6.restoration of the endodontically treated tooth

Restoration of the Restoration of the endodontically endodontically treated toothtreated tooth

Amith Babu Amrita DoraGanesh O.RPraveen JOurvind Singh

CONTENTS CONTENTS

Introduction History Need for final

restoration Objectives Classification

Anterior teeth Posterior teeth Components of final

restoration:

I. Posts

II. Cores

III.Crowns

The tooth as a houseThe tooth as a house

INTRODUCTIONINTRODUCTION

Endodontic treatment is largely performed on teeth significantly affected by caries, multiple repeat restorations and/or fracture. Already structurally weakened, such teeth are often further weakened by the endodontic procedures designed to provide optimal access and by the restorative procedures necessary to rebuild the tooth.

It is therefore accepted that endodontically treated teeth are weaker and tend to have a lower lifetime prognosis.

INTRODUCTIONINTRODUCTION

Hence require special considerations for the final restoration, particularly where there has been extensive loss of tooth structure. The special needs involve ensuring both adequate retention for the final restoration and maximum resistance to tooth fracture. Endodontic success depends not only on the quality of the root canal treatment, but also on timely coronal restoration of the compromised tooth.

CONTENTS CONTENTS




restoration:

I. Posts

II. Cores

III.Crowns

HISTORYHISTORY Various methods of restoring

pulpless teeth have been reported for past 200 years.

In 1747 Pierre Fauchard fabricated gold and silver posts to be placed in root canal space.

Replacement crowns were made from bone, ivory, animal tooth.

Is final restoration after endodontic

treatment important?

LITERATURE REVIEWLITERATURE REVIEW1In this study using radiographs they assessed the followingGood restorations + good endodontic treatments resulted in absence of periapical inflammation in 91.4%.Poor restorations + poor endodontic treatments resulted in the absence of periradicular inflammation in only 18.1%.Poor endodontic treatment + good restorations yielded a success rate of 67.6%.

1Periapical status of endodontically treated teeth in relation to the technical quality of the root filling and the coronal restoration.H. A. Ray and M. TropeInternational Endodontic Journal, vol. 28, no. 1, pp. 12–18, 1995.

This shows the importance of final restoration in endodontically treated teeth

CONTENTS CONTENTS




restoration:

I. Posts

II. Cores

III.Crowns

What are the What are the objectives of Final objectives of Final

restoration?restoration?

GOALSGOALS

2Maintained coronal and apical seal of the root canal treatment

Protect and preserve the remaining tooth structure Provided a supportive and retention foundation for

the placement of definitive restoration Restore the function and esthetics

2Colour atlas of endodontics 2 edition William T.Johnson DDS MSPage no 130

What are the factors What are the factors to be considered to be considered

while planning the while planning the final restoration?final restoration?

FACTORSFACTORS

3Amount of remaining sound tooth structure Occlusal function Opposing dentition Position of the tooth in the arch Length, width and curvature of the roots

3Endodontics : Restoring of Endodontically Treated TeethAmerican Association of Endodontics.1995 Dec Publication

CONTENTS CONTENTS




restoration:

I. Posts

II. Cores

III.Crowns

44Based on the remaining tooth Based on the remaining tooth structurestructure

Classification Description

Class I 4 walls

Class II 3 walls

Class III 2 walls

Class IV 1 wall

Class V No wall

4Restoring endodontically treated teeth with posts and cores—a reviewIngrid peroz et al.Quintessence International no.9 volume 36 oct 2005.

6Restoration of Endodontically Treated Teeth:

An Evidence-Based Literature ReviewUniversity of Toronto, Faculty of Dentistry. Int

J Prosthodont 2008;18(1):40-1.

FERRARI AND OTHERS

FOKKINGA & OTHERS

SAMPLES240 endodontically-treated premolars in 210patients

307 endodontically-treated teeth in 257patients

TEST TREATMENT

Fiber posts Cast post and corePre-fab metal post and composite core

CONTROL TREATMENT

No post Post-free composite core

DURATION (YRS)

2 Up to 17

CONCLUSIONS

4 coronal wall remaining: no difference incomplication rates≤ 3 coronal walls remaining: post placementincreases survival rates

Where “substantial remaining dentin” is available, a post and core does not perform better than a post-free core

8Ferrari M. Post placement affects survival of endodontically treated premolars. JDentRes 2007;86(8):729-734.

8Fokkinga W. Up to 17-year controlled clinical study on post-and-cores and covering crowns. J Dent 2007;35(10):778-786.

CONTENTS CONTENTS




restoration:

I. Posts

II. Cores

III.Crowns

ANTERIOR TEETHANTERIOR TEETH

9Anterior teeth with minimal loss of tooth structure can be restored conservatively with a bonded restoration in the access opening

9Intracoronal reinforcement & coronal coverage:a study of endodontically treated teeth. Sorensen JA, Martinoff JT. J Prosthet Dent 1984;51:780–4.


10A post is of little or no benefit in a structurally sound anterior tooth

Increases the chances of a failure

10Fracture strength and survival rate of endodontically treated maxillary incisors with approximal cavities after restoration with different post and core systems: an in-vitro study. Heydecke G, Butz F, Strub JR. J Dent 2001; 29:427–33.


11In cases of extensive loss of external tooth structure, a post is usually required for anterior teeth, due to the predominantly shearing forces present and the narrow tooth dimensions.

Extra-coronal crown preparation combined with endodontic access preparation significantly weakens the cervical area of anterior teeth.

11Post Placement and Restoration of Endodontically Treated Teeth: A Literature Review. Richard S. Schwartz, et al. Journal of Endodontics:VOL. 30, NO. 5, MAY 2004

Anterior TeethAnterior Teeth

13Biomechanical considerations for the restoration of endodontically treated teeth: A systematic review of the literature. Didier Dietschi,, Ivo Krejci, Quintessence international Volume 39 number 2 february 2008

Anterior TeethAnterior Teeth

14Biomechanical considerations for the restoration of endodontically treated teeth: A systematic review of the literature. Didier Dietschi,, Ivo Krejci, Quintessence international Volume 39 number 2 february 2008

CONTENTS CONTENTS




restoration:

I. Posts

II. Cores

III.Crowns

Considerations for posterior teeth

Endodontically treated posterior teeth are subject to greater loading than anterior teeth, because of their position closer to the insertion of the masticatory mus cles. This, combined with their morphologic character istics, makes them more susceptible to fracture.

Posterior teethPosterior teeth

15The results showed that the clinical success rates of endodontically treated premolars restored with fiber posts and direct composite restorations or full coverage with metal-ceramic crowns were highly successful without any failures, even after 3 years of service .

15J Prosthet Dent 2002 Sep;88(3):297-301. Three-year clinical survival of endodontically treated premolars restored with either full cast coverage or with direct composite restoration. Mannocci F, Bertelli E, Sherriff M, Watson TF, Ford TR

CASE REPORTPost-endodontic restoration of a

deeply decayed tooth - options and limitation Michael Bruder, DDS. Jounal of oral science,11: 2;2007.

Posterior teethPosterior teeth

16Molar teeth rarely require a post unless there has been significant loss of tooth structure. A coronal-radicular core buildup with silver amalgam utilizing the pulp chamber, and possible 2 mm canal extensions, has proved very effective in vitro and in vivo.

16Nayyar, A., An amalgam coronal-radicular dowel and core technique for endodontically treated posterior teeth. J Prosthet Dent, 1980. 43: p. 511.

CASE REPORTReconstruction of Endodontically Treated

Posterior Teeth—with or without Post? Maciej Zarow, Walter Devoto. The European

Journal Of Esthetic Dentistry. Volume 4,number 4,december 2009.

Tooth fracture of an endodontically treated maxillary molar restored with a bonded composite restoration.

CONTENTS CONTENTS




restoration:

I. Posts

II. Cores

III.Crowns

COMPONENTS OF FINAL COMPONENTS OF FINAL RESTORATIONRESTORATION

A. Posts

B. Cores

C. Crowns

CONTENTS CONTENTS




restoration:

I. Posts

II. Cores

III.Crowns

Role of posts Indications Post selection:Factors to be considered Ferrule effect Types Procedure

POSTS

The Role of Posts in the RestorationThe Role of Posts in the Restorationof Endodontically Treated Teethof Endodontically Treated Teeth

18The primary purpose for a post is to retain a core that can be used to support the final restoration.

Posts do not reinforce endodontically treated teeth, and a post is not necessary when substantial tooth structure is present after a tooth has been prepared.

18W. Cheung, “A review of the management of endodontically treated teeth: post, core and the final restoration,” Journal of the American Dental Association, vol. 136, no. 5, pp. 611–619, 2005.

INDICATIONS 19Post placement is indicated if both of the following clinical conditions exist:The remaining coronal tooth structure is inadequate for the retention of a restoration.When there is sufficient root length to accommodate the post while maintaining an adequate apical seal.

19Stockton LW.Factors affecting retention of post systems:A literature review. J Prosthet Dent 1999;81:380–385.

FACTORS TO CONSIDER

Post length

Post diameter

Post design


Post lengthPost length21Guidelines:

1. The post should more than the incisocervical or occlusocervical dimension of the crown.

2. The post should be longer than the crown.

3. The post should be 1 1/3 the length of the crown.

4. The post should end halfway between the crestal bone and the root apex.


Ideal tooth preparation for post placement

Post Size and LengthPost Size and Length

22Post length is unique and individualized for each case. The clinician should have a thorough knowledge of root morphology before placing a post.

The longer the post, the greater the retention. A guideline of one half to three quarters of the root length is often followed but may not be reasonable for extremely long, short, narrow, or curved roots

22Retention of endodontic dowels: effects of cement, dowel length, diameter, and design. Standlee JP, Caputo AA, Hanson EC: J Prosthet Dent 39:401, 1998.

The effect of the embedded depth of posts on retentive capacity has been shown to be

significant

Post diameter

23The diameter of the post is dictated by

the root canal anatomy. A minimal dentin thickness of 1 mm around

the post should be provided.

23Lloyd PM, Palik JF. The philosophies of dowel diameter preparation: A literature review. J Prosthet Dent 1993;69:32–36.

The diameter of the post is dictated by the remaining rootsubstance and root canal space: (A) too narrow; (B) optimumsize post; (C) too large.

Post design 24Posts can be serrated,

smooth, roughened or threaded.

Parallel, serrated posts are cemented into the canal passively. They are retentive and produce less stress in the root dentine than threaded systems


Ferrule EffectFerrule Effect

25The ferrule is the circumferential ring of sound tooth structure that is enveloped by the cervical portion of the crown restoration. A minimum sound dentine height of 1.5-2 mm is required between the core and crown margins.

25Sorensen JA and Engelman MJ. Ferrule design and fracture resistance of endodontically treated teeth. J Prosthet Dent 1999;63:529-536.

Importance of ferruleImportance of ferrule

The ferrule provides bracing or casing action to protect the integrity of the root.

2626Effect of a crown ferrule on the fracture resistance of endodontically treated teeth restored with prefabricated posts STATEMENT OF PROBLEM: Root fracture is

one of the most serious complications following restoration of endodontically treated teeth

Fifty freshly extracted canines were endodontically treated. The teeth were randomly divided into groups of 10 and prepared according to 5 experimental protocols

The results of this study showed that an increased amount of coronal dentin (ferrule) significantly increases

the fracture resistance of endodontically treated teeth.

The results of this study showed that an increased amount of coronal dentin (ferrule) significantly increases

the fracture resistance of endodontically treated teeth.

26Effect of a crown ferrule on the fracture resistance of endodontically treated teeth restored with prefabricated posts.Pereira JR, de Ornelas F, Conti PC, do Valle ALJ Prosthet Dent. 2006 Jan;95(1):50-4.

27An incomplete crown ferrule is associated with greater variation in load capacity and, despite high fracture values, inclines to fracture.

27Effect of incomplete crown ferrules on load capacity of endodontically treated maxillary incisors restored with fiber posts, composite build-ups, and all-ceramic crowns: an in vitro evaluation after chewing simulation.Naumann M, Preuss A, Rosentritt M.Acta Odontol Scand. 2006 Feb;64(1):31-6.

2727CHARACTERISTICS OF AN CHARACTERISTICS OF AN IDEAL POST:IDEAL POST:

Minimum preparation. Resistance to fatigue. Elastic modulus similar to dentin. Non corrosive. Retentive (post & Head). Easy to adjust and fit. Radiopaque. Adequate material Easy Removal

27Factors determining post selection: A literature Review. Fernandes A., Shetty Sh., Coutinho I.-J Prosth. Dent. Dec. 2003.

2828TYPES OF POSTS

METALLICMETALLIC NON-METALLICNON-METALLIC

Stainless Steel Titanium Titanium Alloy Gold-Plated

brass

Carbon Fibre Ceramic Glass-fibre

reinforced Composite

28Fundamental of fixed prosthodontics 3 editions Herbert T. shillingburgPage no 345

Types of PostsTypes of Posts

Prefabricated postsPrefabricated posts

Custom made postsCustom made posts

Direct TechniqueIndirect Technique

Wax pattern before casting. Wax pattern before casting.

Custom cast post and coreCustom cast post and core

Advantages: Preservation of maximum

tooth structure Provision of anti-rotational

properties Core retention Less chances of vertical

fractures during preparation High strength

Disadvantages: Less stiff than

wrought Time consuming,

complex procedure

Recommended Use: Elliptical canalsFlared canals

Recommended Use: Elliptical canalsFlared canals

2929Prefabricated Tapered PostPrefabricated Tapered Post

Advantages: Conserves tooth

structure High strength and

stiffness

Disadvantages: Low retention Longitudinal

splitting of remaining rootRecommended Use:

Small circular canals orVery tapered canals

Recommended Use:Small circular canals orVery tapered canals

29Post placement and restoration of endodontically treated teeth: A literature review. Schwartz. R, Robbins. J. J Endodon 2004, 30: 289-301.

3030Prefabricated Parallel - Sided Prefabricated Parallel - Sided Smooth PostSmooth Post

Advantages: Excellent clinical

retention Minimal stress

production within root

Ease of placement Superior rating

Disadvantages: Precious material

post expensive Corrosion of

stainless-steel Less conservative of

tooth structure

30Color Atlas of Endodontics. , 2nd edition William T.Johnson, page no 133-134.

3131Prefabricated Threaded PostsPrefabricated Threaded Posts

Advantages: High retention

Disadvantages: Stresses generated in

canal may lead to fracture

Does not conserve coronal and radicular tooth structure

Recommended Use:Only when maximum retention is essential

Recommended Use:Only when maximum retention is essential

31Color Atlas of Endodontics. , 2nd editionWilliam T.Johnson, page no, 133-134.

3232Carbon Fiber PostCarbon Fiber Post

Advantages: Dentin bonding Easy removal

Disadvantages: Low strength

(compared to metal) Lack of radiopacity Carbon color

presents an esthetic problem

Recommended Use:Can be used in posteriors with moderate loss of coronal structure

Recommended Use:Can be used in posteriors with moderate loss of coronal structure


3333Fiber Reinforced PostFiber Reinforced Post

Advantages: Esthetic

Disadvantages: Low strength High failure rate

Recommended Use:Should not be used where remaining tooth structure is less than ideal or where high occlusal forces are present.

Recommended Use:Should not be used where remaining tooth structure is less than ideal or where high occlusal forces are present.

33Aesthetic posts and cores for metal free restoration of endodontically treated teeth. Adriana Quintas, Jose Dinato. Pract Periodont Aesthet Dent; 12(9): 875-884

3434Zirconia Ceramic PostZirconia Ceramic Post

Advantages: Esthetics High stiffness High modulus of

elasticity

Disadvantages: Expensive Uncertain clinical

performances

Recommended Use:High esthetic demandsRecommended Use:High esthetic demands

Procedure Procedure

Textbook of Endodontology 2 editionsPreben Hørsted-Bindslev Page no 326

A review of the studies A review of the studies done on the various post done on the various post

systems suggests that the systems suggests that the fiber posts are the most fiber posts are the most

reliable!!!reliable!!!

Background: Post design and material has very important effects on dentinal stress distribution since the post placement can create stresses that lead to root fracture.

Materials:

4 metallic posts (ParaPost XH, ParaPost XT, ParaPost XP, and Flexi-Flange) and 1 fiberglass post (ParaPost Fiber Lux) were used.

35Fiber posts show more homogeneous stress distribution

than metallic posts.

35Fiber posts show more homogeneous stress distribution

than metallic posts.

35Influence of different post design and composition on stress distribution in maxillary posterior teeth. Finite element analysis. Natercia R Silva, Carolina G Castro, Paulo CF Santos-Filho. Indian journal of dental research 2009 vol 20

Purpose. This in vitro study compared the effect of titanium, quartz fiber, glass fiber, and zirconia posts systems on the fracture resistance and fracture patterns of crowned, endodontically treated teeth

Results. Teeth restored with quartz fiber posts exhibited significantly higher resistance to fracture than the other 3 groups. Teeth restored with glass fiber and zirconia posts were statistically similar.

Fractures that would allow repair of the tooth were observed in quartz fiber and glass fiber , whereas unrestorable, catastropic fractures were observed in titanium and zirconia post groups.

36Resistance to fracture of endodontically treated teeth restored with different post systems. Akkayan B, Gulmez T. J Prosthet Dent. 2002;87:431–437.

Fractures allow repairFractures allow repairGood strengthGood strength

Conclusion: The fiber posts evaluated provided an advantage over a conventional post that showed a higher number of irretrievable post and unrestorable root fractures. The fiber posts were readily retrievable after failure, whereas the remaining post systems tested were non retrievable.

37In vitro comparison of the fracture resistance and failure mode of fiber, ceramic, and conventional post systems at various stages of restoration. Cormier CJ, Burns DR, Moon P. J Prosthodont. 2001;10:26–36.

Readily retrievableReadily retrievable

PURPOSE: This retrospective study evaluated treatment outcome of cast post and core and Composipost systems after 4 yrs of clinical service.

The results of this retrospective study indicated that the Composipost(95% success) system(fiber-reinforced epoxy resin posts) was superior to the conventional cast post and core system(84% success) after 4 yrs of clinical service.

38Clinical evaluation of fiber-reinforced epoxy resin posts & cast post & cores. Ferrari M, Vichi A, Garcia-Godoy F.Am J Dent. 2000;13:15B–18B.

Better than cast post system in the long term

Better than cast post system in the long term

PURPOSE: This study aggregated literature data on in vitro failure loads and failure modes of prefabricated fiber-reinforced composite (FRC) post systems and to compare them to those of prefabricated metal, custom-cast, and ceramic post systems.

RESULTS: Custom-cast post systems showed higher failure loads than prefabricated FRC post systems, whereas ceramic showed lower failure loads. Significantly more favourable failures occurred with prefabricated FRC post systems than with prefabricated and custom-cast metal post systems.

39A structured analysis of in vitro failure loads and failure modes of fiber, metal, and ceramic post-and-core systems. Fokkinga WA, Kreulen CM, Vallittu PK, Creugers NH. Int J Prosthodont. 2004;17(4):476–482.

More favourableMore favourable

MECHANICAL PROPERTIESMECHANICAL PROPERTIES

Material Flexural strength

Gpa

Tensile Strength

MPa

Elastic Modulous

GPa

Stainless Steel

800 n/a 200

Titanium Alloy

1000 n/a 110

Zirconium Oxide

820 n/a 200

C-Post (64% Carbon)

1100 2900 17.8

40Evolving Technology in Endodontic Posts. Pitel M., Hicks NComp. Of Cont. Educ. in Dent. January 2003.

CONTENTS CONTENTS




restoration:I. PostsII. CoresIII. Crowns

Indications Principles Types of core build up Procedure

CORES

INDICATIONS

Core restorations are indicated if any of the following clinical conditions exist:The replacement of missing coronal tooth structure is necessary.When the enhanced retention and resistance to displacement of the final restoration is necessary.

41Fundamental of fixed prosthodontics 3 editions Herbert T. shillingburgPage no 367

MATERIALS USED FOR CORE BUILD UP

DIRECT PLACEMENT:

1.Composite resin

2.Amalgam

3.Glass ionomer resinINDIRECT PLACEMENT:

Casting42Fundamental of fixed prosthodontics 3 editions Herbert T. shillingburgPage no 369

Composite resin coreComposite resin core

Advantages: Good compressive

strength Easy to manipulate Rapid

polymerization Dentin bonding

Disadvantages: Polymerization

shrinkage Poor dimensional

stability

Recommended Use:Excellent build-up material for posterior and anterior teeth if isolation assured

Recommended Use:Excellent build-up material for posterior and anterior teeth if isolation assured

Amalgam coreAmalgam core

Advantages: Reduced marginal

leakage Better dimensional

stability Better compressive

strength Better modulus of

elasticity

Disadvantages: Mercury sensitivity Low tensile strength Corrosion with base

metal

Recommended Use:Molars with adequate coronal toothstructure

Recommended Use:Molars with adequate coronal toothstructure

Glass Ionomer resin coreGlass Ionomer resin core

Advantages: Anticariogenic Adhesive Easy to manipulate

Disadvantages: Low resistance to

fracture Low retention to

preformed post Sensitive to moisture

Recommended Use:Teeth with minimum tooth structure missing

Recommended Use:Teeth with minimum tooth structure missing

So which is the best So which is the best material for core material for core

buildup???buildup???

The modulus of elasticity of amalgam is significantly higher than all other material tested and is closer to that of dentin

Prepared core build-ups in a hybrid composite material provided the highest fracture resistance

46Fracture resistance of five pinretained core buildup materials on teeth with and without extracoronal preparation. Burke, FJT, Shaglouf, AG, Combe, EC, Wilson, NHF.Operative Dentistry 2000; 25: 388-394.

This study showed that the tensile and flexural strengths of composite are significantly higher than that of amalgam and glass ionomer.

47Kovarik, Robert E., Breeding, Larry C., Caughman, W. Franklin. Fatigue life of three core materials under simulated chewing conditions. The Journal of Prosthetic Dentistry Oct 1992; 68(4): 584-589.

Tensile strength and modulus of elasticity of glass ionomer cements are significantly lower than dentin and amalgam

Glass ionomers are relatively slow-setting and their early resistance to moisture is poor

48Mechanical properties of direct core buildup materials. Combe, E.C., Shaglouf, A., Watts, D.C., Wilson, N.H.F.Dental Materials 1999; 15: 158-165.

Based on the above stated evidence, composite seems to be the best choice as a core build up

material.

CONTENTS CONTENTS




restoration:

I. Posts

II. Cores

III.Crowns

CROWNS

Indications Advantages Disadvantages Types

CROWN PLACEMENT

INDICATIONSBetter estheticsSituations in which the structural integrity of natural crown is compromised

CONTRAINDICATIONSAnterior teeth have only have conservative access opening

49Textbook of EndodontologyGunnar Bergenholtz Page no 317

CROWNS

Advantages: Durable Good esthetics Restoring dental

function Good Form Protection of tooth

Disadvantages:

Loss of tooth structure Expensive

50Textbook of EndodontologyGunnar Bergenholtz Page no 317

METAL-CERAMIC CROWNS

It consists of a ceramic layer bonded to a thin cast metal coping that fits over the tooth preparation.

It combines the strength and accurate fit of a cast restoration with the esthetic effect of a ceramin crown.

Less tooth preparation required compared to all ceramic crowns.

5151PORCELAIN JACKET CROWN

It consists of a crown entirely made up of ceramic. Superior esthetics and excellent translucency. Good tissue response even with subgingival margins. But is has reduced strength and is the least

conservative of all tooth preparation.

51Endontics Problem-Solving in Clinical PrcticeTR Pitt Ford, BDS, PhDPage No.161

52FULL CAST METAL CROWNS

Cast metal crown is a full crown restoration which is cast with dental alloy.

It had high strength, is long lasting and requires the least amount of tooth preparation.

Cannot be used in areas where esthetics is of prime concern.

52Endodontics Problem-Solving in Clinical Practice First published in the United Kingdom in 2002ISBN 1-85317-695-8TR Pitt Ford, BDS, PhD Page no 161,

5353PARTIAL CAST METAL CROWNS

Partial cast metal crowns may be used when the buccal surface of the tooth is intact. They are more conservative of tooth tissue than complete crowns, but they are more demanding technically both for clinician and in the laboratory

53Color Atlas of Endodontics. William T.Johnson, 2nd edition, 133-134.

5454TEMPORARY CROWNS

Temporary crowns are used to protect a tooth that has been prepared for a permanent crown while the patient waits for the permanent crown to be fabricated by the dental lab.

Types:

i. Polycarbonate

ii. acrylic temporary

iii.Custom-cast temporaries

iv. Composite resin

54Color Atlas of Endodontics. William T.Johnson, 2nd edition, 133-134.

Conclusion

Anterior Tooth

Class IVClass I - III

Complete Coverage is required

Prefabricated fiber post with composite core

full ceramic crown

Complete Coverage is not required

Conservative TrtResin composite

Class V

Complete Coverage is required

Posterior Tooth

Class IV

Class I-III

Conservative TrtOnlay

Class V

Composite CoreFiber post

Metal Ceramic Crown

Pre-fabricated fiber post

Composite CoreMetal Ceramic

crown

Thank You

6.restoration of the endodontically treated tooth

Education