Endocrown restorations for extensively damaged posterior teeth: clinical performance of three cases

Konstantinos Tzimas, Maria Tsiafitsa, Paris Gerasimou, Effrosyni Tsitrou, Konstantinos Tzimas, Maria Tsiafitsa, Paris Gerasimou, Effrosyni Tsitrou

Abstract

The restoration of endodontically treated teeth (ETT) with more than one cusp missing and thin remaining walls is challenging for the general practitioner. The use of posts combined with full coverage restorations is a well-established approach, yet not following the minimal invasive principles of adhesive dentistry. Endocrowns are indirect monoblock restorations that use the pulp chamber of the ETT for retention. In this study the fabrication of 4 endocrowns and their clinical performance will be discussed. Two clinical cases include computer-aided design/computer-aided manufacturing manufactured molar endocrowns (one feldspathic ceramic and one hybrid composite-ceramic restoration) and the other two are dental laboratory manufactured resin composite premolar endocrown restorations. The modified United States Public Health Service criteria were used to assess the clinical behavior of the restorations at different follow up periods. Endocrown restorations present a satisfactory clinical alternative, either by the use of resin composite or glass ceramic and hybrid materials. Specific guidelines with minimal alterations should be followed for an endocrown restoration to be successful. Due to limited evidence regarding the long term evaluation of this restorative technique, a careful selection of cases should be applied.

Keywords: CAD-CAM; Ceramics; Composite resins; Endocrown; Endodontics.

Conflict of interest statement

Conflict of Interest: No potential conflict of interest relevant to this article was reported.

Figures

Figure 1. Case 1. (A) Initial condition;…
Figure 1. Case 1. (A) Initial condition; (B) mesial crack; (C) immediate dentin sealing; (D, E) butt joint margins; (F) endocrowns; (G) comparison of restorations at 20-month recall appointment.
Figure 2. Case 2. (A) Preparation technique;…
Figure 2. Case 2. (A) Preparation technique; (B) ferrule design; (C) computer-aided design/computer-aided manufacturing (CAD/CAM) procedure; (D) staining-glazing; (E) final restoration; (F) comparison of restorations at 10-month recall appointment.
Figure 3. Case 3. (A) Initial condition;…
Figure 3. Case 3. (A) Initial condition; (B) computer-aided design/computer-aided manufacturing (CAD/CAM) design; (C) final restoration; (D) partial fracture after 5 months; (E) repair with resin composite; (F) 12-month follow up period.

References

    1. Dietschi D, Duc O, Krejci I, Sadan A. Biomechanical considerations for the restoration of endodontically treated teeth: a systematic review of the literature, part II (evaluation of fatigue behavior, interfaces, and in vivo studies) Quintessence Int. 2008;39:117–129.
    1. Rocca GT, Krejci I. Crown and post-free adhesive restorations for endodontically treated posterior teeth: from direct composite to endocrowns. Eur J Esthet Dent. 2013;8:156–179.
    1. Pissis P. Fabrication of a metal-free ceramic restoration utilizing the monobloc technique. Pract Periodontics Aesthet Dent. 1995;7:83–94.
    1. Bindl A, Mörmann WH. Clinical evaluation of adhesively placed Cerec endo-crowns after 2 years--preliminary results. J Adhes Dent. 1999;1:255–265.
    1. Otto T. Computer-aided direct all-ceramic crowns: preliminary 1-year results of a prospective clinical study. Int J Periodontics Restorative Dent. 2004;24:446–455.
    1. Biacchi GR, Basting RT. Comparison of fracture strength of endocrowns and glass fiber post-retained conventional crowns. Oper Dent. 2012;37:130–136.
    1. Bindl A, Richter B, Mörmann WH. Survival of ceramic computer-aided design/manufacturing crowns bonded to preparations with reduced macroretention geometry. Int J Prosthodont. 2005;18:219–224.
    1. Zhu J, Rong Q, Wang X, Gao X. Influence of remaining tooth structure and restorative material type on stress distribution in endodontically treated maxillary premolars: a finite element analysis. J Prosthet Dent. 2017;117:646–655.
    1. Ramírez-Sebastià A, Bortolotto T, Roig M, Krejci I. Composite vs ceramic computer-aided design/computer-assisted manufacturing crowns in endodontically treated teeth: analysis of marginal adaptation. Oper Dent. 2013;38:663–673.
    1. Fages M, Bennasar B. The endocrown: a different type of all-ceramic reconstruction for molars. J Can Dent Assoc. 2013;79:d140.
    1. Belleflamme MM, Geerts SO, Louwette MM, Grenade CF, Vanheusden AJ, Mainjot AK. No post-no core approach to restore severely damaged posterior teeth: an up to 10-year retrospective study of documented endocrown cases. J Dent. 2017;63:1–7.
    1. Einhorn M, DuVall N, Wajdowicz M, Brewster J, Roberts H. Preparation ferrule design effect on endocrown failure resistance. J Prosthodont. 2017
    1. Jotkowitz A, Samet N. Rethinking ferrule--a new approach to an old dilemma. Br Dent J. 2010;209:25–33.
    1. Ma PS, Nicholls JI, Junge T, Phillips KM. Load fatigue of teeth with different ferrule lengths, restored with fiber posts, composite resin cores, and all-ceramic crowns. J Prosthet Dent. 2009;102:229–234.
    1. Litzenburger AP, Hickel R, Richter MJ, Mehl AC, Probst FA. Fully automatic CAD design of the occlusal morphology of partial crowns compared to dental technicians' design. Clin Oral Investig. 2013;17:491–496.
    1. Dias MC, Martins JN, Chen A, Quaresma SA, Luís H, Caramês J. Prognosis of indirect composite resin cuspal coverage on endodontically treated premolars and molars: an in vivo prospective study. J Prosthodont. 2016
    1. da Cunha LF, Gonzaga CC, Pissaia JF, Correr GM. Lithium silicate endocrown fabricated with a CAD-CAM system: a functional and esthetic protocol. J Prosthet Dent. 2017;118:131–134.
    1. Mahesh B, Vandana G, Sanjay P, Jaykumar G, Deepika C, Aatif N. Endocrown: conservative treatment modality for restoration of endodontically treated teeth – a case report. Endodontology. 2015;27:188–191.
    1. Chen C, Trindade FZ, de Jager N, Kleverlaan CJ, Feilzer AJ. The fracture resistance of a CAD/CAM Resin Nano Ceramic (RNC) and a CAD ceramic at different thicknesses. Dent Mater. 2014;30:954–962.
    1. Gaintantzopoulou MD, El-Damanhoury HM. Effect of preparation depth on the marginal and internal adaptation of computer-aided design/computer-assisted manufacture endocrowns. Oper Dent. 2016;41:607–616.
    1. Awada A, Nathanson D. Mechanical properties of resin-ceramic CAD/CAM restorative materials. J Prosthet Dent. 2015;114:587–593.
    1. El-Damanhoury HM, Haj-Ali RN, Platt JA. Fracture resistance and microleakage of endocrowns utilizing three CAD-CAM blocks. Oper Dent. 2015;40:201–210.
    1. Gresnigt MM, Özcan M, van den Houten ML, Schipper L, Cune MS. Fracture strength, failure type and Weibull characteristics of lithium disilicate and multiphase resin composite endocrowns under axial and lateral forces. Dent Mater. 2016;32:607–614.
    1. Shin Y, Park S, Park JW, Kim KM, Park YB, Roh BD. Evaluation of the marginal and internal discrepancies of CAD-CAM endocrowns with different cavity depths: an in vitro study. J Prosthet Dent. 2017;117:109–115.
    1. Bernhart J, Bräuning A, Altenburger MJ, Wrbas KT. Cerec3D endocrowns--two-year clinical examination of CAD/CAM crowns for restoring endodontically treated molars. Int J Comput Dent. 2010;13:141–154.
    1. Lin CL, Chang YH, Chang CY, Pai CA, Huang SF. Finite element and Weibull analyses to estimate failure risks in the ceramic endocrown and classical crown for endodontically treated maxillary premolar. Eur J Oral Sci. 2010;118:87–93.
    1. Trivedi S. Finite element analysis: a boon to dentistry. J Oral Biol Craniofac Res. 2014;4:200–203.
    1. Magne P, Knezevic A. Simulated fatigue resistance of composite resin versus porcelain CAD/CAM overlay restorations on endodontically treated molars. Quintessence Int. 2009;40:125–133.
    1. Magne P, Knezevic A. Influence of overlay restorative materials and load cusps on the fatigue resistance of endodontically treated molars. Quintessence Int. 2009;40:729–737.
    1. Sedrez-Porto JA, Rosa WL, da Silva AF, Münchow EA, Pereira-Cenci T. Endocrown restorations: a systematic review and meta-analysis. J Dent. 2016;52:8–14.
    1. Otto T, Mörmann WH. Clinical performance of chairside CAD/CAM feldspathic ceramic posterior shoulder crowns and endocrowns up to 12 years. Int J Comput Dent. 2015;18:147–161.

Source: PubMed

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