restoration of ally treated tooth
TRANSCRIPT
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Restoration of endodontically
treated tooth
Prepared by:
Rawa Omar
Supervised by:
Prof .Dr. Salam Al-
Qaisi
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Are Endodontically Treated
Teeth More Brittle?Contrary to common belief, endodontically treated teeth
are not more brittle . No difference in moisture content was
found between endodontically treated and vital teeth . Theaccess cavity in combination with an early loss of one or both
marginal ridges leaves the tooth at serious risk. A direct
relationship exists between the amount of remaining tooth
structure and the ability to resist occlusal forces
[Restoration of Endodontically Treated Teeth Review and Treatment Recommendations, Iris
Slutzky-Goldberg,etal International Journal of Dentistry
Volume 2009, Article ID 150251.
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Factors influence the choice of
technique Type of tooth
The amount of remaining coronal tooth
structure: the most important prognosis-determining factor
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Criteria of teeth to be restored
1. Good apical seal.2. No sensitivity to pressure.
3. No exudates.
4. No fistula.5. No apical sensitivity.
6. No active inflammation.
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Extension of the axial walls of the crown apical
to missing tooth structure provides what’s
known bythe FERRULE:
It helps to:
1. Bind tooth structure together
Restoration of endo. teeth
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Methods to create ferrule inextensively destryed tooth
- Reduce root length and increase crown length
(crown: root ration unfavorable)
- Reduce root length and unchanged crown length (crown:
root ratio is favorable(
Ortho. extrusion Surgical crown lengthening
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Some of the areas of general agreement regardingpost design include:
When a post is needed, remove little if any additional dentin beyond what isneeded to perform the root canal treatment.
Retain a minimum of 4 mm of gutta-percha apically .
Use a post designed to incorporate mechanical features that resist rotationalforces Since forces concentrate at the crest of bone during function, place thepost to extend apical to the crest of the bone. One “rule of thumb” is that the
post should extend “into bone” at least as far as it protrudes “out of bone.”
Should endodontic retreatment be necessary“retrievability” is an important
property of a post and should be considered in post selection.
AMERICANASSOCIATION OFENDODONTISTS Spring/Summer 2004
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INDICATIONS FOR A POST
The primary function of a post is to retain a core in a tooth
with extensive loss of coronal tooth structure.
preparation of a post channel adds a
degree of risk to a restorative procedure:
Disturbing the seal of the root canal filling, which may lead tomicroleakage
Removal of sound tooth structure, which weakens the root and
may result in
premature loss due to root fracture
Increased risk of perforation.
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Post Classification
Custom
Can be cast from:-Direct pattern in pt mouth
- In direct pattern inlaboratory
Prefabricated
•metal alloy•Carbon fiber posts•Composite fiber posts•Ceramic (zirconia) posts
– ceramic composite
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Restoration of endo. teeth
Prefabricated
dowelsNon-eshetic
Titanium
Carbon fiber
Esthetic
Zirconia
Fiber reinforced
composite resin matrix
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A: smooth, tapered; B: Tapered serrated; C: Threaded tapered; D:
smooth, parallel-sided; E: serrated, parallel-sided; F: Threaded,
parallel-sided
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Mechanical Properties
Product Flexural Tensile Flexural Elastic Fiber Percent ofStrength Strength Modulus Modulus Used Fiber
(Gpa) (Mpa) (Gpa) (Gpa)Stainless Steel 800 n/a n/a 200 n/a n/aTitanium Alloy 1000 n/a n/a 110 n/a n/a
Gold Alloy n/a n/a n/a 77 n/a n/aZirconium Oxide 820 n/a n/a 200 n/a n/aC-Post 1100 2900 120-140 17.8 Carbon 64Aesthetic Plus 1400 2200 44 15 Quartz 62D.T. Light 1600 2050 46 15 Quartz 60FibreKor 960 1200 13.5 n/a Glass 42Para Post White 990 1200 29.5 n/a glass 42
Snow Post n/a 1229 n/a 45.1 Zirconium 65Dentin 15-40
Pitel M., Hicks N.- Evolving Technology in Endodontic Posts. Comp. Of Cont. Educ. in Dent.January 2003.
rxdentistry.in
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2/3 length of the root
1/2 distance of the remaining root into the
bone4 mm of apical seal
Equal to length of clinical core
Ferrari M., Scotti R.- Classification of Endodontic Posts (Chapter 2). In Fiber Posts. Characteristics andClinical Applications. Masson. 2002
Shillingburg H. T., Kessler C. J.- Restoration of Endodontically Treated Teeth. Quint. Books. 1982 McLean A. Predictably restoring endodontically treated teeth. 1998; J Can Dent Assoc 64(11): 782-787
Method for determining the length of the
post:
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Custom-made Posts
Direct Technique:
direct pattern fabricated in the patient’s
mouth using either autopolymerizing orlight-polymerizing resin. Recommendedfor single canals
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Custom-made Posts
Custom-made Post:
Indirect Technique: utilizing an impression for the
post space and indirect pattern fabricated in thelab.
More appropriate for multiple canals
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Core :
Restorative material that replace coronal tooth structure .
Physical characteristic of core:
High compressive strength.
Dimmensional stability .
Ease of manipulation.
Short setting time for cement.
An abillity to bond to both tooth & dowel.
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One-piece post crown
Two-piece post crown
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Core Materials
Amalgam
Zinc oxyphosphate
Glass ionomer
Composite
Cast Metals (gold, silver….)
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Amalgam
• Biggest advantage: doesn’t shrink, so doesn’t
place stress on the bond
• Disadvantages – Esthetics, only to be used in molars
– May stain hard and soft tissues
–Corrosion→expansion→fractures
– Environmental concerns
– Cannot be prepped in the same session
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rxdentistry.in
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Luting Materials
If a post is not cemented in the samevisit as the post space is prepared, the
post space is filled with calcium hydroxidepaste and sealed bacteria-tight until thepost can be cemented. In this wayinfection of the post space and the rootdentin is avoided.
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LUTING FIBER POSTS
Fiber posts are usually luted with lightlyfilled composite resins. Light penetration
is limited, so dual-cure of self-cure lutingresins must be used
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Provisional restoration:
If a cast post & core is made,anadditional provisional restoration isneeded while post & core being
fabricated.
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Provisional Restoration
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