MANAGEMENT OF MUTILATED

TEETH
• DEFINITION OF MUTILATION ITEMS TO DISCUSS
• CHARACTERISTIC OF MUTILATED TEETH
• SEQUALEA OF MUTILATION
• IMPORTANT FACTORS IN DECISION MAKING OF RESTORATION
• DIFFERENT TREATMENT OPTIONS FOR ANTERIOR TEETH/POSTERIOR TEETH
• CUSP CAPPING BY AMALGAM
• PIN RETAINED AMALGAM
• POST RETAINED RESTORATION
• PROBLEMS OF MUTILATED ENDODONTIC TREATED TEETH
• CHOICES AVAILABLE TO CHOOSE FROM BY THE CLINICIAN
• FIBER REINFORCED COMPOSITE
• FACTOR AFFECTING MATERIAL AND TECHNIQUE USED
• ENDOCROWN
• INDICATION, CONTRAINDICATION, ADVANTAGES, DISADVANTAGES, PROGNOSIS
• TRIALS TO INCREASE THE SUCCESS RATE
• CERASMART MATERIAL
• ONLAY VERSUS ENDOCROWN
MUTILATED TEETH
 DEFINITION

• MUTILATED TOOTH IS THAT TOOTH WHICH IS GROSSLY WEAKENED AND BADLY

BROKEN DOWN WHERE THE AMOUNT OF REMAINING TOOTH STRUCTURE IS LESS THAN THE
AMOUNT OF TOOTH LOSS.
 CAUSES OF MUTILATION

• LONG STANDING CARIES

• TRAUMATIC FRACTURE
• RECURRENT CARIES
 CHARACTERISTICS OF MUTILATED TEETH
• PARTIAL OR COMPLETE LOSS OF CUSPS

• LOSS OF MARGINAL RIDGES AND CROSSING RIDGES

• LOSS OF AXIAL ANGLES

• NEGATIVE CROWN/ROOT RATIO, NORMALLY 1:3

• PARTIAL OR COMPLETE LOSS OF CROWN/ROOT JUNCTION.

• MULTIPLE CRACKS WITH AN UNLIMITED EXTENT OR APPEARANCE OF SIGNS AND SYMPTOMS

OF CRACKED TOOTH SYNDROME
 SEQUALEA OF MUTILATION

1. WEAKENING OF REMAINING TOOTH SUBSTANCE AND DECREASE RETENTION AND RESISTANCE

2. MAY ENDANGER NORMAL PULP PHYSIOLOGY , PERIODONTAL HEALTH AND RESTORATION OF

ESTHETICS

3. DRIFTING OR OVER ERUPTION OF TEETH COMPLICATING RESTORATION AND COMPROMISING

SUCCESS
 IMPORTANT FACTORS IN DECISION MAKING OF
RESTORATION

• CARIES INCIDENCE (HIGH OR LOW)

• AMOUNT OF FORCES TO WHICH THE TOOTH IS SUBJECTED

 TREATMENT OPTIONS FOR ANTERIOR TEETH
• RESIN COMPOSITE…COMPLEX FRACTURE AND HORIZONTAL

• PORCELAIN LAMINATE……MULTIPLE FRACTURE

• CERAMIC PORCELAIN FUSED TO METAL…LOSS OF TWO INCISAL ANGLES

 TREATMENT OPTIONS FOR POSTERIOR TEETH
• AMALGAM RESTORATION…MAY REQUIRE CUSP CAPPING

• RESIN COMPOSITE

• INLAYS AND ONLAYS

• POST RETAINED RESTORATION

• ENDOCROWN

• FULL COVERAGE RESTORATION

 CUSP CAPPING BY AMALGAM

• WHEN CARIES IS EXTENSIVE AND WHEN THE LINGUAL OR FACIAL EXTENTION IS TWO THIRDS
FROM A PRIMARY GROOVE TOWARD A CUSP TIP

• NON FUNCTIONAL CUSPS ARE REDUCED BY 1.5 MM, FUNCTIONAL CUSP IS REDUCED BY 2 MM

• SO REDUCTION IN THE LONGITUDINAL WALL RESULT IN THE NEED FOR ADDITIONAL RETENTION
MEANS AS
• RETENTION LOCKS
• SLOTS
• PINS
 PIN RETAINED AMALGAM

• PROBLEMS OF PINS
• FAILURE OF RESTORATION
• BROKEN PINS
• LOOSE PINS
• PENETRATION ONTO THE PULP AND PERIODONTIUM
POSTS
 POST FUNCTION AND PROBLEMS
• IT HAS BEEN SUGGESTED THAT THE PRIMARY PURPOSE OF A PLACING A POST IS TO RETAIN THE
CORE IN TEETH WITH EXTENSIVE LOSS OF CORONAL TOOTH STRUCTURE NOT STRENGHTHENING
THE REMAINING TOOTH STRUCTURE …VENKATESH ET AL., 2018 .

• ALTHOUGH RARE, PROCEDURAL ACCIDENTS DURING THE POST SPACE PREPARATION OCCURS.
THESE ACCIDENTS COULD BE PERFORATION IN AN APICAL AREA OR IN THE LATERAL ROOT SURFACE,
SO-CALLED ―STRIP PERFORATIONS. ALSO, INCIDENTS OF ROOT FRACTURES INCREASES WITH
POSTS PLACEMAT
 GENERAL GUIDELINES FOR POST PLACEMENT
• ANTERIOR TEETH

• IF NO CROWN IS REQUIRED, A POST IS GENERALLY UNNECESSARY.

• IF A CROWN IS NECESSARY, A POST IS GENERALLY REQUIRED.

• GROSS WEAKENING OF THE TOOTH WITH LARGE OR MULTIPLE RESTORATION

• PRESCENCE OF UNDERMINED MARGINAL RIDGES

• IF REQUIRED FORM OR COLOR CHANGE….CAN NOT TREATED BY BLEACHING , RESIN BONDING OR

LAMINATE VENEER

• ACT AS ABUTMENT FOR FPD OR RPD

FIBER POST
 GENERAL GUIDELINES FOR POST PLACEMENT
• POSTERIOR TEETH

• MOLAR TEETH WITH AN ADEQUATE PULP CHAMBER DO NOT REQUIRE A POST

(ENDOCROWN)…SHOULD RECEIVE A CUSPAL COVERAGE

• MOLAR TEETH WITH INADEQUATE PULP CHAMBER MAY REQUIRE A POST.

• MAXILLARY BICUSPIDS GENERALLY REQUIRE A POST.

• MANDIBULAR BICUSPIDS REQUIRE A POST

 PREMOLARS REQUIRE A POST MORE THAN MOLARS

• BULKIER THAN ANTERIOR TEETH

• OFTEN SINGLE ROOTED TEETH WITH SMALL PULP CHAMBER

• SUBJECTED TO LATERAL FORCE DURING MASTICATION

 FERRULE
• FERRULE IS DEFINED AS A VERTICAL BAND OF TOOTH STRUCTURE AT
THE GINGIVAL ASPECT OF CROWN PREPARATION. IT PRIMARILY
PROVIDES RESISTANCE FORM AND ENHANCES LONGEVITY.
• A FERRULE WITH 1-2 MM OF VERTICAL TOOTH STRUCTURE DOUBLES THE RESISTANCE TO
FRACTURE VERSUS TEETH RESTORED WITHOUT A FERRULE.

• IT WAS REPORTED THAT THERE WAS NO DIFFERENCE IN FRACTURE RESISTANCE WITH OR

WITH OUT A 2 MM FERRULE USING PREFABRICATED POSTS AND RESIN CEMENT. BUT
FRACTURE PATTERNS WERE MORE FAVORABLE WHEN A FERRULE WAS PRESENT. VENKATESH
ET AL., 2018

• IN SOME CASES, ESPECIALLY IN ANTERIORS, IT IS NECESSARY TO PERFORM CROWN

LENGTHENING/ORTHODONTIC ERUPTION OF A TOOTH TO PROVIDE AN ADEQUATE
FERRULE
 EFFECT OF DIFFERENT FERRULE DESIGNS ON THE FRACTURE
RESISTANCE AND FAILURE PATTERN OF ENDODONTICALLY
TREATED TEETH RESTORED WITH A FIBER POST AND CERAMIC
CROWNS

• SHERFUDHIN ET AL., 2009 A POINT OF CLINICAL RELEVANCE IS THAT THE FRACTURE

RESISTANCE OF SPECIMENS WITH NON-UNIFORM CORONAL STRUCTURE WAS LOWER THAN

THE SPECIMENS WITHOUT A FERRULE , WITH CONSIDERATION TO MAINTAINING AS MUCH AS

POSSIBLE OF SOUND TOOTH STRUCTURE. IT COULD BE ADVISED TO ADJUST THE CORONAL

STRUCTURE EVENLY TO PROVIDE FLAT SEAT FOR THE CORE-BUILD UP MATERIAL IMPROVE THE

FRACTURE RESISTANCE OF ENDODONTICALLY, TREATED TEETH.

DIFFERENT FERRULE DESIGNS
 EFFECT OF FERRULE LOCATION ON FRACTURE RESISTANCE
AND FAILURE PATTERN OF ENDODONTICALLY TREATED
MAXILLARY INCISORS RESTORED WITH QUARTZ FIBER POSTS

• AMIN ET AL, 2013 TEETH OF A LABIAL FERRULE ORIENTATION SHOWED LOWER

FRACTURE RESISTANCE COMPARED TO THE SIGNIFICANTLY MUCH HIGHER FRACTURE

RESISTANCE DEMONSTRATED BY RESTORED TEETH OF, FULL, PALATAL AND PROXIMAL

FERRULE ORIENTATIONS
 WHEN TO USE A POST ?

• THERE ARE STUDIES RELATING THAT LOSS OF TOOTH

STRUCTURE GREATER THAN 50% WOULD DETERMINE THE
USE OF ROOT POSTS TO RETAIN A CORE AND TO
DISTRIBUTE STRESS.
MUTILATED TEETH
EITHER
ENDODONTIC TREATED
OR
NON ENDODONTIC TREATED
 PROBLEMS OF ENDODONTIC TREATED TEETH
• CONSIDERED MORE BRITTLE, IN THE PAST, DUE TO STRUCTURAL CHANGE IN THE DENTIN,
WHICH LOST WATER AND COLLAGEN CROSS-LINKING AFTER THE ENDODONTIC TREATMENT

• LOSS OF STRUCTURAL INTEGRITY ASSOCIATED WITH THE ACCESS PREPARATION RESULTS IN

INCREASED CUSPAL DEFLECTION DURING FUNCTION,

WHICH LEADS TO A HIGHER OCCURRENCE OF FRACTURES.

• in most endodontically treated teeth there are missing tooth structure caused by caries
or existing restorations

• The coronal microleakage and bacterial contamination that occurs when they are not
immediately restored, causing endodontic failure and requesting retreatment So, the
use of bonded restorations should be considered
to avoid microleakage.
 CHOICES AVAILABLE TO CHOOSE FROM BY THE
CLINICIAN

• DIRECT OR INDIRECT RESTORATIONS

• USING OR NOT POSTS

• THE BETTER MATERIAL

• AND THE PRINCIPLES USED IN THE DESIGN PREPARES

 FIBER REINFORCED COMPOSITE
• INCORPORATION OF FIBERS CAN

• INCREASE STRENGTH,

• STIFFNESS,

• FRACTURE RESISTANCE

• AND TOUGHNESS OF RESIN COMPOSITES.

• CONCERNS RELATED TO CREEP AND SHRINKAGE IS MINIMIZED DUE TO RELATIVE DECREASE IN VOLUME OF
RESIN MATRIX.

• FIBER REINFORCEMENT DEPENDS ON THE ORIENTATION, TYPE AND GEOMETRIC CONFIGURATION OF FIBERS IN
THE COMPOSITE. THERE ARE DIFFERENT TYPES OF FIBERS WHICH CAN REINFORCE COMPOSITE RESTORATION
E.G. GLASS, CARBON, POLYETHYLENE ETC. ………………………. BARKHA & SATHYANARAYANAN 2014
 FACTOR AFFECTING MATERIAL AND TECHNIQUE USED

• THE TOOTH PLACEMENT IN THE ARCH …..ANTERIOR OR POSTERIOR

• THE INCIDENCE OF FRACTURES WAS MORE THAN 2 TIMES HIGHER IN MANDIBULAR FIRST MOLARS THAN
IN MAXILLARY FIRST MOLARS, MAXILLARY FIRST PREMOLARS, MAXILLARY SECOND PREMOLARS AND
MANDIBULAR SECOND MOLARS AND ATTRIBUTED THIS FACT TO THE HEAVIER MASTICATORY FORCE AND
THIN OR FLAT ROOTS IN THIS REGION

• LONGITUDINAL ROOT FRACTURES ARE MORE COMMON IN TEETH OR ROOTS WHOSE MESIODISTAL
DIMENSION IS NARROW, LIKE UPPER PREMOLARS

• CANINES WERE THE TEETH LEAST SUSCEPTIBLE TO FRACTURE (LARGE WIDE ROOT).
 WHY IS THE DIFFERENCE BETWEEN ANTERIOR AND
POSTERIOR TEETH
• THE FORCE INCIDENCE IN ANTERIOR AND POSTERIOR TEETH IS DIFFERENT BECAUSE POSTERIOR TEETH

ARE SUBJECT TO VERTICAL FORCES WHILE THE ANTERIOR MUST RESIST TO LATERAL AND SHEARING TYPES
OF FORCES, INCREASING THE POST REQUIREMENT TO PROVIDE FORCE DISTRIBUTION IN THE CORONAL
AND ROOT PARTS OF THE TEETH, AVOIDING FRACTURES.
 DIFFERENCE IN THE SURVIVAL BETWEEN TEETH TYPES
• MANCEBO ET AL., 2010 MADE A THREE YEAR STUDY FOR THE EFFECT OF BOTH TOOTH TYPE AND
FERRULE ON SURVIVAL RATE OF ENDODONTIC TREATED TEETH AND FOUND THAT

• INCISORS WAS FOUND TO HAVE THE HIGHEST FAILURE RATES BUT ANOTHER STUDIES CONFIRMED THAT
PREMOLARS ARE THE MOST LIABLE TO FRACTURE, BOTH SUBJECTED TO LATERAL FORCE INSTEAD OF
VERTICAL FORCES

• FROM THAT, IT WAS CONCLUDED THAT TYPE OF OCCLUSION, TYPE AND POSITION OF THE TOOTH IN
THE DENTAL ARCH, TYPE OF RESTORATION, TYPE OF ABUTMENT, EXISTENCE OF PROXIMAL CONTACT,
DEGREE OF CORONAL TISSUE LOSS, THE IMPORTANCE OF PRESERVING AT LEAST 2 MM HEIGHT DENTINE
COLLAR (FERRULE EFFECT) AFFECT RESTORATION DURABILITY

• IT SUPPORTS THAT THE WEAKNESS OF ENDODONTIC TREATED TEETH IS NOT RELATED TO NON VITAL
DENTINE BUT TO LOSS OF TOOTH STRUCTURE BY CARIES, FRACTURE OR ENDODONTIC THERAPY
 LOCATION OF REMAINIG CORONAL TOOTH
STRUCTURE

• ANOTHER STUDY THAT EVALUATED THE EFFECT OF REMAINING CORONAL TOOTH STRUCTURE

LOCATION ON THE FRACTURE RESISTANCE OF ENDODONTICALLY TREATED TOOTH

DEMONSTRATED THAT PALATAL WALLS WERE MORE RESISTANT TO FRACTURES THAN LABIAL

BECAUSE AVOID ARC OF CROWN DISPLACEMENT IN THE VESTIBULAR DIRECTION

ENDOCROWN
 ENDOCROWN

• A TOTAL PORCELAIN CROWN WELL ADAPTED TO ROOT CANAL TREATED

TOOTH, THUS OBTAINING MACROMECHANICAL RETENTION (PROVIDED BY THE

PULPAL WALLS), AND MICRORETENTION (BY UTILIZING ADHESIVE

CEMENTATION).
 INDICATION
• EXCESSIVE LOSS OF CORONAL DENTAL TISSUE

• AND LIMITED INTEROCCLUSAL SPACE, IN WHICH IT IS NOT POSSIBLE TO PROCURE ADEQUATE

THICKNESS OF THE CERAMIC COVERING ON THE METAL OR CERAMIC SUBSTRUCTURES.

 CONTRAINDICATION
• IF ADHESION CANNOT BE ASSURED
• IF THE PULPAL CHAMBER IS <3 MM DEEP,
• IF THE CERVICAL MARGIN IS <2 MM WIDE FOR MOST OF ITS CIRCUMFERENCE

N.B.
TEETH WITH INSUFFICIENT CORONAL TOOTH STRUCTURE MAY REQUIRE ADDITIONAL VERTICAL FERRULE AND
SURGICAL RECONTOURING OF THE HARD AND SOFT TISSUES FOR RETENTION OF THE RESTORATION
 PREPARATION REQUIRMENT
• THE BUTT JOINT, OR CERVICAL SIDEWALK, IS THE BASE OF THE RESTORATION – WITH A BAND
OF PERIPHERAL ENAMEL THAT OPTIMIZES BONDING

DEPTH CUT ARE MADE TO DETERMINE AMOUNT OF OCCLUSAL REDUCTION

PULP CHAMPER IS PREPARED FOR THE ENDOCORE TO OBTAIN 4MM DEPTH AND 2NN WIDTH ENDO CAVITY
FLATENNING OF OCCLUSAL SURFACE TO MAKE THE BUTT JOINT WHILE PRESERVING THE ENAMEL COLLAR
APPLYING THA ADHESIVE AGENT BY A BRUSH TO THE FITTING SURFACE OF THE ENDOCROWN
 PROGNOSIS OF ENDOCROWN
• THERE IS A LACK OF DATA ABOUT THE INFLUENCE OF THE ENDOCROWN DESIGN ON THE
BIOMECHANICAL BEHAVIOR OF RESTORED ENDODONTICALLY TREATED PREMOLARS (ETPM).

ENDOCROWNS WERE CONSIDERED UNSUITABLE RESTORATIVE APPROACH FOR

PREMOLARS WITH A FAILURE RATE OF 31% WHILE MOLARS RESTORED WITH ENDOCROWNS
HAD 12% FAILURE RATE. ALOMRAN 2018
 EXPLANATION FOR SUCH VARIATION IN THE FAILURE
RATE
• THIS DIFFERENCE IN THE FAILURE RATES IS ATTRIBUTED TO DECREASED SURFACE AREA AVAILABLE
FOR ADHESION IN PREMOLARS

• THE UNFAVORABLE RATIO BETWEEN CROWN BASIS AND CROWN HEIGHT MIGHT CAUSE A
MOMENT OF FORCE

N.B. IT SEEMS REASONABLE TO HYPOTHESIZE THAT THE DEEPER THE PULP-CAVITY PREPARATION

FOR AN ENDOCROWN AND THE DEEPER THE RESULTANT INTRARADICULAR EXTENSION ―ENDO-
CORE, THE GREATER THE SURFACE AREA FOR ADHESIVE RETENTION AND THE BETTER THE
TRANSMISSION OF MASTICATORY FORCES TO THE ROOT
 ENDOCROWN VS CLASSICAL CROWN

• IN 2018, REPORTED THAT UPPER PREMOLARS RESTORED WITH ENDOCROWNS WITH BOTH 2MM AND
4MM LONG ENDO-CORES DISPLAYED SIMILAR OUTCOMES IN TERMS OF MARGINAL INTEGRITY AND
FATIGUE RESISTANCE EQUIVALENT TO CLASSICAL CROWNS AND DID NOT SEEM TO HAVE AN
INFLUENCE ON ENDOCROWNS PERFORMANCES.

• A SIGNIFICANT DIFFERENCE OF THE STRESS VALUES AT THE LUTING CEMENT INTERFACE BETWEEN
THE ENDOCROWN (2 MPA) AND THE CLASSICAL CROWN (15.36 MPA). THIS INDICATES THAT THE
STRESS CONCENTRATION WITHIN THE CEMENT OCCURRED AT THE CENTRAL GROOVE AREA OF THE
OCCLUSAL SURFACE IN THE CLASSICAL CROWN CONFIGURATION
 EXPLANATION

• HENCE, THE REDUCED EFFECT OF MULTIPLE INTERFACES IN THE RESTORATIVE SYSTEM OF THE ENDOCROWN
CONFIGURATION MIGHT MAKE THE RESTORED TOOTH MORE APPROXIMATE TO A ―MONOBLOC AND
THEREBY REDUCE ADHESIVE INTERFACE FAILURE

• FINALLY, A SYSTEMATIC REVIEW AND META-ANALYSIS OF ENDOCROWNS RESTORATIONS WAS PUBLISHED.

IN THIS SYSTEMATIC REVIEW ENDOCROWNS PRESENTED HIGH CLINICAL SUCCESS RATES (94 TO 100% UP
TO 36 MONTHS). FURTHERMORE, THE REASON OF FAILURE WAS SECONDARY CARIES, AND NO STUDY

REPORTED FRACTURE OR RETENTION LOSS OF ENDOCROWN

 FRACTURE STRENGTH

• HIGHER FRACTURE STRENGTH FOR ENDOCROWNS 674.75 N WHEN COMPARED WITH CONVENTIONAL
CROWNS 469.90 N. THE FAILURE PATTERN WAS CHARACTERIZED BY FRACTURE OF THE TOOTH
ASSOCIATED WITH DISPLACEMENT OF THE RESTORATION ON THE OPPOSITE SIDE

• ENDOCROWNS FRACTURED MESIO-DISTAL VERTICAL FRACTURE WHICH SPLIT THE RESTORATION

―WEDGE-OPENING FRACTURES. IN CONTRAST, THE CONVENTIONAL CROWN WITH POST AND CORE
GROUP DISPLAYED CATASTROPHIC FRACTURES IN MULTIPLE PIECES.
 IDEAS TO INCREASE SUCCESS RATES FOR
ENDOCROWN RESTORATION
• INCREASE THE LENGTH OF ENDO CORE UP TO 4MM (COMPARISON WITH CLASSICAL

CROWNS)

• CAD-CAM ENDOCROWNS (COMPARISON BETWEEN DIFFERENT CAD-CAM SYSTEMS)

• CERASMART ENDOCROWNS (COMPARISON WITH LITHIUM DISILICATE CROWNS

RETAINED WITH FIBER POSTS & LITHIUM DISILICATE FULL COVERAGE CROWN)
 CAD/CAM ENDOCROWNS VS CAD-CAM SINGLE
RESTORATION
• ENDOCROWNS HAD A SIGNIFICANTLY HIGHER FAILURE RATE THAN ALL OTHER RESTORATIONS.

• A STUDY EVALUATED THE MARGINAL AND INTERNAL DISCREPANCIES OF ENDOCROWNS WITH

DIFFERENT CAVITY DEPTHS 2MM AND 4MM FABRICATED USING TWO DIFFERENT CHAIRSIDE

CAD-CAM SYSTEMS (CEREC AC AND E4D) CONCLUDED THAT

………………… MARGINAL AND INTERNAL DISCREPANCIES INCREASED DEPENDING ON CAVITY

DEPTH AND BOTH CHAIRSIDE CAD-CAM SYSTEMS SHOWED SIMILAR DISCREPANCY IN THE

ENDOCROWNS
 CERASMART
• HYBRID MATERIALS HAVE RECENTLY BEEN INTRODUCED TO THE DENTAL MARKET SINCE 2014 AND FORM A
NEW CLASS OF CAD/CAM MATERIALS.

• IT’S A NANOPARTICLE FILLED HIGH-DENSITY COMPOSITE RESIN, WHICH CONTAINS 71% OF FLLER
PARTICLES BY WEIGHT. SINCE CERASMART HAS PARTICULAR BENEFITS SUCH AS LESS BRITTLE AND MORE
FEXIBLE COMPARED TO CONVENTIONAL CERAMICS, FEWER FLAWS AND IRREGULARITIES WERE OBSERVED,
THE POSSIBILITY TO MODIFY OR REPAIR THE SURFACE EASILY AND THEIR STRESS ABSORBING PROPERTIES

• THE UNIQUE COMPOSITION OF CERASMART ALLOWS THE MATERIAL TO HAVE MODULUS OF ELASTICITY
SIMILAR TO THAT OF DENTIN (18 ± 2 GPA) WITH 220 MPA TO 240 MPA FEXURAL STRENGTH, (150) WHICH
IS SLIGHTLY HIGHER THAN FELDSPATHIC CERAMICS
 REGARDING TO THE MATERIALS USED FOR THE
FABRICATION OF ENDOCROWNS
ENDOCROWNS MADE OF CERASMART RECORDED A STATISTICALLY SIGNIFCANT HIGHER MEAN VALUE
FRACTURE LOAD THAN ENDOCROWNS MADE OF IPS E.MAX CAD.

THIS MAY BE ATTRIBUTED TO THE BONDING STRENGTH OF CERASMART TO THE TOOTH STRUCTURE AND STRESS
ABSORPTION NATURE OF HYBRID CERAMIC COMPOSITION WITH BREAKING ENERGY (2.2 MPA) WHILE THE IPS
E.MAX CAD HAS BREAKING ENERGY (0.6 MPA). MOREOVER, DUE TO THE LOW FLEXURAL MODULUS OF
CERASMART (7.9 GPA) AND HIGH FLEXURAL MODULUS OF E.MAX CAD (32.3 GPA)
 TYPE OF CEMENT USED AND ITS EFFECT
• THE ADHESION OF THE RESTORATION IS DEPENDENT ON THE TYPE OF CEMENT USED

MOREOVER, IT CAN BE EXPECTED THAT THE GREATER THE ADHESION OF THE RESTORATION,

THE BETTER THE STRESS DISTRIBUTION WITHIN THE SYSTEM, THUS RESULTING IN HIGHER

FRACTURE RESISTANCE. NOT LESS IMPORTANT, PREMOLARS AND MOLARS MAY RECEIVE

SIMILAR FORCES DURING ORAL FUNCTION, CONTRIBUTING FOR THE SIMILAR RESULTS WHEN

CONSIDERING ONLY POSTERIOR TEETH

 CONCLUSIONS
• CERASMART ENDOCROWNS PROVIDE PROMISING FRACTURE RESISTANCE THAN IPS E.MAX

CAD ENDOCROWNS AS A TREATMENT MODALITY OF ENDODONTICALLY TREATED MAXILLARY

PREMOLARS.

• CERASMART ENDOCROWNS ARE AS PROMISING AS FIBER POST AND CORE SUPPORTED IPS

E.MAX CAD CROWNS IN TERMS OF FRACTURE RESISTANCE. •

• ENDOCROWNS MADE OF IPS E.MAX CAD SHOW LOWER FRACTURE RESISTANCE THAN FIBER

POST AND CORE SUPPORTED IPS E.MAX CAD CROWNS WITH IRREPARABLE FRACTURE •
 FINAL CONCLUSION
• WHEN IT COMES TO SURVIVAL RATE AND MECHANICAL PROPERTIES, ENDOCROWN

RESTORATIONS SHOWED COMPARABLE OR SOMEWHAT SUPERIOR RESULTS TO OTHER

CONVENTIONAL TREATMENTS USING POST AND CORE FOLLOWED BY A CROWN OR

INLAY/ONLAY RESTORATIONS.

• ENODCROWNS ARE MORE PRACTICAL, CONSERVATIVE, AND LESS TECHNIQUE SENSITIVE

 MATERIAL OF CHOICE
• GLASS-CERAMIC BECAUSE OF ITS EXCELLENT BIOCOMPATIBILITY AND ITS WEAR COEFFICIENT IS
PROXIMATE TO THAT OF THE NATURAL TOOTH IS VERY OPPORTUNE OPTION FOR FABRICATION OF
ENDOCROWN

• THE BONDING MATERIAL CONSTITUTES THE CRUCIAL INTERFACE BETWEEN THE RESTORATION AND THE
PREPARED TOOTH. IN INTEGRATION TO ITS ADHESIVE PROPERTIES, ITS MODULUS OF ELASTICITY IS
PARAMOUNT AS IT MUST BE ABLE TO ABSORB PRESSURE, JUST AS THE DENTIN-ENAMEL JUNCTION DOES
THANK YOU