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Restoration Of Root Filled          Tooth        C&B 11           1
Success rates of Endodontics is extremely high incontemporary practice (>95%)Even re- root canal treatment gives a very hi...
Three major changes in rct toothLoss of tooth structureAltered physical charactoristicsAltered esthetic characteristics   ...
Over extended access cavity   Wedging force on unprotected cusp                     C&B 11                                ...
Conventionally, believed that removal of pulp leads tochanges in physical properties – “brittle”No significant change in t...
Aim at treatment with maximum preservationand protection of remaining tooth structureMinimizing stresses within the both t...
Existing endodontic statusDelay the final restoration until peri- radicularhealing is evident radiographicallyDuring such ...
The amount of remaining tooth structureAnatomic position of the toothThe occlusal forces on the toothThe restorative requi...
Preserve as much tooth substance as possibleIf post needed it should be long enough to beretentive and sufficient strong t...
Access cavity should not be over cutRoot canal should not be over flaredPreserve tooth substance by preparing properaccess...
GICAcrylic crownStainless steel crownOver dentureResin bonded bridge                        C&B 11   11
C&B 11   12
Conventional – weak crown   Modified – poor aesthetic                 C&B 11                                 13
Decoronated root treated       No protective ferrule isanterior tooth vulnerable to   provided by core or the crownfractur...
Post and core provide no           Beveling of residual tooth tissueprotection, a ferrule is provide   allows both core an...
Post and core provide no      Protective ferrule provideprotection, a ferrule is      by a cast post andprovide by crown  ...
Minimizing further sacrifice of tooth materialBleachingResin restorations are recommended aboveindirect restorations when ...
Access cavity preparation in posterior teethmake them weekEven in the presence of marginal ridges toothstands a high risk ...
Tooth prepared with minimum access cavity and   having size 1 or 2 lesions can be restored with   sandwich techniqueRemove...
C&B 11   20
Tooth prepared with minimum access cavity and   having size 1 or 2 lesions can be restored with   amalgam or using sandwic...
Remove all the GP and Cement 2-3mm bellow the    cervical margin and use as retentive factorCavity prepare to protect the ...
Cuspal protection – simple metal onlay                  C&B 11                 23
Canal entrance use for core   Ortho band strengthen the crown                   C&B 11                                 24
THREE QUARTER                   FULL METAL CROWN   CROWN          C&B 11                      25
Post offer no reinforcementandmain function of the post is retain the coreDentine removal for insertion of postweakening t...
C&B 11   27
Custom cast metal post little tissue loss   Remove more tissue weaken crown,                                            st...
Roof top preparation remove all the remaining coronal tissue              compromise protective ferrule                   ...
Conservative preparation preserve tooth , lengthens the post,        allow to development of protective ferrules          ...
Long post and parallel are more retentive thanshort post4-5mm GP should remain apicallyPlace the post as long as apicallyP...
Parapost – parallel & serrated              Radex anker- parallel, self tapping or pre-tapped              post           ...
Dentatus screw – tapered self tapping postKurer anchor – parallel threaded post for which the root canal is pre-tapped    ...
Parallel post at the base     Chamfered tip – reduce stress                     C&B 11                                   34
Post space preparation should be done on same day  that RC obturation is done because  operator is more familiar with RC &...
Cast post and core with diaphragm tocover and support a damaged incisor root                    C&B 11                 36
METAL POST AND CORE WITH CHAMFER PREPARATIONSHORT BUCCUL POST AND SEPARATE POST INSERTEDTHROUGH CORE INTO THE PALATAL ROOT...
UNSATISFACTORY        SATISFACTORY RCT WITH POORRCT                   CORONAL SEAL                 C&B 11                 ...
Cutting through porcelain reduce strength ofthe crown, weaken the porcelain bond,predispose to fracture, vibration disturb...
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Endo note 16 restoration of root filled

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Dr. Özkan ADIGÜZEL

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Transcript of "Endo note 16 restoration of root filled"

  1. 1. Restoration Of Root Filled Tooth C&B 11 1
  2. 2. Success rates of Endodontics is extremely high incontemporary practice (>95%)Even re- root canal treatment gives a very highsuccess rates in the present practice >60%Root treated teeth are in vulnerable state untilthey are permanently restored 14% reduction of strength and toughness due to changes in collagen cross link and dehydration Fracture of remaining tooth tissue not due to brittleness but due to loss of structural tissue which is holding tooth together under functional load in posteriors. Rct reduce stiffness by 5% but tooth structure removal by MOD stiffness by 60% C&B 11 2
  3. 3. Three major changes in rct toothLoss of tooth structureAltered physical charactoristicsAltered esthetic characteristics In anteriors fracture is due to over extended access cavity and not incorporating ferrule for coronal restoration Failure rate of restorations is higher compared to vital teeth Mainly attributed to loss/ fracture remaining tooth May be contributed by poorly designed stress generating restorations eg MOD amalgams are wedges splitting teeth Reinfection of the root canal from the mouth C&B 11 3
  4. 4. Over extended access cavity Wedging force on unprotected cusp C&B 11 4
  5. 5. Conventionally, believed that removal of pulp leads tochanges in physical properties – “brittle”No significant change in the physical propertiesfollowing endodonticsMajor effect of RCT is the loss of tooth structure.Root treated have previously being extensivelyrestored.Removing the root filling and preparing a post spacefurther weakens the toothStress generatedddduring endodontic and restorativeprocedures also contribute to failures by promotingcracks and fractures C&B 11 5
  6. 6. Aim at treatment with maximum preservationand protection of remaining tooth structureMinimizing stresses within the both tooth andrestoration. Avoid active restorations optionfor bonded onesConsider extraction and prosthesis when thetooth is unrestorable. C&B 11 6
  7. 7. Existing endodontic statusDelay the final restoration until peri- radicularhealing is evident radiographicallyDuring such period an adequate interimrestoration capable of preventing coronal leakage.Site of the tooth in mouthQuality of root canal treatmentType of final restoration C&B 11 7
  8. 8. The amount of remaining tooth structureAnatomic position of the toothThe occlusal forces on the toothThe restorative requirement of the toothAesthetic requirement of the tooth C&B 11 8
  9. 9. Preserve as much tooth substance as possibleIf post needed it should be long enough to beretentive and sufficient strong to resistdistortionAvoid twist drill for removal of GPAvoid active restoration which induce stressesProvide necessary coronal coverageattempt for the best possible fluid and bacterialtight seal C&B 11 9
  10. 10. Access cavity should not be over cutRoot canal should not be over flaredPreserve tooth substance by preparing properaccess cavity (labial access is acceptable)Posterior teeth should be reduced out ofocclusionRoot treated teeth are vulnerable to fracturebecause of access cavity and more toothsubstance loss due to caries C&B 11 10
  11. 11. GICAcrylic crownStainless steel crownOver dentureResin bonded bridge C&B 11 11
  12. 12. C&B 11 12
  13. 13. Conventional – weak crown Modified – poor aesthetic C&B 11 13
  14. 14. Decoronated root treated No protective ferrule isanterior tooth vulnerable to provided by core or the crownfracture C&B 11 14
  15. 15. Post and core provide no Beveling of residual tooth tissueprotection, a ferrule is provide allows both core and crown toby crown provide protective ferrule A ferrule is a band of metal which totally encircles the tooth, extending 1-2mm into sound tooth tissue to guard against longitudinal fracture C&B 11 15
  16. 16. Post and core provide no Protective ferrule provideprotection, a ferrule is by a cast post andprovide by crown diaphragm C&B 11 16
  17. 17. Minimizing further sacrifice of tooth materialBleachingResin restorations are recommended aboveindirect restorations when ever possible C&B 11 17
  18. 18. Access cavity preparation in posterior teethmake them weekEven in the presence of marginal ridges toothstands a high risk of fractureComposite restoration increases the resistanceto fracture of root filled teeth compared to nonadhesive restorations. Challenge in doing a good restoration in alarge posterior cavity, especially if approximalsurfaces are involved.Indirect tooth coloured restorations arerecommended in difficult cases. C&B 11 18
  19. 19. Tooth prepared with minimum access cavity and having size 1 or 2 lesions can be restored with sandwich techniqueRemove all the GP anddCCement 2mm bellow the cervical margin with heat carrier and carious dentine and discolored restorationsSeal GP with ZnPO4 liningPlace GIC (condensable) without trapping air bubbles to pulp chamber and cavitiesAfter 1-7 days remove 2mm from GIC and restored with LCC C&B 11 19
  20. 20. C&B 11 20
  21. 21. Tooth prepared with minimum access cavity and having size 1 or 2 lesions can be restored with amalgam or using sandwich techniquePlace GIC (condensable) without trapping air bubbles to pulp chamber and cavitiesAfter 1-7 days remove 2mm from GIC and restored with LCC orRemove all the GP and Cement 2-3mm bellow the cervical margin and use as retentive factorPlace amalgam with matrix band and holder C&B 11 21
  22. 22. Remove all the GP and Cement 2-3mm bellow the cervical margin and use as retentive factorCavity prepare to protect the physical fictional cuspIf esthetic and functional demands are fulfill adhesive restorations can be donePlace amalgam with matrix band and holder OrPrepare cavity for onlay or ¾ crown take impression temporized the toothFinal restoration cemented with resin cement C&B 11 22
  23. 23. Cuspal protection – simple metal onlay C&B 11 23
  24. 24. Canal entrance use for core Ortho band strengthen the crown C&B 11 24
  25. 25. THREE QUARTER FULL METAL CROWN CROWN C&B 11 25
  26. 26. Post offer no reinforcementandmain function of the post is retain the coreDentine removal for insertion of postweakening the toothCreate an area of stress concentration at theterminus of the channelIf adequate retension can be obtained withnatural undercuts in pulp chamber and canalentrance post should not be used C&B 11 26
  27. 27. C&B 11 27
  28. 28. Custom cast metal post little tissue loss Remove more tissue weaken crown, stress on sharp edges and fracture C&B 11 28
  29. 29. Roof top preparation remove all the remaining coronal tissue compromise protective ferrule C&B 11 29
  30. 30. Conservative preparation preserve tooth , lengthens the post, allow to development of protective ferrules C&B 11 30
  31. 31. Long post and parallel are more retentive thanshort post4-5mm GP should remain apicallyPlace the post as long as apicallyPreserve the tooth as much as coronally remaining dentine should be prepared wraparound coverage to get ferrule effectApically bevel tapered posts are preparedTreaded post should be insert first to cut atread and then reinsert with cementCustomised post can be prepared withminimum dentine removal and stresses C&B 11 31
  32. 32. Parapost – parallel & serrated Radex anker- parallel, self tapping or pre-tapped post C&B 11 32
  33. 33. Dentatus screw – tapered self tapping postKurer anchor – parallel threaded post for which the root canal is pre-tapped C&B 11 33
  34. 34. Parallel post at the base Chamfered tip – reduce stress C&B 11 34
  35. 35. Post space preparation should be done on same day that RC obturation is done because operator is more familiar with RC & referral point able to condense GP apically can be done under rubber damGP should be removed with Gate bur up to correct lengthCanal should be prepared with proper twist drill which is tally with the post up to correct length C&B 11 35
  36. 36. Cast post and core with diaphragm tocover and support a damaged incisor root C&B 11 36
  37. 37. METAL POST AND CORE WITH CHAMFER PREPARATIONSHORT BUCCUL POST AND SEPARATE POST INSERTEDTHROUGH CORE INTO THE PALATAL ROOT C&B 11 37
  38. 38. UNSATISFACTORY SATISFACTORY RCT WITH POORRCT CORONAL SEAL C&B 11 38
  39. 39. Cutting through porcelain reduce strength ofthe crown, weaken the porcelain bond,predispose to fracture, vibration disturbcement lute and clamp damage cervicalporcelainMetal prevent X ray assessment and loss oforientation misdirected cuttingEach tooth before crowning should be assessedwell (appearance, percussion, biting pressure,caries, NCTSL,, restorations, vitality, X ray andprevious RCT) C&B 11 39
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