Endodontic Restoration Research Articles

Post-Endodontic Restorative and Prosthetic Options - A Review

Background- In the past, conventional wisdom in post-endodontic care dictated the application of full coverage restorations to all teeth. However, recently a shift towards minimally invasive dentistry has gained traction among the restorative dentists. This change has been driven by accumulating evidence revealing that full coverage restorations often result in significant loss of healthy tooth structure. Consequently, clinicians and researchers have advocated for more conservative approaches to restoring endodontically treated teeth. These alternatives encompass partial coverage restorations such as inlays, onlays, overlays, and even simpler resin composite cores. While the allure of this minimally invasive strategy is evident, there are cases where greater coverage is necessary. Various factors, including tooth type, occlusal load, number of missing teeth, remaining healthy tooth structure, and tooth position, must be carefully considered before selecting an appropriate post- endodontic restoration.  Conclusion- The purpose of this review is to summarize the post- endodontic restorations, various new materials their indications depending on the remaining tooth structure and the teeth that needs to be restored. Light has been thrown on the recent advances in the prosthetic aspect in post-endodontic cases with minimally invasive dentistry in mind.

Custom Cast Post and Core: The Key to Successful Endodontic Restoration of Anterior Teeth — Case Report

Custom Cast Post and Core: The Key to Successful Endodontic Restoration of Anterior Teeth — Case Report

A protocol for a comparative evaluation of the fracture resistance of endodontically treated teeth reinforced with Cention N, resin-modified glass ionomer cement (RMGIC) and short fiber reinforced flowable composite as an intraorifice barrier.

Endodontic treatment is the most common method for resolving pulpal and periapical pathology. However, various studies have reported that almost 11%-13% of all teeth that undergo extraction after endodontic treatment show the presence of cracks, craze lines, and vertical root fractures. Teeth with inadequate post endodontic restoration are more prone to fracture and coronal leakage, resulting in the diffusion of oral fluids, bacteria, bacterial products, and possibly root canal treatment failure. Furthermore, studies have advocated the use of endodontically treated teeth with restorative materials that have a similar or higher elastic modulus than the tooth for providing stiffness against forces that cause root fracture. Intraorifice barriers made of restorative materials that can bond to radicular dentin could thus be used to reinforce the radicular dentin while also preventing coronal microleakage. Although the sealing ability of intraorifice barriers has been widely compared in the literature, there have been few studies on the strengthening effect of the materials used in the study as intraorifice barriers when placed into the root canal. As a result, the current in vitro study aims to assess the effect of various materials as intraorifice barriers (Cention N, Resin modified glass ionomer cement, and short fiber reinforced flowable composite) on the force required fracture teeth after root canal treatment. This in vitro study will be done on extracted human mandibular premolars with single root canal where after doing root canal treatment 2-3 mm obturating material would be replaced by intra orifice barriers (Cention N, resin modified glass ionomer cement [RMGIC], and short fiber reinforced flowable composite). The force required to fracture teeth will be calculated using universal testing machine.

A protocol for a comparative evaluation of the fracture resistance of endodontically treated teeth reinforced with Cention N, resin-modified glass ionomer cement (RMGIC) and short fiber reinforced flowable composite as an intraorifice barrier

Background: Endodontic treatment is the most common method for resolving pulpal and periapical pathology. However, various studies have reported that almost 11%–13% of all teeth that undergo extraction after endodontic treatment show the presence of cracks, craze lines, and vertical root fractures. Teeth with inadequate post endodontic restoration are more prone to fracture and coronal leakage, resulting in the diffusion of oral fluids, bacteria, bacterial products, and possibly root canal treatment failure. Furthermore, studies have advocated the use of endodontically treated teeth with restorative materials that have a similar or higher elastic modulus than the tooth for providing stiffness against forces that cause root fracture. Intraorifice barriers made of restorative materials that can bond to radicular dentin could thus be used to reinforce the radicular dentin while also preventing coronal microleakage. Although the sealing ability of intraorifice barriers has been widely compared in the literature, there have been few studies on the strengthening effect of the materials used in the study as intraorifice barriers when placed into the root canal. As a result, the current in vitro study aims to assess the effect of various materials as intraorifice barriers (Cention N, Resin modified glass ionomer cement, and short fiber reinforced flowable composite) on the force required fracture teeth after root canal treatment. Methods: This in vitro study will be done on extracted human mandibular premolars with single root canal where after doing root canal treatment 2-3 mm obturating material would be replaced by intra orifice barriers (Cention N, resin modified glass ionomer cement [RMGIC], and short fiber reinforced flowable composite). The force required to fracture teeth will be calculated using universal testing machine.

Clinical performance of computer-aided design/computer-aided manufacture lithium disilicate ceramic endocrown restorations: A 2-year study.

Optimal restoration methods for endodontically treated teeth (ETTs) have always remained an ongoing discussion among physicians in this day and age. ETTs have a tendency to fracture when chewing, compared to initial teeth. From the perspective of biology, preserving and restoring tooth structure is critical to maintaining biomechanical, functional, and esthetic harmony. Dental bonding techniques have lessened the necessity for post-and-core restorations in ETTs with severe substance loss. A minimally invasive endodontic restoration technique called "endocrown" was initially introduced by Bindl and Mörmann in 1999. The aim of the study was to clinically evaluate all-ceramic mandibular molar endocrowns made using computer-aided design/computer-aided manufacturing (CAD/CAM) following 2 years of follow-up. This unblinded study contains 56 patients with 56 mandibular molars, which had severe substance loss. After teeth preparation, lithium disilicate ceramic endocrowns were manufactured with the CEREC CAD/CAM system, and cementation was performed using a composite luting agent. The endocrowns were assessed using the modified United States Public Health Service criteria at baseline, 6 months, 1 year, and 2 years following placement. Patient satisfaction was evaluated using a questionnaire. This study used descriptive statistics, including mean, standard deviation, and 95% confidence intervals. Data were processed using STATA version 14.0 (StataCorp LLC, USA). Two endocrowns (3.6%) failed throughout the period of observation. The high clinical rating criteria (96.4%, count of 54) and the increased satisfaction percentage (94.6%, count of 53) remained practically stable during the follow-up assessments at 6 months and after 1-2 years. Endocrown offers a less invasive treatment option that may be a better method for endodontically treated mandibular molars. With contemporary CAD/CAM technology and new materials, time in the chair and esthetics optimally improved, bringing satisfaction to the patient.

Quality of post and core placement by final year undergraduate dental students.

The success of endodontic restoration of badly compromised teeth depends on the quality of post and core placement and the extra-coronal restoration. Ensuring that students place posts to acceptable quality standards is therefore essential. The aim of this study was to radiographically evaluate post placement by final year undergraduate dental students and to identify any predictors of performance. Two hundred retrospectively and randomly selected posts placed by sixth year students were evaluated radiographically. Data on student gender; number and quality of radiographs; periapical pathology; tooth location; root canal treatment quality; amount of remaining gutta percha; gap between gutta percha and post; post-to-root width; crown-to-root ratio; and types of core material and crowns were recorded. Four criteria were used to grade post placement quality: (i) amount of remaining gutta percha; (ii) gap between gutta percha and post; (iii) post width to root ratio; and (iv) crown-to-root ratio. Assessments were scored to produce final grades. Data are presented using descriptive statistics and the chi-squared test was used to investigate whether student gender or tooth location were associated with final grade. Post and core quality was acceptable in most cases (97.5% were graded as adequate), with no differences in quality between male and female students nor according to tooth location (anterior, premolar, and molar). Just over half of radiographs were adequate quality (53.5%), while just under half were assessed as less than adequate (46.5%) due to cone cutting, overlap, shortening or elongation, although this did not affect formal assessment of post quality. General outcomes of post and core placement by undergraduate students were good, with few errors that might affect the prognosis and long-term survival of treated teeth. Providing undergraduate dental students with clear guidelines on when and how to take radiographs throughout the procedure may improve the quality of post and core treatment and reduce the risk of multiple unnecessary radiographic exposures. From the clinical perspective, although dental students generally place high quality posts and cores, it remains important to monitor the quality and performance of post placement as this determines the survival of compromised teeth.

Post Endodontic Restoration of Severely Damaged Posterior Teeth : A Case Series

Post Endodontic Restoration of Severely Damaged Posterior Teeth : A Case Series

Evaluation of Fracture Resistance of Root Canal Treated Teeth Restored with Different Types of Post-Endodontic Restorations: An In Vitro Study

Background Clinicians often face issues in restoring teeth with extensive root canals using various restorative methods. For clinical success these methods of restoration must be evaluated.Methods A randomized controlled trial was conducted on sixty extracted intact maxillary premolars. The prmolars were collected and equally divided into six groups. Except for G1 all the other groups were treated endodontically G2 MOD preparation without restoration G3 MOD preparation with resin composite restoration G4 MOD preparation with resin composite restoration amp restored with porcelain fused metal crown G5 MOD preparation restored with glass fiber horizontal post and resin composite and G6 MOD preparation restored with Polyethylene fiber mesh. The specimens were loaded in a micro universal testing machine until the fracture occurred. Failure loads were then statistically analyzed. The mode of failure was determined by visual inspection.Results Composite resin restorations reinforced with a fiberglass horizontal post and polyethylene mesh significantly increased fracture resistance of endodontically treated premolar teeth with MOD cavity. Conclusion Fiberglass horizontal post can be used as an alternative for post endodontic restoration in endodontically treated teeth with MOD cavities.

Research progress of odontogenic extracellular vesicles in regeneration of dental pulp.

It is well understood that maintaining viable pulp is critical for tooth retention. This review focused on cell-free therapy based on extracellular vesicles (EVs), a novel minimally invasive treatment strategy for endodontic restoration. This study was conducted by searching mainstream electronic databases such as Web of Science and PubMed for relevant studies on the therapeutic role of odontogenic EVs in pulp healing published in the last five years. We selected 89 relevant articles and discovered that dental stem cells (DSCs) derived EVs (DSC-EVs) have become a research hotspot in oral regenerative medicine, with significant advantages over cell transplantation in terms of low immunogenicity, ease of isolation, preservation, and management. Here, we introduce in detail the therapeutic effects of DSC-EVs for pulp restoration from three perspectives: excellent odontogenic properties, clinical applications, and possible molecular mechanisms. This article contributes a new viewpoint to the field of regenerative endodontics.

A surgical procedure for re-implanting a tooth that has been rendered hopeless because of periodontitis: a case report

Aim and methodology: This article describes a periodontally compromised, hopeless incisor tooth that was purposefully replanted, along with the results after six months. This entails the deliberate removal of the tooth and its subsequent correct manipulation and endodontic restoration before reinserting it into the socket. Results: Hopeless lower incisors with periodontal involvement were transplanted utilizing an implant surgical drilling approach after receiving root canal therapy and tetracycline-HCI conditioning. Bone graft material was added and the procedure was monitored for six months. The tooth was observed to be asymptomatic, functioning normally, and showing no pathologic radiological changes. With minimal bleeding during probing and no growth of pathological pockets, the periodontal condition was within normal limits. Alveolar bone support was seen to be adequate. The results may suggest that, in some circumstances, purposeful replantation is a viable strategy of treatment for maintaining native dentition. Conclusion: Intentional tooth reimplantation can be an alternative treatment option for periodontally involved teeth with poor or hopeless prognoses.

Retrieval of File from Canal Apical Third: A Report of Two Cases

Background: Procedural mishaps can occur during any step of root canal during cleaning and shaping, and might affect the prognosis of treatment. Among these separation of instruments in the canal is one of the most troublesome incidents in endodontic therapy especially if the fragments cannot be removed. Several techniques have been employed to facilitate the removal of the fragments; however, they are technique sensitive, expensive and require great expertise. Aim: This paper aims to suggest combination of techniques for retrieval of file from apical or beyond the apical third of canal. Materials and Methods: A 30year old patient presented with pain in upper anterior tooth. Clinical examination revealed a temporary restoration in 21 with no soft tissue abnormality. A radio-visio-graph indicated 22 associated with periapical radiolucency and a separated file extending 3mm beyond the radiographic apex in the periapical area. Retrieval of the separated instrument was planned using braiding technique followed by obturation and post endo restoration. Second case report includes a female 43 years old with pain in upper lateral incisor. IOPA radiograph revealed a separated instrument in the apical third of root canal. Retreatment was planned by first bypassing the fractured file and then using ultrasonics to loosen the fragment followed by obturation and post endodontic restoration. Conclusion: Combining different techniques during file retrieval can retrieve file with minimal dentinal destruction. Keywords: braiding, bypass, file retrieval, H file, K file, instrument separation, ultrasonics.

Coronal restoration of endodontically treated posterior teeth

There is still no consensus on the restoration of endodontically treated posterior teeth in the most appropriate way. With the development of adhesive materials with improved properties and a shift in approach towards minimally invasive dentistry, there is a paradigm change in the restorative modalities of root-filled teeth. Conventionally endodontically treated teeth were restored with post and core followed by a crown, but conservative restorative options have gained popularity with the advancements in adhesive techniques. Many studies have been done, but there is a need to re-explore the scholarly literature with the changing trend. This review article provides a brief overview of the literature on the survival of endodontically treated posterior teeth in relation to the type of post endodontic restoration. A literature search of papers related to the survival of endodontically treated teeth and type of post endodontic restorations published till July 2021 was undertaken in PubMed, MEDLINE, SCOPUS, Web of Science and Science direct. A few of the keywords searched were: post endodontic restorations, survival, clinical performance, root canal treated teeth, endodontically treated teeth, success, resin composite, crown, cuspal coverage restoration.

Association of Age and Gender to Custom Made Cast Post Given as Post Endodontic Restoration

Association of Age and Gender to Custom Made Cast Post Given as Post Endodontic Restoration

A multidisciplinary approach for external cervical resorption: A case report with 5-year follow-up

Introduction: External cervical resorption (ECR) is a physiological or pathological event usually detected on radiographic examination, since there are no symptoms in its initial and intermediate phases. Objectives: This case is an important finding because the early detection of this lesion allowed an effective multidisciplinary approach to be carried out. Case Report: Radiography was taken in a 55-year-old male and revealed a radiolucent area on the distal surface of the permanent mandibular left first molar, suggesting ECR with impaired pulpal vitality. Based on the clinical and radiographic examinations, a multidisciplinary approach was established involving endodontic treatment, periodontal surgery and indirect restoration that provided an option for preserve the affected tooth. The early diagnosis of ECR was essential for the successful treatment in order to maintain the satisfactory function for five-year follow-up. Conclusion: Despite the procedures performed, the idiopathic etiology of the lesion contributed to the appearance of recurrences; however, monitoring and maintenance of the affected tooth proved to be important for the longevity of the treatment.

Influence of post type on periapical status: a prospective study in a Brazilian population.

This prospective study assessed the effect of post type used to restore endodontically treated teeth in the onset, progression, and remission of periapical lesions. One hundred and forty teeth (92 patients) were endodontically treated and received a glass fiber post or a cast metal post and a final restoration at a University Clinic by undergraduate students. All patients were followed up for a mean period of 5.1 ± 2.2years. Periapical Index (PAI) was used for endodontic assessment. Two calibrated and blind examiners assessed the radiographs. The longevity of the endodontic treatment was analyzed using Kaplan-Meier statistics. Of the included teeth, 67.1% received glass fiber posts while 32.9% received cast metal posts. There were 4 endodontic failures, two glass fiber posts with a PAI = 3 in the baseline and PAI = 4 in the last follow-up, and one PAI = 4 in baseline and last follow-up. One cast metal post-failure was PAI = 4 in the baseline and the last follow-up. After 9.4years, the overall success rate of the endodontic treatment was 97.1% (p = 0.7). The tested posts presented similar endodontic healing. Precautions taken during endodontic therapy, post cementation, and final restoration are more likely to be responsible for the success of endodontic treatment rather than a specific type of post. Clinical relevance The type of post is not related to the success of the endodontic treatment.

Uncomplicated crown fracture management

Background: Trauma-related injuries of the maxillofacial region occur more often these days and dentists are facing this condition frequently in their regular practice life. Traumatic dental injuries affects the same region with different frequencies in different age groups. It should be noted that upper central incisors are mostly traumatized by injuries compare to the other incisors. The maxillary central incisors were about 72%, while premolars, canine, mandibular incisors, the upper lateral incisors injury rate is up to 8%. A strong impact most often affects the crown and a weak and dull impact on the root apical direction and may result in avulsion of tooth and root fracture. Dental injuries caused by trauma have been an emergency condition, treatment options depend on the severity of injuries and clinical condition of the tooth at that moment. Combination treatment for a traumatic fracture of the tooth includes fixation of the tooth, the performance of surgical manipulation, determination of the need for endodontic treatment, restoration, and orthodontic consultations.
 Problem: In our case patient has an uncomplicated crown fracture.
 Solution: Direct composite restoration.
 Update Dent. Coll. j: 2021; 11 (1): 20-22

GIC as fiber post cementation material: A case report

Treatment prognosis in a traumatically injured tooth depends on the post endodontic restoration. FRC-supported post endodontic restorations have been extensively used due to their superior properties. Despite GIC showing promising results, it is infrequently used for cementation of fiber posts; whereas resin cements are highly preferred for the same. This case report describes a successful management of a complicated crown fractured anterior tooth of a 12-year-old patient by using GIC as the fiber post cementation material.

Esthetic Dentistry: A case report on metal core concealment approach for endodontically treated maxillary anterior tooth

Aim: To fulfil esthetic restoration demand of a badly mutilated maxillary anterior tooth. Background: The life span of endodontically treated teeth has been extraordinarily upgraded by proceeding with improvements made in endodontic treatment and restorative systems. It has been accounted for that an enormous number of endodontically treated teeth are re-established to their unique function with the utilization of intra-radicular instruments and restorative materials. Over the most recent couple of many years, numerous pre-fabricated post and core systems have been developed. To mask the greyish appearance of oxidized subsurface of metal, an opaque layer of porcelain is required once the casting is done, scilicet is reflective eminently. The biggest advantage is gaining the supremacy of both metal and ceramic in terms of strength and aesthetic, both altogether. Case Description: This article reports a case where endodontic retreatment followed by restoration with a ceramic coated cast post was carried out mainly due to the aesthetic priority of the patient. Conclusion: Ceramic coping is an adjunct treatment modality to hide the blackish hue of cast metal post and core when aesthetic need is a concern. Keywords: Aesthetic restorations, Metal cast post, Post and core, Post endodontic restoration.

Endodontic management of middle third root fracture of upper lateral incisor with glass fiber post & core endodontic restoration: A case report

Endodontic management of middle third root fracture of upper lateral incisor with glass fiber post & core endodontic restoration: A case report - IJCE- Print ISSN No: - 2581-9534 Online ISSN No:- 2581-8988 Article DOI No:- 10.18231/j.ijce.2021.010, IP Indian Journal of Conservative and Endodontics-IP Indian J Conserv E

Reinstating the function of grossly mutilated Posterior teeth through endocrown: Case reports

Reinstating the function of grossly mutilated Posterior teeth through endocrown: Case reports - IJCE- Print ISSN No: - 2581-9534 Online ISSN No:- 2581-8988 Article DOI No:- 10.18231/j.ijce.2021.012, IP Indian Journal of Conservative and Endodontics-IP Indian J Conserv Endod