RESTORATION OF ENDO TX TEETH

T or F: Endo tx have bad prognosis

F - can have good prognosis

Do endo tx teeth have higher risk of fracture?

What is lost? why?

Reduced capacity for what?

Complications?

Structural integrity and increased cuspal deflection due to access opening

Protective feedback mechanism associated with plual innervation is lost

Functional loads

Fractures and microleakage

Two Factors Influence Choice of Restoration Post RCT???

Type of tooth

AMount of remaining tooth structure *

How to prevent contamination of the completed endodontic therapy?

by sealing the canal and preventing leakage if immediate coronal restoration is not possible

What should be used to maintain isolation during placement of definitive coronal restoration?

Rubber dam

When is endo retx indicated?

if the definite restoration is delayed by 2-3 months compromising the coronal seal

Signs to Avoid Post Endo Tx:

Inadequate ____ ____ or poor _____ _____ _____

Sensitivity to ______

Presence of _____ or _____

Apical ______

Active ______

apical seal

gutta percha condensation

pressure

Exudate or Fistula

sensitivity

inflammation

Posts are usually made of what?

Metal or fiber reinforced composite resin

restoration placed inside the root of a structurally damaged tooth to provide retention for the core and coronal restoration

Post

Ideal properties of posts???? (4)

Biocompatible

Retentive

Radiopaque

Tooth colored

What are the 5 ways posts can be classified?

1. Material

2. Fabrication

3. Design

4. Surface texture

5. Fit

What are the three types of metallic posts?

Advantage?

SS, titanium, gold

More rigid

What are three types of non metallic posts?

Advantage?

Glass fiber reinforced, quartz fiber reinforced, carbon fiber reinforced

Modulus of elasticity similar to dentin

What are the three post materials categories?

Metallic

Non metallic

Ceramic

What are the two types of ceramic posts?

Zirconia and pressed ceramic

Are prefab or custom posts better?

Why?

Custom - better fit and can be used in ovoid canals

This post design has greater retention but is also more destructive?

Parallel

What is the disadvantage of tapered posts?

When active, can cause a wedging effect in the root and result in root fracture

What surface texture post has better retention?

Serrated

Describe active posts?

Has threads that mechanically engages the dentin

Active posts have high risk of _____

Why?

Root fractore

Engage root canal to improve retention but can introduce stress into root dentin

What post material has highest risk of tooth fracture

Medium risk?

Lowest risk

Ceramic and zirconia

Metal

Fiber posts

How to remove metal posts?

Rotary and ultrasonic instruments

____ posts that are opaque are considered easy to retrieve, ______ fiber posts are difficult to retrieve due to lack of color differentiation

Fiber

translucent

Tx Recommendations for Endo tx Anteriors:

Minimal Loss of Tooth Structure →

Moderate Loss of Tooth Structure →

Significant Loss of Tooth Structure →

Composite plug

Core and crown

Cast Post & Core

What type of post and core is indicated for endo tx anteriors/pms with significant loss of tooth structure

why?

What if esthetic demand?

Cast - ovoid canal shape

Fiber posts

Tx Recommendations for Endo tx Premolars:

Minimal-Moderate Loss of Tooth Structure?

Significant Loss of Tooth Structure?

Core & Coronal Coverage

Cast Post & Core

Tx Recommendations for Endo tx Molars:

Minimal-Moderate Loss of Tooth Structure?

Significant Loss of Tooth Structure?

Compromised Chamber Retention?

Core & Coronal Coverage

Chamber Retained amalgam core

Prefabricated post and core

Band or ring of prosthetic crown encircling the coronal surface of the tooth?

Ferrule

the vertical tooth structure that is enclosed by the prosthetic crown is also referred to as?

Ferrule

Circumferential____-____ mm ferrule height with a minimum of __ mm remaining dentin thickness directly above the finish line improves long-term survival of endodontic treated teeth restored with a post and core

1.5-2

1

Ferrule adds to some ____ but mainly improves what

What effect does it have?

Retention

Resistance

bracing effect of the tooth by the coronal restoration

Required supra-alveolar tooth structure to ensure effective ferrule length?

Supracrestal attachment + Supragingival/ Equigingival finish line location+ Recommended Ferrule Length

= 2.04 + (0.5-1.0) + (1.5- 2.0)

= 4-5mm

Tx Options for Lack of 4-5mm of Supra-Alveolar Tooth Structure to Ensure Effective Ferrule??? (3)

Crown Lengthening

Ortho Extrusion

EXT

Criteria for Post Space Prep - Length:

Equal to the length of the ____ or 3/4th the length of _____

Without compromising the_______mm of apical ____ ____ seal (<__mm, increased risk of _____ )

Molars → Max __ mm from canal orifice

crown - root

4-5 - gutta percha, 4 - leakage

7

Criteria for Post Space Prep - Diameter:

Maximum, ______ of the root diameter

Need to have at least ____ mm dentin around the post at any location.

Ideally, the post diameter should range within _____ _____ mm with the tip not exceeding ____ mm

1/3

1.5 - 2

0.6- 1.2, 1.0

Criteria for Post Space Prep - Location and Number:

Use ____ roots with _____ _____ access

Limit to _____ post for multi-rooted teeth

Severely _____ canals are contraindicated for post space preparation due to increased risk of _____

primary - straight line

one

curved, perforation

Retention Factors of Posts:????? (5)

Post Length, Diameter, Taper

Type of Luting Cement

Active vs. Passive fit

Resistance factors of posts:

Remaining ______

Post ____ and _____

Presence of _______ feature

Presence of ______

tooth structure

length and rigidity

antirotational

ferrule

Removal of RCT Material:

What method is not recommended? Why?

Chemical

depth of penetration cannot be controlled

Three ways to remove RCT material???

Chemical:

Thermal:

Mechanical:

This method of RCT material removal involves System B is heated to 100 degrees and lowered to a predetermined height, Height is then switched off and the tip is rotated and removed. A plugger is then used to condense the apical filling?

Thermal

______ Removal of RCT material May result in perforation of the root. A non ____ _____ bur is a safe option

GP can also be removed with ____ ____ files

Mechanical

end cutting

NiTi rotary

Technique is crucial for success of posts?

What two things should you avoid?

Cementation

Air entrapment & excess hydraluic pressure

How to do cementation of posts?

Use a lentulospiral on slow speed to place cement in the canal. Apply a small increment on the post as well.

What types of cemenrs are preffered for prefab posts???

Dual cured resin cements and paracore

Complications of Posts:

Post _______

Root ______

Post _____

Coronal _____ & Periapical _____

_____ Caries

Post preparation may ______ tooth

Dislodgment

Fracture

Fracture

Leakage

Reinfection

Recurrent

weaken

Tips to avoid Post complications:

Maintaining Adequate ____

Preserve Maximum ____ _____

Appropriate ____ of post space and use of _____, ____ sided, well ____, _____ posts

Well ____ restorations post endo tx under isolation with a well fitted _____ _____ to avoid coronal leakage

Use of a ____ agent with minimal ___ _____ and appropriate _____ technique

Ferrule

Tooth Structure

design

passive, parallel sided, well adapted, rigid

timed - coronal coverage

luting - water sorption - cementation