Restoration of endodontically treated tooth

Prepared by:
Rawa Omar

Supervised by: Prof .Dr. Salam AlQaisi

Are Endodontically Treated Teeth More Brittle?

Contrary to common belief, endodontically treated teeth are not more brittle . No difference in moisture content was found between endodontically treated and vital teeth . The access cavity in combination with an early loss of one or both marginal ridges leaves the tooth at serious risk. A direct relationship exists between the amount of remaining tooth structure and the ability to resist occlusal forces
[Restoration of Endodontically Treated Teeth Review and Treatment Recommendations, Iris Slutzky-Goldberg,etal International Journal of Dentistry Volume 2009, Article ID 150251.

Factors influence the choice of technique

Type of tooth The amount of remaining coronal tooth structure: the most important prognosisdetermining factor

Criteria of teeth to be restored

1. 2. 3. 4. 5. 6.

Good apical seal. No sensitivity to pressure. No exudates. No fistula. No apical sensitivity. No active inflammation.

Restoration of endo. teeth Extension of the axial walls of the crown apical to missing tooth structure provides whats known by the FERRULE:

It helps to: 1. Bind tooth structure together

Methods to create ferrule in extensively destryed tooth

Surgical crown lengthening - Reduce root length and increase crown length (crown: root ration unfavorable) Orthodontic extrusion - Reduce root length and unchanged crown length (crown: ( root ratio is favorable

Ortho. extrusion

Surgical crown lengthening

Some of the areas of general agreement regarding post design include:

When a post is needed, remove little if any additional dentin beyond what is needed to perform the root canal treatment. Retain a minimum of 4 mm of gutta-percha apically . Use a post designed to incorporate mechanical features that resist rotational forces Since forces concentrate at the crest of bone during function, place the post to extend apical to the crest of the bone. One rule of thumb is that the post should extend into bone at least as far as it protrudes out of bone. Should endodontic retreatment be necessaryretrievability is an important property of a post and should be considered in post selection.
AMERICANASSOCIATION OF ENDODONTISTS Spring/Summer 2004

INDICATIONS FOR A POST The primary function of a post is to retain a core in a tooth with extensive loss of coronal tooth structure.

preparation of a post channel adds a degree of risk to a restorative procedure:

Disturbing the seal of the root canal filling, which may lead to microleakage Removal of sound tooth structure, which weakens the root and may result in premature loss due to root fracture

Increased risk of perforation.

Post Classification

Custom

Prefabricated

Can be cast from: -Direct pattern in pt mouth - In direct pattern in laboratory

metal alloy Carbon fiber posts Composite fiber posts Ceramic (zirconia) posts ceramic composite

Restoration of endo. teeth

Prefabricated dowels
Non-eshetic
Titanium Carbon

Esthetic
Zirconia Fiber

fiber

reinforced

composite resin matrix

A: smooth, tapered; B: Tapered serrated; C: Threaded tapered; D: smooth, parallel-sided; E: serrated, parallel-sided; F: Threaded, parallel-sided

Mechanical Properties
Product Flexural Strength (Gpa)
800 1000 n/a 820 1100 1400 1600 960 990 n/a

Tensile Flexural Elastic Fiber Percent of Strength Modulus Modulus Used Fiber (Mpa) (Gpa) (Gpa)
n/a n/a n/a n/a 2900 2200 2050 1200 1200 1229 n/a n/a n/a n/a 120-140 44 46 13.5 29.5 n/a 200 110 77 200 17.8 15 15 n/a n/a 45.1 15-40 n/a n/a n/a n/a Carbon Quartz Quartz Glass glass Zirconium n/a n/a n/a n/a 64 62 60 42 42 65

Stainless Steel Titanium Alloy Gold Alloy Zirconium Oxide C-Post Aesthetic Plus D.T. Light FibreKor Para Post White Snow Post Dentin

Pitel M., Hicks N.- Evolving Technology in Endodontic Posts. Comp. Of Cont. Educ. in Dent. January 2003.
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Method for determining the length of the post:

2/3 length of the root 1/2 distance of the remaining root into the bone 4 mm of apical seal Equal to length of clinical core

Ferrari M., Scotti R.- Classification of Endodontic Posts (Chapter 2). In Fiber Posts. Characteristics and Clinical Applications. Masson. 2002 Shillingburg H. T., Kessler C. J.- Restoration of Endodontically Treated Teeth. Quint. Books. 1982 McLean A. Predictably restoring endodontically treated teeth. 1998; J Can Dent Assoc 64(11): 782-787

Custom-made Posts
Direct Technique:
direct pattern fabricated in the patients mouth using either autopolymerizing or light-polymerizing resin. Recommended for single canals

Direct technique using Parapost system and GC acrylic pattern

Custom-made Posts
Custom-made Post:
Indirect Technique: utilizing an impression for the post space and indirect pattern fabricated in the lab. More appropriate for multiple canals

Core :
Restorative material that replace coronal tooth structure .

Physical characteristic of core: High compressive strength. Dimmensional stability . Ease of manipulation. Short setting time for cement. An abillity to bond to both tooth & dowel.

One-piece post crown

Two-piece post crown

Core Materials

Amalgam Zinc oxyphosphate Glass ionomer Composite Cast Metals (gold, silver.)

Amalgam
Biggest advantage: doesnt shrink, so doesnt place stress on the bond Disadvantages Esthetics, only to be used in molars May stain hard and soft tissues Corrosionexpansionfractures Environmental concerns Cannot be prepped in the same session

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Luting Materials
If a post is not cemented in the same visit as the post space is prepared, the post space is filled with calcium hydroxide paste and sealed bacteria-tight until the post can be cemented. In this way infection of the post space and the root dentin is avoided.

LUTING FIBER POSTS

Fiber posts are usually luted with lightly filled composite resins. Light penetration is limited, so dual-cure of self-cure luting resins must be used

Provisional restoration:
If a cast post & core is made,an additional provisional restoration is needed while post & core being fabricated.

Provisional Restoration

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