul><li>Posts </li></ul><ul><li>Cores </li></ul><ul><li>Crowns </li></ul>
    35. 41. CONTENTS <ul><li>Introduction </li></ul><ul><li>History </li></ul><ul><li>Need for final restoration </li></ul><ul><li>Objectives </li></ul><ul><li>Classification </li></ul><ul><li>Anterior teeth </li></ul><ul><li>Posterior teeth </li></ul><ul><li>Components of final restoration: </li></ul><ul><li>Posts </li></ul><ul><li>Cores </li></ul><ul><li>Crowns </li></ul>
    36. 42. <ul><li>Role of posts </li></ul><ul><li>Indications </li></ul><ul><li>Post selection:Factors to be considered </li></ul><ul><li>Ferrule effect </li></ul><ul><li>Types </li></ul><ul><li>Procedure </li></ul>POSTS
    37. 43. The Role of Posts in the Restoration of Endodontically Treated Teeth <ul><li>18 The primary purpose for a post is to retain a core that can be used to support the final restoration. </li></ul><ul><li>Posts do not reinforce endodontically treated teeth, and a post is not necessary when substantial tooth structure is present after a tooth has been prepared. </li></ul><ul><li>18 W. Cheung, “A review of the management of endodontically treated teeth: post, core and the final restoration,” Journal of the American Dental Association, vol. 136, no. 5, pp. 611–619, 2005. </li></ul>
    38. 44. INDICATIONS <ul><li>19 Post placement is indicated if both of the following clinical conditions exist: </li></ul><ul><li>The remaining coronal tooth structure is inadequate for the retention of a restoration. </li></ul><ul><li>When there is sufficient root length to accommodate the post while maintaining an adequate apical seal. </li></ul>19 Stockton LW.Factors affecting retention of post systems: A literature review. J Prosthet Dent 1999;81:380–385.
    39. 45. FACTORS TO CONSIDER <ul><li>Post length </li></ul><ul><li>Post diameter </li></ul><ul><li>Post design </li></ul>20 Stockton LW.Factors affecting retention of post systems: A literature review. J Prosthet Dent 1999;81:380–385.
    40. 46. Post length <ul><li>21 Guidelines: </li></ul><ul><li>1. The post should more than the incisocervical or occlusocervical dimension of the crown. </li></ul><ul><li>2. The post should be longer than the crown. </li></ul><ul><li>3. The post should be 1 1/3 the length of the crown. </li></ul><ul><li>4. The post should end halfway between the crestal bone and the root apex. </li></ul>21 Stockton LW.Factors affecting retention of post systems: A literature review. J Prosthet Dent 1999;81:380–385.
    41. 47. Ideal tooth preparation for post placement
    42. 49. Post Size and Length <ul><li>22 Post length is unique and individualized for each case. The clinician should have a thorough knowledge of root morphology before placing a post. </li></ul><ul><li>The longer the post, the greater the retention. A guideline of one half to three quarters of the root length is often followed but may not be reasonable for extremely long, short, narrow, or curved roots </li></ul>22 Retention of endodontic dowels: effects of cement, dowel length, diameter, and design. Standlee JP, Caputo AA, Hanson EC: J Prosthet Dent 39:401, 1998. The effect of the embedded depth of posts on retentive capacity has been shown to be significant
    43. 50. Post diameter <ul><li>23 The diameter of the post is dictated by </li></ul><ul><li>the root canal anatomy. </li></ul><ul><li>A minimal dentin thickness of 1 mm around the post should be provided. </li></ul>23 Lloyd PM, Palik JF. The philosophies of dowel diameter preparation: A literature review. J Prosthet Dent 1993;69:32–36.
    44. 51. The diameter of the post is dictated by the remaining root substance and root canal space: (A) too narrow; (B) optimum size post; (C) too large.
    45. 52. Post design <ul><li>24 Posts can be serrated, smooth, roughened or threaded. </li></ul><ul><li>Parallel, serrated posts are cemented into the canal passively. They are retentive and produce less stress in the root dentine than threaded systems </li></ul>24 Post Placement and Restoration of Endodontically Treated Teeth: A Literature Review. Richard S. Schwartz, et al. Journal of Endodontics:VOL. 30, NO. 5, MAY 2004
    46. 53. Ferrule Effect <ul><li>25 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. </li></ul>25 S orensen JA and Engelman MJ. Ferrule design and fracture resistance of endodontically treated teeth. J Prosthet Dent 1999;63:529-536.
    47. 54. Importance of ferrule <ul><li>The ferrule provides bracing or casing action to protect the integrity of the root. </li></ul>
    48. 55. 26 Effect of a crown ferrule on the fracture resistance of endodontically treated teeth restored with prefabricated posts <ul><li>STATEMENT OF PROBLEM: Root fracture is one of the most serious complications following restoration of endodontically treated teeth </li></ul><ul><li>Fifty freshly extracted canines were endodontically treated. The teeth were randomly divided into groups of 10 and prepared according to 5 experimental protocols </li></ul>The results of this study showed that an increased amount of coronal dentin (ferrule) significantly increases the fracture resistance of endodontically treated teeth. 26 Effect of a crown ferrule on the fracture resistance of endodontically treated teeth restored with prefabricated posts. Pereira JR, de Ornelas F, Conti PC, do Valle AL J Prosthet Dent. 2006 Jan;95(1):50-4.
    49. 56. <ul><li>27 An incomplete crown ferrule is associated with greater variation in load capacity and, despite high fracture values, inclines to fracture. </li></ul>27 Effect of incomplete crown ferrules on load capacity of endodontically treated maxillary incisors restored with fiber posts, composite build-ups, and all-ceramic crowns: an in vitro evaluation after chewing simulation. Naumann M, Preuss A, Rosentritt M. Acta Odontol Scand. 2006 Feb;64(1):31-6.
    50. 57. 27 CHARACTERISTICS OF AN IDEAL POST: <ul><li>Minimum preparation. </li></ul><ul><li>Resistance to fatigue. </li></ul><ul><li>Elastic modulus similar to dentin. </li></ul><ul><li>Non corrosive. </li></ul><ul><li>Retentive (post & Head). </li></ul><ul><li>Easy to adjust and fit. </li></ul><ul><li>Radiopaque. </li></ul><ul><li>Adequate material </li></ul><ul><li>Easy Removal </li></ul><ul><ul><li>27 Factors determining post selection: A literature Review. </li></ul></ul><ul><ul><li>Fernandes A., Shetty Sh., Coutinho I.- </li></ul></ul><ul><ul><li>J Prosth. Dent. Dec. 2003. </li></ul></ul>
    51. 58. 28 TYPES OF POSTS METALLIC NON-METALLIC <ul><li>Stainless Steel </li></ul><ul><li>Titanium </li></ul><ul><li>Titanium Alloy </li></ul><ul><li>Gold-Plated brass </li></ul><ul><li>Carbon Fibre </li></ul><ul><li>Ceramic </li></ul><ul><li>Glass-fibre reinforced </li></ul><ul><li>Composite </li></ul>28 Fundamental of fixed prosthodontics 3 editions Herbert T. shillingburg Page no 345
    52. 59. Types of Posts
    53. 60. Prefabricated posts
    54. 61. Custom made posts <ul><li>Direct Technique </li></ul><ul><li>Indirect Technique </li></ul>Wax pattern before casting.
    55. 62. Custom cast post and core <ul><li>Advantages: </li></ul><ul><li>Preservation of maximum tooth structure </li></ul><ul><li>Provision of anti-rotational properties </li></ul><ul><li>Core retention </li></ul><ul><li>Less chances of vertical fractures during preparation </li></ul><ul><li>High strength </li></ul><ul><li>Disadvantages: </li></ul><ul><li>Less stiff than wrought </li></ul><ul><li>Time consuming, complex procedure </li></ul>Recommended Use: Elliptical canals Flared canals
    56. 63. 29 Prefabricated Tapered Post <ul><li>Advantages: </li></ul><ul><li>Conserves tooth structure </li></ul><ul><li>High strength and stiffness </li></ul><ul><li>Disadvantages: </li></ul><ul><li>Low retention </li></ul><ul><li>Longitudinal splitting of remaining root </li></ul>Recommended Use: Small circular canals or Very tapered canals 29 Post placement and restoration of endodontically treated teeth: A literature review. Schwartz. R, Robbins. J. J Endodon 2004, 30: 289-301.
    57. 64. 30 Prefabricated Parallel - Sided Smooth Post <ul><li>Advantages: </li></ul><ul><li>Excellent clinical retention </li></ul><ul><li>Minimal stress production within root </li></ul><ul><li>Ease of placement </li></ul><ul><li>Superior rating </li></ul><ul><li>Disadvantages: </li></ul><ul><li>Precious material post expensive </li></ul><ul><li>Corrosion of stainless-steel </li></ul><ul><li>Less conservative of tooth structure </li></ul>30 Color Atlas of Endodontics. , 2 nd edition William T.Johnson, page no 133-134.
    58. 65. 31 Prefabricated Threaded Posts <ul><li>Advantages: </li></ul><ul><li>High retention </li></ul><ul><li>Disadvantages: </li></ul><ul><li>Stresses generated in canal may lead to fracture </li></ul><ul><li>Does not conserve coronal and radicular tooth structure </li></ul>Recommended Use: Only when maximum retention is essential 31 Color Atlas of Endodontics. , 2 nd edition William T.Johnson, page no, 133-134.
    59. 66. 32 Carbon Fiber Post <ul><li>Advantages: </li></ul><ul><li>Dentin bonding </li></ul><ul><li>Easy removal </li></ul><ul><li>Disadvantages: </li></ul><ul><li>Low strength (compared to metal) </li></ul><ul><li>Lack of radiopacity </li></ul><ul><li>Carbon color presents an esthetic problem </li></ul>Recommended Use: Can be used in posteriors with moderate loss of coronal structure 32 Post Placement and Restoration of Endodontically Treated Teeth: A Literature Review. Richard S. Schwartz, et al. Journal of Endodontics:VOL. 30, NO. 5, MAY 2004
    60. 67. 33 Fiber Reinforced Post <ul><li>Advantages: </li></ul><ul><li>Esthetic </li></ul><ul><li>Disadvantages: </li></ul><ul><li>Low strength </li></ul><ul><li>High failure rate </li></ul>Recommended Use: Should not be used where remaining tooth structure is less than ideal or where high occlusal forces are present. 33 Aesthetic posts and cores for metal free restoration of endodontically treated teeth. Adriana Quintas, Jose Dinato. Pract Periodont Aesthet Dent; 12(9): 875-884
    61. 68. 34 Zirconia Ceramic Post <ul><li>Advantages: </li></ul><ul><li>Esthetics </li></ul><ul><li>High stiffness </li></ul><ul><li>High modulus of elasticity </li></ul><ul><li>Disadvantages: </li></ul><ul><li>Expensive </li></ul><ul><li>Uncertain clinical performances </li></ul>Recommended Use: High esthetic demands
    62. 69. Procedure Textbook of Endodontology 2 editions Preben Hørsted-Bindslev Page no 326
    63. 70. A review of the studies done on the various post systems suggests that the fiber posts are the most reliable!!!
    64. 71. <ul><li>Background: Post design and material has very important effects on dentinal stress distribution since the post placement can create stresses that lead to root fracture. </li></ul><ul><li>Materials : </li></ul><ul><li>4 metallic posts (ParaPost XH, ParaPost XT, ParaPost XP, and Flexi-Flange) and 1 fiberglass post (ParaPost Fiber Lux) were used. </li></ul>35 Fiber posts show more homogeneous stress distribution than metallic posts. 35 Influence of different post design and composition on stress distribution in maxillary posterior teeth. Finite element analysis. Natercia R Silva, Carolina G Castro, Paulo CF Santos-Filho. Indian journal of dental research 2009 vol 20
    65. 72. <ul><li>Purpose. This in vitro study compared the effect of titanium, quartz fiber, glass fiber, and zirconia posts systems on the fracture resistance and fracture patterns of crowned, endodontically treated teeth </li></ul><ul><li>Results. Teeth restored with quartz fiber posts exhibited significantly higher resistance to fracture than the other 3 groups. Teeth restored with glass fiber and zirconia posts were statistically similar. </li></ul><ul><li>Fractures that would allow repair of the tooth were observed in quartz fiber and glass fiber , whereas unrestorable, catastropic fractures were observed in titanium and zirconia post groups. </li></ul>36 Resistance to fracture of endodontically treated teeth restored with different post systems. Akkayan B, Gulmez T. J Prosthet Dent. 2002;87:431–437. Fractures allow repair Good strength
    66. 73. <ul><li>Conclusion : The fiber posts evaluated provided an advantage over a conventional post that showed a higher number of irretrievable post and unrestorable root fractures. The fiber posts were readily retrievable after failure, whereas the remaining post systems tested were non retrievable. </li></ul>37 In vitro comparison of the fracture resistance and failure mode of fiber, ceramic, and conventional post systems at various stages of restoration. Cormier CJ, Burns DR, Moon P. J Prosthodont. 2001;10:26–36. Readily retrievable
    67. 74. <ul><li>PURPOSE: This retrospective study evaluated treatment outcome of cast post and core and Composipost systems after 4 yrs of clinical service. </li></ul><ul><li>The results of this retrospective study indicated that the Composipost(95% success) system(fiber-reinforced epoxy resin posts) was superior to the conventional cast post and core system(84% success) after 4 yrs of clinical service. </li></ul>38 Clinical evaluation of fiber-reinforced epoxy resin posts & cast post & cores. Ferrari M, Vichi A, Garcia-Godoy F. Am J Dent. 2000;13:15B–18B. Better than cast post system in the long term
    68. 75. <ul><li>PURPOSE: This study aggregated literature data on in vitro failure loads and failure modes of prefabricated fiber-reinforced composite (FRC) post systems and to compare them to those of prefabricated metal, custom-cast, and ceramic post systems. </li></ul><ul><li>RESULTS: Custom-cast post systems showed higher failure loads than prefabricated FRC post systems, whereas ceramic showed lower failure loads. Significantly more favourable failures occurred with prefabricated FRC post systems than with prefabricated and custom-cast metal post systems. </li></ul>39 A structured analysis of in vitro failure loads and failure modes of fiber, metal, and ceramic post-and-core systems. Fokkinga WA, Kreulen CM, Vallittu PK, Creugers NH. Int J Prosthodont. 2004;17(4):476–482. More favourable
    69. 76. MECHANICAL PROPERTIES 40 Evolving Technology in Endodontic Posts. Pitel M., Hicks N Comp. Of Cont. Educ. in Dent. January 2003. Material Flexural strength Gpa Tensile Strength MPa Elastic Modulous GPa Stainless Steel 800 n/a 200 Titanium Alloy 1000 n/a 110 Zirconium Oxide 820 n/a 200 C-Post (64% Carbon) 1100 2900 17.8
    70. 77. CONTENTS <ul><li>Introduction </li></ul><ul><li>History </li></ul><ul><li>Need for final restoration </li></ul><ul><li>Objectives </li></ul><ul><li>Classification </li></ul><ul><li>Anterior teeth </li></ul><ul><li>Posterior teeth </li></ul><ul><li>Components of final restoration: </li></ul><ul><li>Posts </li></ul><ul><li>Cores </li></ul><ul><li>Crowns </li></ul>
    71. 78. <ul><li>Indications </li></ul><ul><li>Principles </li></ul><ul><li>Types of core build up </li></ul><ul><li>Procedure </li></ul>CORES
    72. 79. INDICATIONS <ul><li>Core restorations are indicated if any of the following clinical conditions exist: </li></ul><ul><li>The replacement of missing coronal tooth structure is necessary. </li></ul><ul><li>When the enhanced retention and resistance to displacement of the final restoration is necessary. </li></ul>41 Fundamental of fixed prosthodontics 3 editions Herbert T. shillingburg Page no 367
    73. 80. MATERIALS USED FOR CORE BUILD UP <ul><li>DIRECT PLACEMENT: </li></ul><ul><li>Composite resin </li></ul><ul><li>Amalgam </li></ul><ul><li>Glass ionomer resin </li></ul><ul><li>INDIRECT PLACEMENT: </li></ul><ul><li>Casting </li></ul>42 Fundamental of fixed prosthodontics 3 editions Herbert T. shillingburg Page no 369
    74. 81. Composite resin core <ul><li>Advantages: </li></ul><ul><li>Good compressive strength </li></ul><ul><li>Easy to manipulate </li></ul><ul><li>Rapid polymerization </li></ul><ul><li>Dentin bonding </li></ul><ul><li>Disadvantages: </li></ul><ul><li>Polymerization shrinkage </li></ul><ul><li>Poor dimensional stability </li></ul>Recommended Use: Excellent build-up material for posterior and anterior teeth if isolation assured
    75. 82. Amalgam core <ul><li>Advantages: </li></ul><ul><li>Reduced marginal leakage </li></ul><ul><li>Better dimensional stability </li></ul><ul><li>Better compressive strength </li></ul><ul><li>Better modulus of elasticity </li></ul><ul><li>Disadvantages: </li></ul><ul><li>Mercury sensitivity </li></ul><ul><li>Low tensile strength </li></ul><ul><li>Corrosion with base metal </li></ul>Recommended Use: Molars with adequate coronal tooth structure
    76. 83. Glass Ionomer resin core <ul><li>Advantages: </li></ul><ul><li>Anticariogenic </li></ul><ul><li>Adhesive </li></ul><ul><li>Easy to manipulate </li></ul><ul><li>Disadvantages: </li></ul><ul><li>Low resistance to fracture </li></ul><ul><li>Low retention to preformed post </li></ul><ul><li>Sensitive to moisture </li></ul>Recommended Use: Teeth with minimum tooth structure missing
    77. 84. So which is the best material for core buildup???
    78. 85. <ul><li>The modulus of elasticity of amalgam is significantly higher than all other material tested and is closer to that of dentin </li></ul><ul><li>Prepared core build-ups in a hybrid composite material provided the highest fracture resistance </li></ul>46 Fracture resistance of five pinretained core buildup materials on teeth with and without extracoronal preparation. Burke, FJT, Shaglouf, AG, Combe, EC, Wilson, NHF. Operative Dentistry 2000; 25: 388-394.
    79. 86. <ul><li>This study showed that the tensile and flexural strengths of composite are significantly higher than that of amalgam and glass ionomer. </li></ul>47 Kovarik, Robert E., Breeding, Larry C., Caughman, W. Franklin. Fatigue life of three core materials under simulated chewing conditions. The Journal of Prosthetic Dentistry Oct 1992; 68(4): 584-589.
    80. 87. <ul><li>Tensile strength and modulus of elasticity of glass ionomer cements are significantly lower than dentin and amalgam </li></ul><ul><li>Glass ionomers are relatively slow-setting and their early resistance to moisture is poor </li></ul>48 Mechanical properties of direct core buildup materials. Combe, E.C., Shaglouf, A., Watts, D.C., Wilson, N.H.F. Dental Materials 1999; 15: 158-165. Based on the above stated evidence, composite seems to be the best choice as a core build up material.
    81. 88. CONTENTS <ul><li>Introduction </li></ul><ul><li>History </li></ul><ul><li>Need for final restoration </li></ul><ul><li>Objectives </li></ul><ul><li>Classification </li></ul><ul><li>Anterior teeth </li></ul><ul><li>Posterior teeth </li></ul><ul><li>Components of final restoration: </li></ul><ul><li>Posts </li></ul><ul><li>Cores </li></ul><ul><li>Crowns </li></ul>
    82. 89. CROWNS <ul><li>Indications </li></ul><ul><li>Advantages </li></ul><ul><li>Disadvantages </li></ul><ul><li>Types </li></ul>
    83. 90. CROWN PLACEMENT <ul><li>INDICATIONS </li></ul><ul><li>Better esthetics </li></ul><ul><li>Situations in which the structural integrity of natural crown is compromised </li></ul><ul><li>CONTRAINDICATIONS </li></ul><ul><li>Anterior teeth have only have conservative access opening </li></ul>49 Textbook of Endodontology Gunnar Bergenholtz Page no 317
    84. 91. CROWNS <ul><li>Advantages: </li></ul><ul><li>Durable </li></ul><ul><li>Good esthetics </li></ul><ul><li>Restoring dental function </li></ul><ul><li>Good Form </li></ul><ul><li>Protection of tooth </li></ul><ul><li>Disadvantages: </li></ul><ul><li>Loss of tooth structure </li></ul><ul><li>Expensive </li></ul>50 Textbook of Endodontology Gunnar Bergenholtz Page no 317
    85. 92. METAL-CERAMIC CROWNS <ul><li>It consists of a ceramic layer bonded to a thin cast metal coping that fits over the tooth preparation. </li></ul><ul><li>It combines the strength and accurate fit of a cast restoration with the esthetic effect of a ceramin crown. </li></ul><ul><li>Less tooth preparation required compared to all ceramic crowns. </li></ul>
    86. 93. 51 PORCELAIN JACKET CROWN <ul><li>It consists of a crown entirely made up of ceramic. </li></ul><ul><li>Superior esthetics and excellent translucency. </li></ul><ul><li>Good tissue response even with subgingival </li></ul><ul><li>margins. </li></ul><ul><li>But is has reduced strength and is the least conservative of all tooth preparation. </li></ul>51 Endontics Problem-Solving in Clinical Prctice TR Pitt Ford, BDS, PhD Page No.161
    87. 94. 52 FULL CAST METAL CROWNS <ul><li>Cast metal crown is a full crown restoration which is cast with dental alloy. </li></ul><ul><li>It had high strength, is long lasting and requires the least amount of tooth preparation. </li></ul><ul><li>Cannot be used in areas where esthetics is of prime concern. </li></ul>52 Endodontics Problem-Solving in Clinical Practice First published in the United Kingdom in 2002 ISBN 1-85317-695-8 TR Pitt Ford, BDS, PhD Page no 161,
    88. 95. 53 PARTIAL CAST METAL CROWNS <ul><li>Partial cast metal crowns may be used when the buccal surface of the tooth is intact. They are more conservative of tooth tissue than complete crowns, but they are more demanding technically both for clinician and in the laboratory </li></ul>53 Color Atlas of Endodontics. William T.Johnson, 2nd edition, 133-134.
    89. 96. 54 TEMPORARY CROWNS <ul><li>Temporary crowns are used to protect a tooth that has been prepared for a permanent crown while the patient waits for the permanent crown to be fabricated by the dental lab. </li></ul><ul><li>Types: </li></ul><ul><li>Polycarbonate </li></ul><ul><li>acrylic temporary </li></ul><ul><li>Custom-cast temporaries </li></ul><ul><li>Composite resin </li></ul>54 Color Atlas of Endodontics. William T.Johnson, 2nd edition, 133-134.
    90. 97. Conclusion
    91. 98. Anterior Tooth Class IV Class I - III Complete Coverage is required Prefabricated fiber post with composite core full ceramic crown Complete Coverage is not required Conservative Trt Resin composite Class V Complete Coverage is required
    92. 99. Posterior Tooth Class IV Class I-III Conservative Trt Onlay Class V Composite Core Fiber post Metal Ceramic Crown Pre-fabricated fiber post Composite Core Metal Ceramic crown
    93. 100. Thank You
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