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Restoration of Endo -dontically treated teeth

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on 6 December 2013

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Transcript of Restoration of Endo -dontically treated teeth

Restoration of endodontically treated teeth
Is it that simple to take a decision ??!!!
Indications for post and core ttt modality :
How
There are different treatment modalities for restoring an endodontially treated tooth , your choice is mainly guided by the following factors :
prior to endo treatment :
After endo treatement
"New restorations particularly complex ones shouldn't be placed on a tooth of questionable endodontic treatment "
Treatment modalities include :
1.simple composite restoration for the access cavity .

2.core build up .

3.post and core .

4.post and core crown .

5.Endo crowns .
why
2-Reduced propriocepion .
A vital over loaded tooth .....proprioceptors in PDL ....signal to CNS ..... modification of occlusion ...sudden opening


An endo treated tooth suffers reduction in proprioception ...so it is more liable to fracture in case of over loading
1- Loss of tooth structure.
"mechanical point of view "
Caries attack
Trauma
Access cavity preparation
3-changes in physical properties of the tooth.
4- Esthetic considerations .
VS
1.Amount of remaining tooth structures .
2.Anatomical position and esthetic requirements of the tooth
vs
3.functional load
or
or
Here comes the importance of tooth evaluation
I.Prior to endo treatment
II.After endo treatment
clinical
radiographic
1) health of peridontium and PDL support of the tooth.


2) asymptomatic tooth
no exudates
no fistula
no apical sensitivity
no pain on percussion
1.Excellent endo dontic treatment with no PA pathosis
vs
or
2.sufficient bony support
1-badly decayed endo ttt tooth
2-endo ttt tooth serves as an abutment in short span bridge
3-fracture or extensive proximal crown with exposed pulp after endo ttt

Contraindications for post and core ttt modalities :

-improper RCT
-weak thin short narrow or dilacerated roots
-periapical pathosis
-periodontal disease grade 3 mobility
-symptomatic tooth
-root concavities increases incidence of perforation.
Advantages of post and core ttt:

- provides good retention
-provide strengthening of mutilated endo treated tooth
-liability to use the root after complete loss of coronal portion
-high eshtetic restoration can be achieved
-correction of malaligned tooth can be done
- The post can be used for treating both single or multi-rooted teeth and also in combination with other types of prosthetics.

-limited to non-vital teeth
-improper preparation of RC leads to weakening of the root
-improper selection of post size leads to root fracture
-Increases plaque accumulation
-Damage to soft tissues and remaining teeth, due to either poor denture design or lack of patient care

Disadvantages:
post and core components :
Post
Core
Crown
Is the tooth restorable ??!!!
and if not ??!!
Have you heard about surgical crown lengthening ??!
Orthodontic extrusion .
Classification of post systems
1.according to attachment
a.post crown
"obsolete"
Attached
"one piece"
Detached
Two pieces
Three pieces
b.casted post -core
c.post and core build up
and both will need an extracoronal coverage
according to manufacture :
Prefabricated post
Custom-made post
according to shape :
Parallel sided
"para-post"
Tapered
1.needs more canal preparation esp. at apical area .
2.in thin or concave roots can cause "horizontal root fracture "
1.conforms better to canal anatomy so more conservative.
2.increased incidence of wedging under exceessive forces "vertical root split "

in canals to which prefabricated posts can't conform i.e very thin or curved roots
according to surface texture :
smooth
serrated
threaded
-not screwed but cemented
-cement mechanically interlocks in grooves .
-screwed and engages dentin for better retention
-but with high incidence of vertical root split
Can we use the threaded post safely ??!!
1.During canal preparation .

2.during screwing .

3.Flexi-post
according to material of construction :
Metallic
Non metalic
1.Dentatus post
"Gold plated brass"
2.stainless steel
3.Titanuim
"Recent"
The metal of manufacture should have :


1.high yield strength .
2.high modulus of elasticity.
3.high corosion resistance
Ceramic
fiber posts
Zirconia post
carbon fiber post
fiber glass posts
Advantages of zirconia :
1.Can be cemented by any conventional cement .
2.Radio-opaque.
3.give good esthetics.
1.fiber posts have lesser strength than dentin
"favorable complication "
2.excellent esthetics .
3.should be cemented by resin cement .
Post and core techniques :
custom -made
Prefabricated technique
principles of tooth preparation :
1.conservation of tooth structure :
Crown :
Root:
Custom made techniques are less conservative as it is obligate to remove any undermined or any tooth structure that hinder seating of the core !!!!
excessive widening of root canal to receive the post decrease the tooth resistance to fracture !!
especially apically and cervically
"areas of stress conc ."

2.Retention form :
1.parallel sided posts are superior to tapered ones .
2.threaded posts "safe use" are superior to serrated , serrated are superior to smooth .

4.length : as post length increases ...retention increases but meanwhile stresses delivered to apical area increase as well.
So , the question is , How much tooth structure should be removed
3.Diameter :as post diameter increases ,retention increases but to a limit !!
Resistance form :
"resistance of tooth to fracture"



1-stress concentration 2- post
-avoid short or loose posts.
-avoid unsafe use of threaded post.
3-ferrule effect
Anti-rotation aids:
1-ferrule effect .

2-M or D grooves
"an old tech."
3-additional post
4- interlocking core
"obsolete"
1.Materials :
Metallic posts
Non-metallic
1.Fill post .
2.anatomical root post system
3.integra-post.
1.Twin luscent anchor post.
4-luminex post
3.everstick post
2.dentin post
• It is engineered from pure (99.8%) titanium
• Biocompatibility
• can be shortened and bent to meet the requirements of the root canal.

• designed to restore coronally destroyed anteriors, canines, and premolars.
• combine the advantages of individually produced posts with the fast and easy application of prefabricated posts.

• is a passive, secure integrating core retainer.
• “Adhesive Buffer Zone.” !!!

• This unique Anchor is used to cure composites within the canal, and provides flawless aesthetics
• Provides the one-stop core anchor foundation with all restorative materials

"physical choke."
• The vent groove
• It all adds up to a winning combination of light transmission, attractive esthetics and twice the retention.


a prefabricated tapered root post made of glass fiber embedded in epoxy resin.
• The root posts are largely composed of unidirectional special glass fibers, ensuring high stability.
• Dentin Post is radio opaque and features a modulus of elasticity similar to that of dentin to guarantee an aesthetically pleasing result.
• Dentin Posts permit a strong reconstruction even in cases of severely destroyed teeth due to their pronounced retention head.

2. surface configuration

Hybrid post (multiple taper)


3. surface texture

Flexi-Post
• split shank post
• It offers maximum retention with minimal insertional stress.



Cementation
Luntelo spiral

• A rotary(Lentulo) paste filler or cement tube is used to fill canal with cement.
• The post is inserted gently to reduce hydrostatic pressure , which could cause root fracture.


Is it that simple to sacrifice your successful endo treatment ???!!!
•Definition :
a restorative option for endodontically treated teeth.
It consists of a circular butt-joint margin and a central retention cavity inside the pulp chamber and lacks intra radicular anchorage.
• Concept :
It is milled from a ceramic block via CAD CAM system as a core build up and crown restoration in one piece.
Endocrown is desirable in the case of root canal treated tooth with thin walls of coronal structure and substantial loss of tooth tissue.

It is esthetically pleasing.

vs
• Advantages
1. Superior strength.
2. Esthetically pleasing.
3. Conservation of remaining tooth structure.
4. If retreatment is necessary, the removal of endo-crown is easy.
• Disadvantages
1. Long term clinical results are needed.
2. High cost

In the tooth preparation, a ferrule of 1.5 mm – 2mm should be established to protect the tooth from fracture.
Dual-cure resin cement is required for adhesive luting of ceramic endo-crown.

wt do u think ???
Seminar team:
1.Norhan saied
2.Norhan mohamed abo el-ela
3.Nehal mohsen mostafa
4.Namies yousri mohamed
5.Mariam mohamed said
6. Abdulrahman abubaker
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