1. Restoration of Endodontically Treated Teeth

2. Dr. Nawfal Zakarea
Assistant professor MBCHB.1990 MSc.1994, PhD.2015 In Conservative Dentistry

3. Endodontically treated teeth often exhibit minimal tooth structure after treatment,
these teeth should be restored in a manner that will provide:
coronal seal, adequate retention and a strength to ensure optimal success.
Endodontic success depends not only on the quality of the root canal treatment, but also on timely coronal restoration of the compromised tooth.

4. Treatment Goals Maintain coronal seal of the root canal treatment
Protect and preserve the remaining tooth structure
Provide a supportive and retention foundation for the placement of definitive restoration
Restore the function and esthetics

5. Factors Affecting the Planning of the Restoration
Amount of remaining sound tooth structure
Occlusal function
Opposing dentition
Position of the tooth in the arch
Length, width and curvature of the roots

6. Classification
Endodontically treated teeth can be classified according to the remaining tooth structure into:
Classification Description
Class I 4 walls
Class II 3 walls
Class III 2 walls
Class IV 1 wall
Class V No wall

10. CL II
CLV

11. Anterior Teeth
With only a conservative access opening, anterior teeth can be restored with a resin restoration.
Placement of a post is not necessary when a complete coverage restoration is not indicated.

12. Anterior Teeth

13. Anterior Teeth
Post installation may inhibit attempts to bleach a discolored endodontically treated tooth. Moreover, a post does not strengthen the root.
Large interproximal restorations, incisal edge fractures, or esthetic concerns may necessitate the placement of a post and core, as well as full coronal coverage.

14. Anterior Teeth
In cases of extensive loss of external tooth structure, a post is usually required for anterior teeth, due to the predominantly shear forces present and the narrow tooth dimensions.
Extra-coronal crown preparation combined with endodontic access preparation significantly weakens the cervical area of anterior teeth.

15. Anterior Teeth

16. Anterior Teeth

17. 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 muscles.
This, combined with their morphologic characteristics, makes them more susceptible to fracture.
Hence, Full-coverage crowns are indicated to prevent fracture when occlusal forces act to fratured the cusp tips.

18. Posterior Teeth
If significant tooth structure has been retained, a crown may be all the coverage required.
If minimal structure remains, a post may be necessary to help retain a foundation before crown placement.
In ultra conservative access cavity with minimal caries the tooth may not need crown, just composite restoration.

19. Posterior Teeth

20. Components of Final Restoration
Post
Core
Crown

21. Posts
Role of Post:
The 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 (except in case of fiber post), and a post is not necessary when substantial tooth structure is present after a tooth has been prepared.

22. Indications of Posts
Post 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.

23. Factors to be Considered
Post length
Post diameter
Post design (end design of the post)
Selection of root for post:
A- The largest
B- Straight or with minimal curvature

24. Post Length Post length is unique and individualized for each case.
The clinician should have a thorough knowledge of root morphology before placing a post.
The post should more than the incisocervical or occlusocervical dimension of the crown.
The post should end halfway between the crestal bone and the root apex.
The longer the post, the greater the retention.

25. Post Length
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.
At a minimum, the post length should be equal to or greater than the crown length of the restored tooth.
At least 4 to 5 mm of gutta-percha should be left in the apical portion of the canal to ensure an adequate seal.
If this guideline cannot be followed and the post is shorter than the crown, extraction should be considered.