Current opinions concerning the restoration of endodontically treated teeth: basic principles

By Vârlan C, Dimitriu B, Vârlan V, Bodnar D, Suciu I.

Date: 08/2010
Journal: J Med Life

Purpose: a survey of the current knowledge about the clinical approach of restoring endodontically treated teeth

Summary: 

Significance of remaining coronal tooth structure

•Most important predictor of clinical success

•To ensure functional longevity, endodontically treated teeth must have at least 5 mm of tooth structure coronal to the crestal bone, 3mm are needed to maintain a healthy soft tissue complex and 2mm of coronal tooth structure incisal to the preparation finish line are necessary to ensure structural integrity

•A 1:1 crown-to-root ratio has been advocated as the minimum ratio for resisting lateral forces

•A retrospective study of 400 teeth during a 9-years period found that endodontically treated teeth with cuspal coverage were six times more likely to survive than those with intracoronal restorations (Aquilino SA, Caplan DJ.2002)

•When direct bonded restorations are not suitable, a core build-up followed by a partial or a complete crown coverage will be considered and the presence of a ferrule is needed

Significance of occlusal forces

•Endodontically treated teeth can withstand a maximum bite force comparable to natural teeth, being therefore able to regain a level of masticatory function similar to that in sound teeth (Woodmansey KF, Ayik M, 2009)

•Endodontically treated teeth retain the natural periodontal ligament, allows physiologic movement  and adapt to functional occlusal forces •Continuous loading as in clenching is more destructive than cyclic loading as in chewing

Most highlighted Results:

The basic principles in the restoration of endodontically treated teeth

• Cuspal coverage restorations appear to grant higher longevity to posterior teeth with RCT

•Bonded restorations represent the main choice for conservatively restoring anterior teeth with minimal loss

•Maximum preservation of coronal and radicular sound tooth structure is recommended

•When a tooth has more than 50% of its coronal structure missing, the use of a post-and- core is recommended

•Posts indicated only when there is inadequate tooth structure to retain a core

•An adequate ferrule is considered to need a minimum of 2 mm of vertical height and 1 mm of dentin thickness.