1. SESSION XIII - RESTORATION dr B.Cerkaski preclinical course
ENDODONTICS
preclinical course

2. Restoration of the endodontically treated teeth
SESSION XIII - RESTORATION dr B.Cerkaski
Restoration of the endodontically treated teeth

3. SESSION XIII - RESTORATION dr B.Cerkaski
Session outline
Coronal seal
Structural and biomechanical considerations
Restoration timing
Restoration design
Temporary restorations

4. Objectives of tooth restoration
The permanent restoration must:
Provide coronal seal
Protect the remaining tooth structure
Minimize cuspal flexure
Satisfy function and esthetics

5. → sealer disintegration & bacterial contamination
Coronal seal
RCT will fail if the obturating materials become exposed to oral fluids
lost restoration
marginal discrepancy
recurrent caries
→ sealer disintegration & bacterial contamination
Restoration (temporary and permanent) provides the coronal seal

6. Restorative failures Restorative failures commonly include:
Cusp fracture
Crown-root fracture

7. Structural and biomechanical considerations
STRUCTURAL CHANGES IN DENTIN
Root canal treated teeth become brittle, supposedly losing resilience as the moisture content of dentin declines after pulp loss. Changes in collagen cross-linking in dentin is also observed in non-vital teeth.

8. Structural and biomechanical considerations
LOSS OF TOOTH STRUCTURE
Teeth after RCT are weakened even by occlusal cavity preparation
There is a greater susceptibility to fracture in teeth with caries, trauma or large restorations

9. Structural and biomechanical considerations
BIOMECHANICS
Cuspal flexure (especially premolars, molars) can lead to cyclic opening of margins between the tooth and restorative material → leakage, fracture
As cavity preparation become larger and deeper – usupported cusps become weaker and show more deflection under occlusal loads

10. Restoration timing As soon as possible!
In teeth requiring restoration of only the access (f.e. minimally restored anterior teeth) the final restoration is best placed immediately after obturation (temporary restoration protect against bacterial contamination but do not provide complete protection against occlusal forces)
It may be necessary to defer the restoration but the delay should be minimal

11. Indications for delaying final restoration
Questionable prognosis (where failure would lead to extraction)
Use of tooth as a bridge abutment may demand evidence of healing before an expensive prosthesis is placed
Only few indications justify delaying restoration!

12. Principles of restoration design
CONSERVATION OF TOOTH STRUCTURE – further dentin removal should be minimized but cuspal reduction may be necessary
RETENTION – the coronal restoration should be retained by remaining dentin or the post and core.
PROTECTION OF REMAINING TOOTH STRUCTURE – protection of unsupported cuspsto minimize the flexure and fracture

13. Restoration designs DIRECT RESTORATIONS /composite, amalgam/
INDIRECT RESTORATIONS /onlays, prosthetic crowns/

14. Direct restorations - indications
Minimal tooth structure lost before and during RCT
Uncertain prognosis
Ease of placement and cost

15. Direct restoration (composite)

16. Direct restoration (composite)

17. Direct restoration (composite)

18. Direct restoration (composite)

19. Direct restoration (composite)

20. Direct restoration (composite)

21. Direct restoration (composite)
Another case: tooth 36 after RCT (temporary filling)

22. Direct restoration (composite)
…after removal of temporary filling

23. Direct restoration (composite)
…adhesive procedure + wall restored

24. Direct restoration (composite)
…final effect

25. Direct restoration (composite)
Another case: tooth 36
Tooth 36 after RCT

26. Indirect restorations
Cast restorations provide the greatest occlusal protection and are optimal if there is extensive loss of tooth structure
Full crown is a reliable and strong restoration that protects against crown-root fractures. In this situation a post and core must be placed!

27. Indirect restoration (composite)

28. Indirect restoration (composite overlay)

29. Indirect restoration (porcelain inlays / onlays)
Another case: teeth

30. Post and core + prosthetic crown

31. Objectives of temporization
Different materials are required depending on:
Time
Occlusal load and wear
Complexity of access
Loss of tooth structure

32. Temporary restorations
Must do the following:
Seal coronally, preventing ingress of oral fluids and bacteria and egress of intracanal medicaments
Enhance isolation during treatment procedures
Protect tooth structure until the final restoration is placed
Allow ease of placement and removal

33. Temporary restorations
Premixed cements (CAVIT, COLTOSOL, PROVIDENT)
Intermediate restorative materials (IRM)
Glassionomers
Temporary endodontic restorative materials (TERM)

34. Temporary restorations

35. Technique for temporization
cotton pellet
3-4 mm of temporary material are required!
Minimal space should be occupied by cotton pellet

36. Technique for temporization
The „blob” technique is wrong because it does not seal the walls.
The incremental technique which adds succesive layers,
pressing against the chaber walls is correct.

37. … thank you for your attention…