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CORONAL PRE-ENDODONTIC
RESTORATION
Article by Dr. JOSE PEDRO
CORTS
INTRODUCTION
Very often, teeth that need to be treated endodontically have suffered
extensive destruction due to caries, traumatisms, fractures, etc. and
therefore are very weak.
In such cases, it is imperative to rebuild or to reinforce the weakened
walls previous to the endodontic treatments.
It is necessary then, to restore the natural crown of the tooth, partially
at least, in order to achieve the following goals:
- prevent the fracture of walls, event
that would complicate or make impossible the endodontic
treatment, or final restoration.
- return the tooth to its normal or
habitual function, or as close to it as possible.
- improve esthetics, often the most
important aspect for patients
- prevent leakage, that would
re-contaminate the canal, or would percolate medicaments
outwards
- allow the use of clamps and rubber dam, in order to achieve absolute
isolation of the operatory field.
Copper rings were the custom devices usually used to meet these goals,
but had serious drawbacks concerning esthetics and were always potential
soft tissue irritants.
The purpose of this article is to present clinical cases that were solved
with alternative techniques that restorative dentistry offers, and that
will comprise partially at least the final restoration.
CLINICAL CASES
Case 1.- Female, 17 years old, with very
important carious lesions in her teeth 1.1 and 2.1. Left central incisor
(2.1) needed endodontic treatment (fig.1)
Figure 1
Several authors (1-4) recommend the use of radicular posts,
only when retention for the coronal restoration is needed, while as other
authors have recommended composite resin based in adhesive dentistry to
reinforce the remaining dental structures (5-8); so this technique was
selected as the final restoration in this case (fig 2a-b).
Figure 2a-b
In addition, the definitive restoration can be made previous to the endodontic
treatment.
Same technique and filling material will be used to fill the endodontic
access after treatment is completed.
Gutta-percha points seen in picture 3, just in order to maintain the endodontic
access while restorative proceedings are being completed. Endodontic access,
extirpation and irrigation, were the endodontic procedures that had been
done up to that moment.
Figure 3.....
Pictures 4 a-b show the stage the canal measurement step
was being done, and figure 5 shows a buccal view at the end of the treatment.
"Ferrule effect" is supplied with this coronal adhesive restoration,
that "holds the walls of the tooth together" (2).
Figure 4a-b
Figure 5
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Case
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