restoration of endodontically treated teeth (02) /certified fixed orthodontic courses by indian...

RESTORATION OF ENDODONTICALLY TREATED TEETH

INDIAN DENTAL ACADEMY

Leader in continuing dental education www.indiandentalacademy.com

www.indiandentalacademy.com

DIAGNOSIS AND TREATMENT PLANNING

Prior to performing any dental procedure, the clinician must first examine the patient and arrive at a diagnosis. Following this process, a treatment plan can be formulated based on the medical and dental history, the clinical and radiographic examination, and the patient’s needs and chief complaint.


Endodontic considerations Attention must be given to the quality of the endodontic therapy. Prior to restorative procedures, it is essential that the endodontic treatment be successful. Predictable success in endodontic therapy requires a dense, uniform, three dimensional obturation of the root canal system.


Prosthetic Considerations In evaluating tooth type, the

clinician must realize that each tooth exhibits a unique morphology and structure, which will be subjected to different degrees of stress during function. Morphologically, the circumference of the tooth at the cementoenamel junction is of great concern when considering a restorative procedure. www.indiandentalacademy.com

In posterior teeth, the occlusal forces are directed more axially than in anterior teeth in which the forces are more lateral. In addition, the direction and degree of occlusal stress can be increased if the tooth is to be an abutment for a fixed or removable prosthesis.


Periodontal considerations Periodontal disease should be treated prior to placement of definitive restorations. A healthy periodontium provides the best prognosis for the tooth and will make procedures such as placement of margins and making of an impression easier and more accurate.


Clinical Protocol for restoring endodontically treated teethAnterior teeth

As a consensus, anterior teeth that exhibit intact marginal ridges, can be restored by placement of a base over the guttapercha obturating material and sealing the lingual access with an acid etch composite resin provided the teeth meets the occlusal requirements and the patient is happy with the appearance.


Pulp less anterior teeth can also be conservatively restored with a bonded composite resin restoration rather than artificial crown. A laminate veneer offers a conservative alternative if the facial surface is intact with moderate discolouration.


Anterior teeth that exhibit mesial and distal restoration should be restored with a post and core prior to the placement of a crown. The loss of both marginal ridges and a lingual access opening leaves the facial portion of the tooth unsupported.

Mandibular incisors and maxillary lateral incisors would always require a post and core before placing an artificial crown.


Posterior teeth The need for a core or a post and core is determined on the basis of remaining tooth structures as well as expected occlusal and prosthetic forces that will be applied.


Post&coreIt consists of two components. The post is the component that is inserted into the root canal and the core is the retentive component which behaves like a prepared crown for the placement of retainer.


ClassificationBased on the method of fabrication

Pre fabricated – They are available as post systems which use either amalgam or composite resin as core build up material. The most commonly used materials are stainless steel, titanium, nickel or chromium containing alloys. Non- metallic fiber reinforced resin posts are also available.

Custom made – they are cast from wax and resin patterns fabricated in the prepared canal .the post and core are cast as a single unit.


Based on their shape

Parallel sided

Tapered


Based on the surface characteristics

Plain Threaded Serrated Sandblasted Vented Split shank


FACTORS AFFECTING RETENTION OF POST SYSTEMS

Post Length The post should equal the incisocervical or occlusocervical dimension of the crown. The length of the post has a significant effect on its retention and in most instances, the more deeply the post is placed, the more retentive it becomes.


Post Diameter Post diameters should not exceed one third of the root diameter at any location. Increasing the diameter of the post does not provide a significant increase in the retention of the post; however, it can increase the stiffness of the post at the expense of the remaining dentin and the fracture resistance of the root


Post Design- parallel sided posts and posts with surface characteristics have better retention.


Canal preparation for placement of post

Peeso reamer is the instrument of choice for removing the guttapercha and for enlarging the canal. These instruments do not perforate the canal because they have non-cutting tips, which follow the path of least resistance


Peeso reamerwww.indiandentalacademy.com

A hot condenser can be used to remove GP remnants

After removing the GP, the peeso reamer should again be inserted to the required depth and used to enlarge the canal

A test radiograph should be taken to decide the amount of canal enlargement.


The canal should be prepared such that there is at least 1mm of tooth structure at the apical end. The diameter of the canal should be at least 1 /3rd the width of the tooth

A No: 170 bur is used to prepare a keyway in the tooth along the length of the canal for a distance of 4 mm. The keyway should be equal to the width of the bur


A contrabevel is placed around the occluso axial line angle so that a metal collar is formed during casting which will embrace the remaining coronal tooth structure and protect it from fracture (Ferrule).


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