A Thorough Analysis of the Endocrown Restoration: A Literature Review

Abstract

The aim of this literature review is to determine whether endocrowns are a reliable alternative for endodontically treated teeth with extensive loss of tooth structure, the indications and contraindications of this restorative choice, the principles that should be followed for tooth preparation and which material is most appropriate for endocrown fabrication. Rehabilitation of endodontically treated teeth with severe coronal destruction has always been a challenge for the dental clinician. Until recently, the fabrication of a metal-ceramic or all-ceramic full-coverage crown along with a metal or glass fiber post has been the "gold standard" proving its efficacy via numerous clinical studies. With the development of CAD/CAM technology and the evolution of dental materials, new minimally invasive techniques have been introduced with less need for adjustments and less incorporation of structural defects. One of them, the "monoblock technique," proposed by Pissis in 1995, was the forerunner of endocrown restoration, a term used by Bindl and Mörmann to describe an all-ceramic crown anchored to the internal portion of the pulp chamber and on the cavity margins, thus obtaining macromechanical retention provided by the axial opposing pulpal walls and microretention attained with the use of adhesive cementation. Endocrowns require a decay-oriented preparation taking advantage of both the adhesion and the retention from the pulp-chamber walls, they are strongly indicated in endodontically treated molars in cases where minimal interocclusal space and curved or narrow root canals are present and they should be manufactured from materials that can be bonded to the tooth structure. Endocrowns are a reliable alternative to traditional restorative choices, given that the clinicians respect the requirements and indications describing this technique. Traditional restorative techniques demanding tooth substance removal and minimizing the opportunity for reinterventions should be reconsidered.