1/25 Restoration of Endodontically Treated Teeth (Dr. Anderson)

Factors for Restoring Endodontically Treated Teeth

• Pre-existing status prior to RCT
• Quality of previous endo treatment
• Loss of tooth structure
• Fracture resistance of endo teeth
• Preservation of remaining tooth structure
• Longevity of tooth and final restoration

During the caries cleanout, extirpation/RCT evaluate for what?

cracks, fracture lines

Who must do the restorability check?

restorative dentist

What causes loss of tooth structure in endodontically treated teeth?

Caries and cavity preparation
• Unsupported tooth structure
• Fractured cusps
• Tooth wear
• Endo access & instrumentation
• Endo occlusal relief (in the past..)

Factors that influence Selection of the Type of Restoration

• Remaining tooth structure and fracture resistance
• Position of tooth in the arch
• Esthetics and occlusion • Function and parafunction
• Ability to properly isolate with rubber dam
• Longevity of tooth and restoration

The amount of remaining tooth structure will dictate ?

fracture resistance of a tooth and the type of restoration

Edelhoff & Sorensen found that approximately ____ of the coronal tooth structure was removed when teeth were prepared for all-ceramic and metal ceramic crowns.

63-72%

Complete gold crown required approx. ___% tooth removal.

56%

Only about ___% of tooth is removed for an Onlay, unless more tissue has already been lost.

30

An edo treated teeth is discolored and the patient is disturb by this UGLY sight. What to do?

- may require prior internal/external bleaching or full coverage crown

Isolation where Rubber Dam is required

• Removing amalgam restorations
• Caries cleanout and cavity preparation
• Endodontic treatment
• Exposing the endo treated tooth for future procedures
• All adhesive bonding procedures
• Bonding indirect restorations

What are the restorative options for endo treated teeth?

direct, indirect bonded, indirect cemented restorations

DIRECT RESTORATION is done when?

• When RCT was the only procedure done
• Anterior teeth with minimal tooth loss
• When RCT was done through an existing full coverage crown that does not need replacement

Deflective contacts and excursive interferences (particularly in patients with parafunction) may lead to ____ in endo treated teeth without cuspal coverage

excessive lateral forces and increased risk of vertical root fracture

INDIRECT BONDED RESTORATION depends on what?

• Amount of tooth loss and remaining tooth structure
• Preservation of remaining tooth structure
• Ability to properly isolate with rubber dam
• Restoration of choice for posterior endo treated teeth

Evaluate the thickness of the remaining cusps and if less than ____ at the base of the cusp, _____

1.5 mm, cover the cusp

Keep margins _____ when possible - easier to isolate and bond while preserving remaining tooth Design of this preparation provides proper occlusal clearance for a short clinical crown

supragingival

The design of the restoration should focus on what three things?

Preservation of marginal ridges, margins should not finish on an occlusal contact and sufficient pulpal depth for thickness of the material.

What is D2949?

restorative foundation: Placement of restorative material to yield a more ideal form by eliminating internal undercuts, or filling in voids and concavities and to control the thickness of the overlying restoration

What do you when there are missing opposing or adjacent teeth?

must mount denture tooth on cast to properly evaluate occlusal and proximal clearance and for adequate design of the final restoration

Can you use the oscillator for separation?

it will create beveled margins(unacceptable), so no

Proper isolation was not possible for a planned bonded partial coverage, what should you do?

change tx plan to a full coverage cemented crown

Should posts be placed in cracked endo teeth?

no

An endo treated tooth have a crack that extends below the CEJ, what should be done?

composite core buildup and Tx plan for full coverage crown

survival rates of cracked endo treated teeth with full coverage?

84.1%-88% at 1-5 years

survival rates of non cracked endo treated teeth with full coverage?

86-93% over 2-10 years

core build up can be retained in the pulp chamber and extended into the canals, post needed?

no

When is a post indicated

Significant tooth loss with no mechanical retention for the buildup

What is D2950?

core buildup: Refers to building up of coronal structure when the loss of tooth structure does not provide sufficient retention for an extracoronal restoration

Custom metal cast post and core are indicated when?

cases of anterior teeth with large canals or posterior teeth with shallow pulp chamber

For posterior teeth, what is the restoration of choice?

bonded inlay/onlay, unless isolation is not possible or endo treeted tooth is cracked

When should you consider covering cusps?

to avoid tooth fracture due to cuspal flexure in endo treated teeth with loss of both marginal ridges