Restoration of endodontically treated teeth /prosthodontic courses

RESTORATION OF
ENDODONTICALLY TREATED
TEETH
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

 DIAGNOSIS AND TREATMENT
PLANNING
Prior to performing any dental procedure, the
clinician must first examine the patient and
arrive at a diagnosis. Following this process, a
treatment plan can be formulated based on the
medical and dental history, the clinical and
radiographic examination, and the patient’s
needs and chief complaint.

 Endodontic considerations
Attention must be given to the quality of
the endodontic therapy. Prior to
restorative procedures, it is essential
that the endodontic treatment be
successful. Predictable success in
endodontic therapy requires a dense,
uniform, three dimensional obturation of
the root canal system.

 Prosthetic Considerations
In evaluating tooth type, the clinician
must realize that each tooth exhibits a
unique morphology and structure, which
will be subjected to different degrees of
stress during function. Morphologically,
the circumference of the tooth at the
cementoenamel junction is of great
concern when considering a restorative
procedure.

In posterior teeth, the occlusal forces
are directed more axially than in
anterior teeth in which the forces are
more lateral. In addition, the
direction and degree of occlusal
stress can be increased if the tooth is
to be an abutment for a fixed or
removable prosthesis.

 Periodontal considerations
Periodontal disease should be treated
prior to placement of definitive
restorations. A healthy periodontium
provides the best prognosis for the tooth
and will make procedures such as
placement of margins and making of an
impression easier and more accurate.

 Clinical Protocol for restoring
endodontically treated teeth
Anterior teeth
As a consensus, anterior teeth that exhibit
intact marginal ridges, can be restored by
placement of a base over the guttapercha
obturating material and sealing the lingual
access with an acid etch composite resin
provided the teeth meets the occlusal
requirements and the patient is happy with the
appearance.

Pulp less anterior teeth can also be
conservatively restored with a bonded
composite resin restoration rather than
artificial crown. A laminate veneer
offers a conservative alternative if the
facial surface is intact with moderate
discolouration.

Anterior teeth that exhibit mesial and distal
restoration should be restored with a post
and core prior to the placement of a crown.
The loss of both marginal ridges and a
lingual access opening leaves the facial
portion of the tooth unsupported.
Mandibular incisors and maxillary lateral
incisors would always require a post and
core before placing an artificial crown.

Posterior teeth
The need for a core or a post and
core is determined on the basis of
remaining tooth structures as well as
expected occlusal and prosthetic
forces that will be applied.

 Post&core
It consists of two components. The
post is the component that is inserted
into the root canal and the core is the
retentive component which behaves
like a prepared crown for the
placement of retainer.

 Classification
Based on the method of fabrication
Pre fabricated – They are available as post systems
which use either amalgam or composite resin as core
build up material. The most commonly used materials
are stainless steel, titanium, nickel or chromium
containing alloys. Non- metallic fiber reinforced resin
posts are also available.
Custom made – they are cast from wax and resin
patterns fabricated in the prepared canal .the post and
core are cast as a single unit.

Based on their shape
 Parallel sided
 Tapered

Based on the surface
characteristics
 Plain
 Threaded
 Serrated
 Sandblasted
 Vented
 Split shank

FACTORS AFFECTING RETENTION
OF POST SYSTEMS
 Post Length The post should equal
the incisocervical or occlusocervical
dimension of the crown. The length of
the post has a significant effect on its
retention and in most instances, the
more deeply the post is placed, the
more retentive it becomes.

Post Diameter Post diameters should
not exceed one third of the root
diameter at any location. Increasing
the diameter of the post does not
provide a significant increase in the
retention of the post; however, it can
increase the stiffness of the post at
the expense of the remaining dentin
and the fracture resistance of the root

Post Design- parallel sided posts and
posts with surface characteristics
have better retention.

Canal preparation for placement of
post
 Peeso reamer is the instrument of choice
for removing the guttapercha and for
enlarging the canal. These instruments
do not perforate the canal because they
have non-cutting tips, which follow the
path of least resistance

Peeso reamer

 A hot condenser can be used to
remove GP remnants
 After removing the GP, the peeso
reamer should again be inserted to
the required depth and used to
enlarge the canal
 A test radiograph should be taken to
decide the amount of canal
enlargement.

 The canal should be prepared such that
there is at least 1mm of tooth structure
at the apical end. The diameter of the
canal should be at least 1 /3rd the width
of the tooth
 A No: 170 bur is used to prepare a
keyway in the tooth along the length of
the canal for a distance of 4 mm. The
keyway should be equal to the width of
the bur

 A contrabevel is placed around the
occluso-axial line angle so that a
metal collar is formed during casting
which will embrace the remaining
coronal tooth structure and protect it
from fracture (Ferrule).

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