RESTORATION OF THE ENDODONTICALLY TREATED TOOTH

THIS COURSE IS AVAILABLE IN CD AND MP3 FORMAT-PLEASE SPECIFY YOUR PREFERENCE IN THE COMMENTS/SUGGESTIONS SECTION.

Nadim Baba, D.M.D., M.S.D.

Dentistry has long been concerned with both the restoration of teeth with pulpal disease and teeth with clinical crowns damaged by decay or trauma. But only recently have practi­tioners been able to successfully predict outcomes of treating these conditions.

Patient-Health Related Factors: 

• Systemic and local health factors: poorly or uncontrolled diabetes, immune-suppressed, smokers have elevated risk of developing complications after implant placement.
• Patient comfort and perceptions

• Limited remaining tooth structure
  • Fatigue resistance is crucial to long-term success
  • Success requires a tooth be able to accept repeated forces at a lower level to succeed rather than be resistant to one maximal traumatic event
  • Importance of using adhesive resin regardless of post and core build-up used
  • In additional to ferrule, thickness of remaining walls of the tooth will impact success (need for studies)
  • Bruzism (ideal ferrule) 
• Crown-to-root ratio
• Preparation for resistance and retention form
• Ability to perform oral hygiene
• Quantity and quality of bone (type IV worst)
• Soft tissue anatomy or esthetic issues: papilla, periodontal biotype (if thin avoid implants)
  • No more need for heroic treatment to save isolated single tooth because of predictability and success rate of single implant
  •  Implant close to natural teeth, better papilla
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OBJECTIVES

• Determine indications for including endodontics as part of the treatment plan
• Evaluate suitability of teeth for root canal treatment and prosthetic restoration
• Identify potential problems that can result in failure of endodontically treated teeth
• Recognize the need for retreatment
• Determine when and where posts are needed
• Understand current concepts in restoration
• Be aware of the decision criteria for cast post and cores vs. prefabricated posts and endodontic treatment vs. implant therapy
• Recognize materials available for prefabricated posts
• Determine advantages and limitations of various types of prefabricated posts
• Select cements and method of cementation of posts
• Identify different core materials available for core buildup with an emphasis on their advantages and disadvantages.