Restoration of

Endodontically Treated Teeth

Department of dental concervative

Hasanuddin university
IMPORTANCE OF CORONAL
RESTORATION
Postendodontic coronal restoration is important to
prevent ingress of microorganisms into coronal
pulp. To prevent coronal leakage, the clinician
should:
1. Temporarily seal the tooth during or after the
treatment
2. Provide adequate coronal restoration after
treatment
3. Do long term follow-up so as to evaluate the
integrity of restoration
IMPORTANCE OF CORONAL
RESTORATION
Even a well done endodontic treatment can get
infected due to following reasons:
• Poor quality of temporary restoration
• Delay in permanent restoration after completion
of endodontic treatment
• Poor marginal integrity of final restoration
• Fractured tooth.
Effects of endodontic treatment
on tooth
vStructural changes
Tooth weakening caused by:
§ Caries
§ Trauma
§ Access cavity preparation
§ Radicular preparation
Compromised structural integrity.
vChanges in dentin
§ A reduced amount of moisture in nonvital
teeth.
Effects of endodontic treatment
on tooth
vEsthetic considerations
§ Loss of tooth structure
§ Change in appearance because of alteration
in biochemical properties of dentin.
§ Discoloration because of:
§ Incomplete debridement
§ Accumulation of sealer or debris.
PLANNING POST ENDODONTIC
RESTORATION PROCEDURE
The restoration plan depends on:
§ Amount of remaining tooth
structure
§ Functional needs of the patient
§ Position/location of tooth in the
arch
§ Morphology/anatomy of the root
canal.
Planning for Anterior Teeth

§ Not all endodontically treated

teeth require posts
§ Most teeth with healthy
remaining tooth can be restored
by direct restoration of the
access cavity
Planning for Anterior Teeth

§ For devitalized, discolored anterior teeth, where

more than half of the coronal structure is intact,
the preferred treatment should be bleaching
and/or composite or porcelain laminate veneers
rather than the full coverage crowns or post and
core
§ But if there is doubt regarding the adequacy of
resistance form of the coronal portion of the
tooth for any restoration, then in such cases post
and core is indicated
Planning for Porterior Teeth
§ If there are no proximal fillings, caries or unsupported
cusps or strong facets, the access cavity of posterior
teeth can be easily restored with amalgam or high
strength posterior composites
§ If there is moderate damage of posterior teeth having at
least minimum of one sound cusp, the choice of
restoration can be:
§ Amalgam: Coronal-radicular core (Nayyers
Technique) which is finally restored with cast
restoration
§ Pin retained restorations
§ Onlay
§ Prosthetic crown.
Planning for Porterior Teeth
§ In case there is presence of severely damaged clinical
crown with no remaining cusps (Fig. 26.10), the root
canal is used as a space for intraradicular retention
(Fig. 26.11).
§ Generally all the endodontically treated teeth should be
restored using the crown. A post is indicated in the
tooth when it is severely damaged, or it is to serve as
an abutment for a removable partial denture. In such
cases, the forces which act on teeth are not
physiologic, thus a coronal reinforcement is indicated.
Post is usually given in palatal canal of maxillary molars
and distal canal of mandibular molars.
In case of severely damaged
crown, root canal space is used
for intra-radicular retention.
Radiograph showing post
placement in distal canal of 36
Features Evaluated before
Going for Post and Core

§ Restorability of the tooth

§ Role of tooth in the month
§ Periodontal considerations
§ Functional loading
Requirements of a Tooth to
Accept a Post and Core
§ Optimal apical seal
§ Absence of fistula or exudate
§ Absence of active inflammation
§ No sensitivity to percussion
§ Absence of associated periodontal disease
§ Sufficient bone support around the root
§ Sound tooth structure coronal to alveolar crest
§ Absence of any fracture of root.
Component of Post and Core System
Ideal Requirements of a Post
A Post Should:
§ Provide maximum protection of the root to resist root
fractures
§ Provide maximum retention of the core and crown
§ Be easy to place
§ Be less technique sensitive
§ Have high strength and fatigue resistance
§ Be visible radiographically
§ Be biocompatible
§ Be easily retrievable when required
§ Be esthetic
§ Be easily available and not expensive.
CLASSIFICATION OF POSTS
A. Posts can be classified as:
I. Prefabricated
II. Custom made
Prefabricated Post and Core & Custom Made Post
and Core
CLASSIFICATION OF POSTS
I. Prefabricated post
1. Metal prefabricated posts are made up of:
• Gold alloy
• High platinum alloys
• Co-Cr-Mo alloys
• Stainless steel
• Titanium and titanium alloys
2. Carbon fiber post
3. Quartz fiber post
4. Zirconia posts
5. Glass fiber post
6. Plastic posts.
CLASSIFICATION OF POSTS
II. Custom made posts
a. Custom cast metal post and core are usually made up
of:
• Gold alloys
• Platinum-palladium alloys
• Base metal alloys
• Co-Cr-Mo alloys
• Ni-Cr alloys.
b. Ceramic custom made posts are made up of all
ceramic.
CLASSIFICATION OF POSTS
B. Posts can also be classified as:
1. Active post: Active posts
mechanically engage the canal walls.
They are retentive in nature but can
generate stresses during their
placement and functional loading
2. Passive or cemented posts: Passive
posts do not engage the canal walls.
They are less retentive but also
produce low stresses while placement
and functional loading
CLASSIFICATION OF POSTS
C. According to post design :
• Smooth
• Serrated
• Tapered
• Parallel sided
• Combination of above
FACTORS TO BE CONSIDERED
WHILE PLANNING POST AND CORE
Factors affecting post retention
• Post length
• Post diameter
• Post taper and design
• Luting agent
• Luting method
• Canal shape
• Post position in dental arch.
FACTORS TO BE CONSIDERED
WHILE PLANNING POST AND CORE
Factors affecting post resistance
• Post length
• Rigidity
• Presence of antirotational features
• Presence of ferrule.
Diagram showing post
and core placement with
ferrule effect, positive
stop and antirotation
notch
Accepted Guidelines for
Determining Post Length
These include:
§ Post should be equal to clinical crown length.
§ Post should be equal to one-half to two-thirds of
the length of the remaining root.
§ Post should end halfway between the crestal
bone and the root apex.
§ Post should be as long as possible without
disturbing the apical seal.
Accepted Guidelines for
Determining Post Diameter
§ The conservationist: It suggests the narrowest diameter that
allows the fabrication of a post to the desired length. It allows
minimal instrumentation of the canal for post space preparation
According to this, teeth with smaller dowels exhibit greater
resistance to fracture.
§ The preservationist: It advocates that at least 1 mm of sound
dentin should be maintained circumferentially to resist the
fracture
§ The proportionist: This advocates that post width should not
exceed one-third of the root width at its narrowest dimensions
to resist fracture. The guideline for determining appropriate
diameter of post involves mesiodistal width of the roots.
Conservationist approach

Preservationist approach

Proportionist approach
LUTING AGENTS

Commonly used dental cements for luting the

posts are
§ Zinc phosphate cement
§ Polycarboxylate cement
§ Glass ionomer cement type I
§ Resin based composite
§ Hybrid of resin and ionomer
 Reference:

§ Textbook of endodontic
nishagarg & amitgarg.