Restoration of the Restoration of the endodontically endodontically treated toothtreated tooth
Amith Babu Amrita DoraGanesh O.RPraveen JOurvind Singh
CONTENTS CONTENTS
Introduction History Need for final
restoration Objectives Classification
Anterior teeth Posterior teeth Components of final
restoration:
I. Posts
II. Cores
III.Crowns
The tooth as a houseThe tooth as a house
INTRODUCTIONINTRODUCTION
Endodontic treatment is largely performed on teeth significantly affected by caries, multiple repeat restorations and/or fracture. Already structurally weakened, such teeth are often further weakened by the endodontic procedures designed to provide optimal access and by the restorative procedures necessary to rebuild the tooth.
It is therefore accepted that endodontically treated teeth are weaker and tend to have a lower lifetime prognosis.
INTRODUCTIONINTRODUCTION
Hence require special considerations for the final restoration, particularly where there has been extensive loss of tooth structure. The special needs involve ensuring both adequate retention for the final restoration and maximum resistance to tooth fracture. Endodontic success depends not only on the quality of the root canal treatment, but also on timely coronal restoration of the compromised tooth.
CONTENTS CONTENTS
Introduction History Need for final
restoration Objectives Classification
Anterior teeth Posterior teeth Components of final
restoration:
I. Posts
II. Cores
III.Crowns
HISTORYHISTORY Various methods of restoring
pulpless teeth have been reported for past 200 years.
In 1747 Pierre Fauchard fabricated gold and silver posts to be placed in root canal space.
Replacement crowns were made from bone, ivory, animal tooth.
Is final restoration after endodontic
treatment important?
LITERATURE REVIEWLITERATURE REVIEW1In this study using radiographs they assessed the followingGood restorations + good endodontic treatments resulted in absence of periapical inflammation in 91.4%.Poor restorations + poor endodontic treatments resulted in the absence of periradicular inflammation in only 18.1%.Poor endodontic treatment + good restorations yielded a success rate of 67.6%.
1Periapical status of endodontically treated teeth in relation to the technical quality of the root filling and the coronal restoration.H. A. Ray and M. TropeInternational Endodontic Journal, vol. 28, no. 1, pp. 12–18, 1995.
This shows the importance of final restoration in endodontically treated teeth
CONTENTS CONTENTS
Introduction History Need for final
restoration Objectives Classification
Anterior teeth Posterior teeth Components of final
restoration:
I. Posts
II. Cores
III.Crowns
What are the What are the objectives of Final objectives of Final
restoration?restoration?
GOALSGOALS
2Maintained coronal and apical seal of the root canal treatment
Protect and preserve the remaining tooth structure Provided a supportive and retention foundation for
the placement of definitive restoration Restore the function and esthetics
2Colour atlas of endodontics 2 edition William T.Johnson DDS MSPage no 130
What are the factors What are the factors to be considered to be considered
while planning the while planning the final restoration?final restoration?
FACTORSFACTORS
3Amount of remaining sound tooth structure Occlusal function Opposing dentition Position of the tooth in the arch Length, width and curvature of the roots
3Endodontics : Restoring of Endodontically Treated TeethAmerican Association of Endodontics.1995 Dec Publication
CONTENTS CONTENTS
Introduction History Need for final
restoration Objectives Classification
Anterior teeth Posterior teeth Components of final
restoration:
I. Posts
II. Cores
III.Crowns
44Based on the remaining tooth Based on the remaining tooth structurestructure
Classification Description
Class I 4 walls
Class II 3 walls
Class III 2 walls
Class IV 1 wall
Class V No wall
4Restoring endodontically treated teeth with posts and cores—a reviewIngrid peroz et al.Quintessence International no.9 volume 36 oct 2005.
6Restoration of Endodontically Treated Teeth:
An Evidence-Based Literature ReviewUniversity of Toronto, Faculty of Dentistry. Int
J Prosthodont 2008;18(1):40-1.
FERRARI AND OTHERS
FOKKINGA & OTHERS
SAMPLES240 endodontically-treated premolars in 210patients
307 endodontically-treated teeth in 257patients
TEST TREATMENT
Fiber posts Cast post and corePre-fab metal post and composite core
CONTROL TREATMENT
No post Post-free composite core
DURATION (YRS)
2 Up to 17
CONCLUSIONS
4 coronal wall remaining: no difference incomplication rates≤ 3 coronal walls remaining: post placementincreases survival rates
Where “substantial remaining dentin” is available, a post and core does not perform better than a post-free core
8Ferrari M. Post placement affects survival of endodontically treated premolars. JDentRes 2007;86(8):729-734.
8Fokkinga W. Up to 17-year controlled clinical study on post-and-cores and covering crowns. J Dent 2007;35(10):778-786.
CONTENTS CONTENTS
Introduction History Need for final
restoration Objectives Classification
Anterior teeth Posterior teeth Components of final
restoration:
I. Posts
II. Cores
III.Crowns
ANTERIOR TEETHANTERIOR TEETH
9Anterior teeth with minimal loss of tooth structure can be restored conservatively with a bonded restoration in the access opening
9Intracoronal reinforcement & coronal coverage:a study of endodontically treated teeth. Sorensen JA, Martinoff JT. J Prosthet Dent 1984;51:780–4.
ANTERIOR TEETHANTERIOR TEETH
10A post is of little or no benefit in a structurally sound anterior tooth
Increases the chances of a failure
10Fracture strength and survival rate of endodontically treated maxillary incisors with approximal cavities after restoration with different post and core systems: an in-vitro study. Heydecke G, Butz F, Strub JR. J Dent 2001; 29:427–33.
ANTERIOR TEETHANTERIOR TEETH
11In cases of extensive loss of external tooth structure, a post is usually required for anterior teeth, due to the predominantly shearing forces present and the narrow tooth dimensions.
Extra-coronal crown preparation combined with endodontic access preparation significantly weakens the cervical area of anterior teeth.
11Post Placement and Restoration of Endodontically Treated Teeth: A Literature Review. Richard S. Schwartz, et al. Journal of Endodontics:VOL. 30, NO. 5, MAY 2004
Anterior TeethAnterior Teeth
13Biomechanical considerations for the restoration of endodontically treated teeth: A systematic review of the literature. Didier Dietschi,, Ivo Krejci, Quintessence international Volume 39 number 2 february 2008
Anterior TeethAnterior Teeth
14Biomechanical considerations for the restoration of endodontically treated teeth: A systematic review of the literature. Didier Dietschi,, Ivo Krejci, Quintessence international Volume 39 number 2 february 2008
CONTENTS CONTENTS
Introduction History Need for final
restoration Objectives Classification
Anterior teeth Posterior teeth Components of final
restoration:
I. Posts
II. Cores
III.Crowns
Considerations for 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 mus cles. This, combined with their morphologic character istics, makes them more susceptible to fracture.
Posterior teethPosterior teeth
15The results showed that the clinical success rates of endodontically treated premolars restored with fiber posts and direct composite restorations or full coverage with metal-ceramic crowns were highly successful without any failures, even after 3 years of service .
15J Prosthet Dent 2002 Sep;88(3):297-301. Three-year clinical survival of endodontically treated premolars restored with either full cast coverage or with direct composite restoration. Mannocci F, Bertelli E, Sherriff M, Watson TF, Ford TR
CASE REPORTPost-endodontic restoration of a
deeply decayed tooth - options and limitation Michael Bruder, DDS. Jounal of oral science,11: 2;2007.
Posterior teethPosterior teeth
16Molar teeth rarely require a post unless there has been significant loss of tooth structure. A coronal-radicular core buildup with silver amalgam utilizing the pulp chamber, and possible 2 mm canal extensions, has proved very effective in vitro and in vivo.
16Nayyar, A., An amalgam coronal-radicular dowel and core technique for endodontically treated posterior teeth. J Prosthet Dent, 1980. 43: p. 511.
CASE REPORTReconstruction of Endodontically Treated
Posterior Teeth—with or without Post? Maciej Zarow, Walter Devoto. The European
Journal Of Esthetic Dentistry. Volume 4,number 4,december 2009.
Tooth fracture of an endodontically treated maxillary molar restored with a bonded composite restoration.
CONTENTS CONTENTS
Introduction History Need for final
restoration Objectives Classification
Anterior teeth Posterior teeth Components of final
restoration:
I. Posts
II. Cores
III.Crowns
COMPONENTS OF FINAL COMPONENTS OF FINAL RESTORATIONRESTORATION
A. Posts
B. Cores
C. Crowns
CONTENTS CONTENTS
Introduction History Need for final
restoration Objectives Classification
Anterior teeth Posterior teeth Components of final
restoration:
I. Posts
II. Cores
III.Crowns
Role of posts Indications Post selection:Factors to be considered Ferrule effect Types Procedure
POSTS
The Role of Posts in the RestorationThe Role of Posts in the Restorationof Endodontically Treated Teethof Endodontically Treated Teeth
18The 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, and a post is not necessary when substantial tooth structure is present after a tooth has been prepared.
18W. Cheung, “A review of the management of endodontically treated teeth: post, core and the final restoration,” Journal of the American Dental Association, vol. 136, no. 5, pp. 611–619, 2005.
INDICATIONS 19Post 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.
19Stockton LW.Factors affecting retention of post systems:A literature review. J Prosthet Dent 1999;81:380–385.
FACTORS TO CONSIDER
Post length
Post diameter
Post design
20Stockton LW.Factors affecting retention of post systems:A literature review. J Prosthet Dent 1999;81:380–385.
Post lengthPost length21Guidelines:
1. The post should more than the incisocervical or occlusocervical dimension of the crown.
2. The post should be longer than the crown.
3. The post should be 1 1/3 the length of the crown.
4. The post should end halfway between the crestal bone and the root apex.
21Stockton LW.Factors affecting retention of post systems:A literature review. J Prosthet Dent 1999;81:380–385.
Ideal tooth preparation for post placement
Post Size and LengthPost Size and Length
22Post length is unique and individualized for each case. The clinician should have a thorough knowledge of root morphology before placing a post.
The longer the post, the greater the retention. 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
22Retention of endodontic dowels: effects of cement, dowel length, diameter, and design. Standlee JP, Caputo AA, Hanson EC: J Prosthet Dent 39:401, 1998.
The effect of the embedded depth of posts on retentive capacity has been shown to be
significant
Post diameter
23The diameter of the post is dictated by
the root canal anatomy. A minimal dentin thickness of 1 mm around
the post should be provided.
23Lloyd PM, Palik JF. The philosophies of dowel diameter preparation: A literature review. J Prosthet Dent 1993;69:32–36.
The diameter of the post is dictated by the remaining rootsubstance and root canal space: (A) too narrow; (B) optimumsize post; (C) too large.
Post design 24Posts can be serrated,
smooth, roughened or threaded.
Parallel, serrated posts are cemented into the canal passively. They are retentive and produce less stress in the root dentine than threaded systems
24Post Placement and Restoration of Endodontically Treated Teeth: A Literature Review. Richard S. Schwartz, et al. Journal of Endodontics:VOL. 30, NO. 5, MAY 2004
Ferrule EffectFerrule Effect
25The ferrule is the circumferential ring of sound tooth structure that is enveloped by the cervical portion of the crown restoration. A minimum sound dentine height of 1.5-2 mm is required between the core and crown margins.
25Sorensen JA and Engelman MJ. Ferrule design and fracture resistance of endodontically treated teeth. J Prosthet Dent 1999;63:529-536.
Importance of ferruleImportance of ferrule
The ferrule provides bracing or casing action to protect the integrity of the root.
2626Effect of a crown ferrule on the fracture resistance of endodontically treated teeth restored with prefabricated posts STATEMENT OF PROBLEM: Root fracture is
one of the most serious complications following restoration of endodontically treated teeth
Fifty freshly extracted canines were endodontically treated. The teeth were randomly divided into groups of 10 and prepared according to 5 experimental protocols
The results of this study showed that an increased amount of coronal dentin (ferrule) significantly increases
the fracture resistance of endodontically treated teeth.
The results of this study showed that an increased amount of coronal dentin (ferrule) significantly increases
the fracture resistance of endodontically treated teeth.
26Effect of a crown ferrule on the fracture resistance of endodontically treated teeth restored with prefabricated posts.Pereira JR, de Ornelas F, Conti PC, do Valle ALJ Prosthet Dent. 2006 Jan;95(1):50-4.
27An incomplete crown ferrule is associated with greater variation in load capacity and, despite high fracture values, inclines to fracture.
27Effect of incomplete crown ferrules on load capacity of endodontically treated maxillary incisors restored with fiber posts, composite build-ups, and all-ceramic crowns: an in vitro evaluation after chewing simulation.Naumann M, Preuss A, Rosentritt M.Acta Odontol Scand. 2006 Feb;64(1):31-6.
2727CHARACTERISTICS OF AN CHARACTERISTICS OF AN IDEAL POST:IDEAL POST:
Minimum preparation. Resistance to fatigue. Elastic modulus similar to dentin. Non corrosive. Retentive (post & Head). Easy to adjust and fit. Radiopaque. Adequate material Easy Removal
27Factors determining post selection: A literature Review. Fernandes A., Shetty Sh., Coutinho I.-J Prosth. Dent. Dec. 2003.
2828TYPES OF POSTS
METALLICMETALLIC NON-METALLICNON-METALLIC
Stainless Steel Titanium Titanium Alloy Gold-Plated
brass
Carbon Fibre Ceramic Glass-fibre
reinforced Composite
28Fundamental of fixed prosthodontics 3 editions Herbert T. shillingburgPage no 345
Types of PostsTypes of Posts
Prefabricated postsPrefabricated posts
Custom made postsCustom made posts
Direct TechniqueIndirect Technique
Wax pattern before casting. Wax pattern before casting.
Custom cast post and coreCustom cast post and core
Advantages: Preservation of maximum
tooth structure Provision of anti-rotational
properties Core retention Less chances of vertical
fractures during preparation High strength
Disadvantages: Less stiff than
wrought Time consuming,
complex procedure
Recommended Use: Elliptical canalsFlared canals
Recommended Use: Elliptical canalsFlared canals
2929Prefabricated Tapered PostPrefabricated Tapered Post
Advantages: Conserves tooth
structure High strength and
stiffness
Disadvantages: Low retention Longitudinal
splitting of remaining rootRecommended Use:
Small circular canals orVery tapered canals
Recommended Use:Small circular canals orVery tapered canals
29Post placement and restoration of endodontically treated teeth: A literature review. Schwartz. R, Robbins. J. J Endodon 2004, 30: 289-301.
3030Prefabricated Parallel - Sided Prefabricated Parallel - Sided Smooth PostSmooth Post
Advantages: Excellent clinical
retention Minimal stress
production within root
Ease of placement Superior rating
Disadvantages: Precious material
post expensive Corrosion of
stainless-steel Less conservative of
tooth structure
30Color Atlas of Endodontics. , 2nd edition William T.Johnson, page no 133-134.
3131Prefabricated Threaded PostsPrefabricated Threaded Posts
Advantages: High retention
Disadvantages: Stresses generated in
canal may lead to fracture
Does not conserve coronal and radicular tooth structure
Recommended Use:Only when maximum retention is essential
Recommended Use:Only when maximum retention is essential
31Color Atlas of Endodontics. , 2nd editionWilliam T.Johnson, page no, 133-134.
3232Carbon Fiber PostCarbon Fiber Post
Advantages: Dentin bonding Easy removal
Disadvantages: Low strength
(compared to metal) Lack of radiopacity Carbon color
presents an esthetic problem
Recommended Use:Can be used in posteriors with moderate loss of coronal structure
Recommended Use:Can be used in posteriors with moderate loss of coronal structure
32Post Placement and Restoration of Endodontically Treated Teeth: A Literature Review. Richard S. Schwartz, et al. Journal of Endodontics:VOL. 30, NO. 5, MAY 2004
3333Fiber Reinforced PostFiber Reinforced Post
Advantages: Esthetic
Disadvantages: Low strength High failure rate
Recommended Use:Should not be used where remaining tooth structure is less than ideal or where high occlusal forces are present.
Recommended Use:Should not be used where remaining tooth structure is less than ideal or where high occlusal forces are present.
33Aesthetic posts and cores for metal free restoration of endodontically treated teeth. Adriana Quintas, Jose Dinato. Pract Periodont Aesthet Dent; 12(9): 875-884
3434Zirconia Ceramic PostZirconia Ceramic Post
Advantages: Esthetics High stiffness High modulus of
elasticity
Disadvantages: Expensive Uncertain clinical
performances
Recommended Use:High esthetic demandsRecommended Use:High esthetic demands
Procedure Procedure
Textbook of Endodontology 2 editionsPreben Hørsted-Bindslev Page no 326
A review of the studies A review of the studies done on the various post done on the various post
systems suggests that the systems suggests that the fiber posts are the most fiber posts are the most
reliable!!!reliable!!!
Background: Post design and material has very important effects on dentinal stress distribution since the post placement can create stresses that lead to root fracture.
Materials:
4 metallic posts (ParaPost XH, ParaPost XT, ParaPost XP, and Flexi-Flange) and 1 fiberglass post (ParaPost Fiber Lux) were used.
35Fiber posts show more homogeneous stress distribution
than metallic posts.
35Fiber posts show more homogeneous stress distribution
than metallic posts.
35Influence of different post design and composition on stress distribution in maxillary posterior teeth. Finite element analysis. Natercia R Silva, Carolina G Castro, Paulo CF Santos-Filho. Indian journal of dental research 2009 vol 20
Purpose. This in vitro study compared the effect of titanium, quartz fiber, glass fiber, and zirconia posts systems on the fracture resistance and fracture patterns of crowned, endodontically treated teeth
Results. Teeth restored with quartz fiber posts exhibited significantly higher resistance to fracture than the other 3 groups. Teeth restored with glass fiber and zirconia posts were statistically similar.
Fractures that would allow repair of the tooth were observed in quartz fiber and glass fiber , whereas unrestorable, catastropic fractures were observed in titanium and zirconia post groups.
36Resistance to fracture of endodontically treated teeth restored with different post systems. Akkayan B, Gulmez T. J Prosthet Dent. 2002;87:431–437.
Fractures allow repairFractures allow repairGood strengthGood strength
Conclusion: The fiber posts evaluated provided an advantage over a conventional post that showed a higher number of irretrievable post and unrestorable root fractures. The fiber posts were readily retrievable after failure, whereas the remaining post systems tested were non retrievable.
37In vitro comparison of the fracture resistance and failure mode of fiber, ceramic, and conventional post systems at various stages of restoration. Cormier CJ, Burns DR, Moon P. J Prosthodont. 2001;10:26–36.
Readily retrievableReadily retrievable
PURPOSE: This retrospective study evaluated treatment outcome of cast post and core and Composipost systems after 4 yrs of clinical service.
The results of this retrospective study indicated that the Composipost(95% success) system(fiber-reinforced epoxy resin posts) was superior to the conventional cast post and core system(84% success) after 4 yrs of clinical service.
38Clinical evaluation of fiber-reinforced epoxy resin posts & cast post & cores. Ferrari M, Vichi A, Garcia-Godoy F.Am J Dent. 2000;13:15B–18B.
Better than cast post system in the long term
Better than cast post system in the long term
PURPOSE: This study aggregated literature data on in vitro failure loads and failure modes of prefabricated fiber-reinforced composite (FRC) post systems and to compare them to those of prefabricated metal, custom-cast, and ceramic post systems.
RESULTS: Custom-cast post systems showed higher failure loads than prefabricated FRC post systems, whereas ceramic showed lower failure loads. Significantly more favourable failures occurred with prefabricated FRC post systems than with prefabricated and custom-cast metal post systems.
39A structured analysis of in vitro failure loads and failure modes of fiber, metal, and ceramic post-and-core systems. Fokkinga WA, Kreulen CM, Vallittu PK, Creugers NH. Int J Prosthodont. 2004;17(4):476–482.
More favourableMore favourable
MECHANICAL PROPERTIESMECHANICAL PROPERTIES
Material Flexural strength
Gpa
Tensile Strength
MPa
Elastic Modulous
GPa
Stainless Steel
800 n/a 200
Titanium Alloy
1000 n/a 110
Zirconium Oxide
820 n/a 200
C-Post (64% Carbon)
1100 2900 17.8
40Evolving Technology in Endodontic Posts. Pitel M., Hicks NComp. Of Cont. Educ. in Dent. January 2003.
CONTENTS CONTENTS
Introduction History Need for final
restoration Objectives Classification
Anterior teeth Posterior teeth Components of final
restoration:I. PostsII. CoresIII. Crowns
Indications Principles Types of core build up Procedure
CORES
INDICATIONS
Core restorations are indicated if any of the following clinical conditions exist:The replacement of missing coronal tooth structure is necessary.When the enhanced retention and resistance to displacement of the final restoration is necessary.
41Fundamental of fixed prosthodontics 3 editions Herbert T. shillingburgPage no 367
MATERIALS USED FOR CORE BUILD UP
DIRECT PLACEMENT:
1.Composite resin
2.Amalgam
3.Glass ionomer resinINDIRECT PLACEMENT:
Casting42Fundamental of fixed prosthodontics 3 editions Herbert T. shillingburgPage no 369
Composite resin coreComposite resin core
Advantages: Good compressive
strength Easy to manipulate Rapid
polymerization Dentin bonding
Disadvantages: Polymerization
shrinkage Poor dimensional
stability
Recommended Use:Excellent build-up material for posterior and anterior teeth if isolation assured
Recommended Use:Excellent build-up material for posterior and anterior teeth if isolation assured
Amalgam coreAmalgam core
Advantages: Reduced marginal
leakage Better dimensional
stability Better compressive
strength Better modulus of
elasticity
Disadvantages: Mercury sensitivity Low tensile strength Corrosion with base
metal
Recommended Use:Molars with adequate coronal toothstructure
Recommended Use:Molars with adequate coronal toothstructure
Glass Ionomer resin coreGlass Ionomer resin core
Advantages: Anticariogenic Adhesive Easy to manipulate
Disadvantages: Low resistance to
fracture Low retention to
preformed post Sensitive to moisture
Recommended Use:Teeth with minimum tooth structure missing
Recommended Use:Teeth with minimum tooth structure missing
So which is the best So which is the best material for core material for core
buildup???buildup???
The modulus of elasticity of amalgam is significantly higher than all other material tested and is closer to that of dentin
Prepared core build-ups in a hybrid composite material provided the highest fracture resistance
46Fracture resistance of five pinretained core buildup materials on teeth with and without extracoronal preparation. Burke, FJT, Shaglouf, AG, Combe, EC, Wilson, NHF.Operative Dentistry 2000; 25: 388-394.
This study showed that the tensile and flexural strengths of composite are significantly higher than that of amalgam and glass ionomer.
47Kovarik, Robert E., Breeding, Larry C., Caughman, W. Franklin. Fatigue life of three core materials under simulated chewing conditions. The Journal of Prosthetic Dentistry Oct 1992; 68(4): 584-589.
Tensile strength and modulus of elasticity of glass ionomer cements are significantly lower than dentin and amalgam
Glass ionomers are relatively slow-setting and their early resistance to moisture is poor
48Mechanical properties of direct core buildup materials. Combe, E.C., Shaglouf, A., Watts, D.C., Wilson, N.H.F.Dental Materials 1999; 15: 158-165.
Based on the above stated evidence, composite seems to be the best choice as a core build up
material.
CONTENTS CONTENTS
Introduction History Need for final
restoration Objectives Classification
Anterior teeth Posterior teeth Components of final
restoration:
I. Posts
II. Cores
III.Crowns
CROWNS
Indications Advantages Disadvantages Types
CROWN PLACEMENT
INDICATIONSBetter estheticsSituations in which the structural integrity of natural crown is compromised
CONTRAINDICATIONSAnterior teeth have only have conservative access opening
49Textbook of EndodontologyGunnar Bergenholtz Page no 317
CROWNS
Advantages: Durable Good esthetics Restoring dental
function Good Form Protection of tooth
Disadvantages:
Loss of tooth structure Expensive
50Textbook of EndodontologyGunnar Bergenholtz Page no 317
METAL-CERAMIC CROWNS
It consists of a ceramic layer bonded to a thin cast metal coping that fits over the tooth preparation.
It combines the strength and accurate fit of a cast restoration with the esthetic effect of a ceramin crown.
Less tooth preparation required compared to all ceramic crowns.
5151PORCELAIN JACKET CROWN
It consists of a crown entirely made up of ceramic. Superior esthetics and excellent translucency. Good tissue response even with subgingival margins. But is has reduced strength and is the least
conservative of all tooth preparation.
51Endontics Problem-Solving in Clinical PrcticeTR Pitt Ford, BDS, PhDPage No.161
52FULL CAST METAL CROWNS
Cast metal crown is a full crown restoration which is cast with dental alloy.
It had high strength, is long lasting and requires the least amount of tooth preparation.
Cannot be used in areas where esthetics is of prime concern.
52Endodontics Problem-Solving in Clinical Practice First published in the United Kingdom in 2002ISBN 1-85317-695-8TR Pitt Ford, BDS, PhD Page no 161,
5353PARTIAL CAST METAL CROWNS
Partial cast metal crowns may be used when the buccal surface of the tooth is intact. They are more conservative of tooth tissue than complete crowns, but they are more demanding technically both for clinician and in the laboratory
53Color Atlas of Endodontics. William T.Johnson, 2nd edition, 133-134.
5454TEMPORARY CROWNS
Temporary crowns are used to protect a tooth that has been prepared for a permanent crown while the patient waits for the permanent crown to be fabricated by the dental lab.
Types:
i. Polycarbonate
ii. acrylic temporary
iii.Custom-cast temporaries
iv. Composite resin
54Color Atlas of Endodontics. William T.Johnson, 2nd edition, 133-134.
Conclusion
Anterior Tooth
Class IVClass I - III
Complete Coverage is required
Prefabricated fiber post with composite core
full ceramic crown
Complete Coverage is not required
Conservative TrtResin composite
Class V
Complete Coverage is required
Posterior Tooth
Class IV
Class I-III
Conservative TrtOnlay
Class V
Composite CoreFiber post
Metal Ceramic Crown
Pre-fabricated fiber post
Composite CoreMetal Ceramic
crown
Thank You