restoration of endodontically treated teeth

lecture given 6/11/2026, does not include the last 2 slides of maps on determining if a tooth is restorable bc how tf would i put that on a card

tooth structure loss can complicate subsequent restorations and…

increase the likelihood of fracture during function

before any restoration, endodontically treated teeth should be assessed for…

good apical seal, no sensitivity, no active inflammation, good endodontic treatment

before any endodontic treatment, you should assess…

periodontal status, restorative status, esthetic status, financial status

t/f endodntically treated teeth not crowned after obturation were lost at a 6.0x greater rate than the teeth crowned after obturation

true

t/f there is a 10 yr survival of 63% for crowned RCT and a 10 yr survival of 81% for RCT with direct restorations (resin composites, amalgam, cements)

false- opposite

the decision on how to restore a tooth with a non-vital pulp is dependent on…

location of the tooth in the arch

amount of occlusal stress

degree of coronal destruction

root morphology

t/f anterior teeth with sound coronal tooth structure can be conservatively restored with lingual composite restorations

true

posterior teeth should recieve a restoration with _____ because of their ______

cuspal coverage, naturally divided occlusal surface

lazarski found that ____ had the highest extraction rate, followed by _____, and then _____ teeth

molars, premolars, anterior

aquilino & caplan observed higher failure rates for _____ molars, highlighting poor survival rates for ____ teeth

on the same study, teeth with ____ remaining proximal contact had superior survival to those with _____

second, terminal

two, one

t/f there is a huge difference between survival rates for RCT maxillary and RCT mandibular teeth

false- no reported difference

the choice of restoration that a tooth with non-vital pulp will receive is dependent on…

location of the tooth in the arch, amount of occlusal stress, degree of coronal destruction, root morphology

degree of coronal destruction

the more coronal stucture is missing, the higher the need for additional help to retain the proposed final restoration

core only → prefab post and core → cast post and core

core only

the function of the core is to replace missing tooth structure and aid in retaining a crown

to be successful, the core should be well retained and supported within the tooth

prefab post and core

recommended when ~50% coronal tooth structure is absent and retenion of core material alone may not be possible

cast post and core

recommended when more than 50% of coronal tooth structure is missing or when undermined coronal tooth structure is remaining

how can you determine amount of coronal structure remaining?

complete tooth preparation as planned for the desired restorative outcome

evaluate remaining tooth structure and determine if very thin or undermined areas are present

preservation of tooth structure should be primary goal

however, additional apical extension may be needed to create ferrule

ferrule

a band or ring used to encompass the root of crown of a tooth

any short tube or bushing for making a tight joint

why is ferrule important?

the presence of a circumferential ferrule is beneficial for the survival of both anterior and posterior teeth

it should be noted that ferrule is the actual bracing of the complete crown over the tooth structure, rather than the amount of remaining sound dentin above the finish line

teeth with 2mm of ferrule were more resistant to fracture

a ferrule height of 1.5-2.0 mm and dentin thickness of >/= 1mm are associated with improved biomechanical and clinical outcomes

why should root morphology be considered for endo treated teeth?

determine if a post is needed

improper post space preparation can present a risk of…

apical or lateral perforation

post type can initiate…

cracks in the dentinal walls

what are the types of posts?

prefab- active, passive

custom- cast

what are the advantages of cast post?

custom fit on various root configurations

adaptable to large, irregular shapes

what are the disadvantages of cast post?

expensive

possible metal show thru

requires at leasat 2 vists

provisonal restoration is more difficult

may require additional tooth structure removal to achieve passive path of insertion

what are the advantages of prefab post?

simpler to use

can be completed in 1 visit

simple provisional restoration fabrication

what are the disadvantages of prefab post?

cannot adapt well to different root configurations

limited use in severely damaged teeth

core material can chip, break, or dislodge from the post

conservationist approach to post width

minimal canal preparation to preserve as much structure as possible

preservationist approach to post width

post should be surrounded by at least 1mm of sound dentin

proportionist approach to post width

post should not be greater than 1/3 of the root width at its narrowest dimension

gutta percha removal for canal preparation

maintenace of the apical seal is crucial for the success of the endo treatment

different methods can be used for the removal of gutta percha, with the use of burs (mechanical) or heat being the most common

~5-7mm of apical gutta percha should remain

what are the parameters for post length?

should be at least equal to the clinical crown length

should be at least ½ of the root length (while some studies say 2/3 or 4/5 of root length)

should be as long as possible without disturbing the apical seal

for molars it should be no more than 7mm when measured from the canal orifice

should be at least ½ of the root length (in bone)

should extend more than 4mm apical to the bone

what are the risks of posts and cores?

root perforation, post fracture, post debonding, core debonding/fracture

do you always need a post?

no!

t/f a post reinforces the tooth

false!

what are some important points to know about posts in endo treated teeth?

posts should fit passively in the canal

residual tooth structure, and not the presence (or absence) of a post dictates tooth survival

some evidence points to teeth with less remaining residual coronal structure benefiting from the placement of posts

there is no consensus on the need for intra-radicular posts following endodontic treatment

the purpose of the post is to retain the core

if post space is needed, it is the responsibility of the restorative dentist to create it (or request it from the endodontist on the referral)

endodontic treatment should only be a recommendation if you know…

the tooth is 100% restorable