Dr. Özkan ADIGÜZEL

1. Restoration Of Root Filled
Tooth
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2. Success rates of Endodontics is extremely high in
contemporary practice (>95%)
Even re- root canal treatment gives a very high
success rates in the present practice >60%
Root treated teeth are in vulnerable state until
they are permanently restored
14% reduction of strength and toughness due to
changes in collagen cross link and dehydration
Fracture of remaining tooth tissue not due to
brittleness but due to loss of structural tissue
which is holding tooth together under functional
load in posteriors.
Rct reduce stiffness by 5% but tooth structure
removal by MOD stiffness by 60%
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3. Three major changes in rct tooth
Loss of tooth structure
Altered physical charactoristics
Altered esthetic characteristics
In anteriors fracture is due to over extended access
cavity and not incorporating ferrule for coronal
restoration
Failure rate of restorations is higher compared to
vital teeth
Mainly attributed to loss/ fracture remaining tooth
May be contributed by poorly designed stress
generating restorations eg MOD amalgams are
wedges splitting teeth
Reinfection of the root canal from the mouth
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4. Over extended access cavity Wedging force on unprotected cusp
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5. Conventionally, believed that removal of pulp leads to
changes in physical properties – “brittle”
No significant change in the physical properties
following endodontics
Major effect of RCT is the loss of tooth structure.
Root treated have previously being extensively
restored.
Removing the root filling and preparing a post space
further weakens the tooth
Stress generatedddduring endodontic and restorative
procedures also contribute to failures by promoting
cracks and fractures
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6. Aim at treatment with maximum preservation
and protection of remaining tooth structure
Minimizing stresses within the both tooth and
restoration. Avoid active restorations option
for bonded ones
Consider extraction and prosthesis when the
tooth is unrestorable.
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7. Existing endodontic status
Delay the final restoration until peri- radicular
healing is evident radiographically
During such period an adequate interim
restoration capable of preventing coronal leakage.
Site of the tooth in mouth
Quality of root canal treatment
Type of final restoration
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8. The amount of remaining tooth structure
Anatomic position of the tooth
The occlusal forces on the tooth
The restorative requirement of the tooth
Aesthetic requirement of the tooth
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9. Preserve as much tooth substance as possible
If post needed it should be long enough to be
retentive and sufficient strong to resist
distortion
Avoid twist drill for removal of GP
Avoid active restoration which induce stresses
Provide necessary coronal coverage
attempt for the best possible fluid and bacterial
tight seal
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10. Access cavity should not be over cut
Root canal should not be over flared
Preserve tooth substance by preparing proper
access cavity (labial access is acceptable)
Posterior teeth should be reduced out of
occlusion
Root treated teeth are vulnerable to fracture
because of access cavity and more tooth
substance loss due to caries
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11. GIC
Acrylic crown
Stainless steel crown
Over denture
Resin bonded bridge
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13. Conventional – weak crown Modified – poor aesthetic
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14. Decoronated root treated No protective ferrule is
anterior tooth vulnerable to provided by core or the crown
fracture
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15. Post and core provide no Beveling of residual tooth tissue
protection, a ferrule is provide allows both core and crown to
by crown provide protective ferrule
A ferrule is a band of metal which totally encircles the tooth,
extending 1-2mm into sound tooth tissue to guard against
longitudinal fracture
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16. Post and core provide no Protective ferrule provide
protection, a ferrule is by a cast post and
provide by crown diaphragm
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17. Minimizing further sacrifice of tooth material
Bleaching
Resin restorations are recommended above
indirect restorations when ever possible
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18. Access cavity preparation in posterior teeth
make them week
Even in the presence of marginal ridges tooth
stands a high risk of fracture
Composite restoration increases the resistance
to fracture of root filled teeth compared to non
adhesive restorations.
Challenge in doing a good restoration in a
large posterior cavity, especially if approximal
surfaces are involved.
Indirect tooth coloured restorations are
recommended in difficult cases.
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19. Tooth prepared with minimum access cavity and
having size 1 or 2 lesions can be restored with
sandwich technique
Remove all the GP anddCCement 2mm bellow the
cervical margin with heat carrier and carious
dentine and discolored restorations
Seal GP with ZnPO4 lining
Place GIC (condensable) without trapping air
bubbles to pulp chamber and cavities
After 1-7 days remove 2mm from GIC and
restored with LCC
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21. Tooth prepared with minimum access cavity and
having size 1 or 2 lesions can be restored with
amalgam or using sandwich technique
Place GIC (condensable) without trapping air bubbles
to pulp chamber and cavities
After 1-7 days remove 2mm from GIC and restored
with LCC
or
Remove all the GP and Cement 2-3mm bellow the
cervical margin and use as retentive factor
Place amalgam with matrix band and holder
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22. Remove all the GP and Cement 2-3mm bellow the
cervical margin and use as retentive factor
Cavity prepare to protect the physical fictional cusp
If esthetic and functional demands are fulfill adhesive
restorations can be done
Place amalgam with matrix band and holder
Or
Prepare cavity for onlay or ¾ crown take impression
temporized the tooth
Final restoration cemented with resin cement
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23. Cuspal protection – simple metal onlay
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24. Canal entrance use for core Ortho band strengthen the crown
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25. THREE QUARTER
FULL METAL CROWN
CROWN
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26. Post offer no reinforcementand
main function of the post is retain the core
Dentine removal for insertion of post
weakening the tooth
Create an area of stress concentration at the
terminus of the channel
If adequate retension can be obtained with
natural undercuts in pulp chamber and canal
entrance post should not be used
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28. Custom cast metal post little tissue loss Remove more tissue weaken crown,
stress on sharp edges and fracture
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29. Roof top preparation remove all the remaining coronal tissue
compromise protective ferrule
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30. Conservative preparation preserve tooth , lengthens the post,
allow to development of protective ferrules
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31. Long post and parallel are more retentive than
short post
4-5mm GP should remain apically
Place the post as long as apically
Preserve the tooth as much as coronally
remaining dentine should be prepared wrap
around coverage to get ferrule effect
Apically bevel tapered posts are prepared
Treaded post should be insert first to cut a
tread and then reinsert with cement
Customised post can be prepared with
minimum dentine removal and stresses
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32. Parapost – parallel & serrated
Radex anker- parallel, self tapping or pre-tapped
post
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33. Dentatus screw – tapered self tapping post
Kurer anchor – parallel threaded post for which the root canal is pre-
tapped
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34. Parallel post at the base Chamfered tip – reduce stress
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35. Post space preparation should be done on same day
that RC obturation is done because
operator is more familiar with RC & referral point
able to condense GP apically
can be done under rubber dam
GP should be removed with Gate bur up to correct
length
Canal should be prepared with proper twist drill
which is tally with the post up to correct length
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36. Cast post and core with diaphragm to
cover and support a damaged incisor root
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37. METAL POST AND CORE WITH CHAMFER PREPARATION
SHORT BUCCUL POST AND SEPARATE POST INSERTED
THROUGH CORE INTO THE PALATAL ROOT
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38. UNSATISFACTORY SATISFACTORY RCT WITH POOR
RCT CORONAL SEAL
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39. Cutting through porcelain reduce strength of
the crown, weaken the porcelain bond,
predispose to fracture, vibration disturb
cement lute and clamp damage cervical
porcelain
Metal prevent X ray assessment and loss of
orientation misdirected cutting
Each tooth before crowning should be assessed
well (appearance, percussion, biting pressure,
caries, NCTSL,, restorations, vitality, X ray and
previous RCT)
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