Accepted Manuscript

Title: No post-no core approach<!–<query id="Q1">Please

check the D̈ocument Headeränd correct if
necessary.</query>–> to restore severely damaged posterior
teeth: An up to 10-year retrospective study of documented
endocrown cases

Authors: Marcia M. Belleflamme, Sabine O. Geerts, Marie M.

Louwette, Charlotte F. Grenade, Alain J. Vanheusden, Amélie
K. Mainjot

PII: S0300-5712(17)30093-3
DOI: http://dx.doi.org/doi:10.1016/j.jdent.2017.04.009
Reference: JJOD 2761

To appear in: Journal of Dentistry

Received date: 18-2-2017

Revised date: 19-4-2017
Accepted date: 25-4-2017

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 No post-no core approach to restore severely damaged posterior teeth: an

up to 10-year retrospective study of documented endocrown cases

Marcia M. Belleflamme 1,2, Sabine O. Geerts1,2, Marie M. Louwette1,2,

Charlotte F. Grenade2,3, Alain J. Vanheusden2,3, Amélie K. Mainjot 2,3*

1
Department of Conservative Dentistry and Endodontics, Institute of Dentistry, University

of Liège Hospital (CHU), Liège, Belgium.

2
Dental Biomaterials Research Unit (d-BRU), Institute of Dentistry, University of Liège,

(ULg), Liège, Belgium.

3
Department of Fixed Prosthodontics, Institute of Dentistry, University of Liège Hospital

(CHU), Liège, Belgium.

* 45 Quai G. Kurth, Liège, 4020, Belgium. Fax: +32 4 270 31 10 Tel: +32 4 270 31 29

Email: a.mainjot@chu.ulg.ac.be.

Keywords

Endocrowns; fixed dental prostheses; minimal intervention dentistry; post and core; lithium-

disilicate glass-ceramic; Polymer Infiltrated Ceramic Network.

1
No post-no core approach to restore severely damaged posterior teeth: an up to 10-year

retrospective study of documented endocrown cases

Abstract

Objectives: The objectives of the present study were to (1) retrospectively evaluate

documented cases of ceramic and composite endocrowns performed using immediate dentin

sealing (IDS); (2) correlate failures with clinical parameters such as tooth preparation

characteristics and occlusal parameters.

Methods: 99 documented cases of endocrowns were evaluated after a mean observation

period of 44.7 ± 34.6 months. A classification of restorations was established in function of

the level of damage of residual tooth tissues after preparation, from 1 to 3. Evaluation was

performed according to FDI criteria and endodontic outcomes were analyzed. Occlusal risk

factors were examined and fractographic analysis was performed in case of fracture.

Results: 48.4% of patients were shown to present occlusal risk factors. 75.8% of restorations

were Class 3 endocrowns. 56.6% were performed on molars, 41.4% on premolars and 2.0%

on canines. 84.8% were performed in lithium-disilicate glass-ceramic and 12.1% in Polymer-

Infiltrated Ceramic Network (PICN) material. The survival and success rates of endocrowns

were 99.0% and 89.9% respectively, while the 10-year Kaplan-Meier estimated survival and

success rates were 98.8% and 54.9% respectively. Ten failures were detected: periodontal

disease (n=3), endocrown debonding (n=2), minor chipping (n=2), caries recurrence (n=2)

and major fractures (n=1). Due to the reduced amount of failures, no statistical correlation

could be established with clinical parameters.

Conclusions: Endocrowns were shown to constitute a reliable approach to restore severely

damaged molars and premolars, even in the presence of extensive coronal tissue loss or

occlusal risk factors, such as bruxism or unfavorable occlusal relationships.

2
Clinical significance: Practitioners should consider the endocrown instead of the post and

core approach to restore severely damaged non-vital posterior teeth. This minimally invasive

solution reduces the risk of catastrophic failures and is easily performed. The use of IDS

procedure and lithium-disilicate glass-ceramic as prosthesis material gave very good results.

3
Introduction

Nowadays, the development of adhesive dentistry has reduced the need of posts and cores to

restore endodontically non-vital posterior teeth with extensive coronal tissue loss. Indeed, it

has been more than 20 years since Pissis [1] introduced the “mono-block porcelain technic” in

which the retention of the restoration lies on the use of adhesive cementation and

macromechanical retention in canal entrance. In 1999, Bindl and Mormann [2] introduced the

term “endocrown” to describe a mono-block ceramic crown bonded to a depulped posterior

tooth. This minimally invasive approach is easily performed, less expensive and most of all

could reduce failures related to post placement [3] [4]. Yet, surprisingly few in vitro [5] [4]

[6] [7] [8] [9] [10] [11] [12] and clinical [13] [2] [14] [15] [16] studies have been dedicated to

those restorations. Moreover, there is no exact definition of the endocrown, particularly

regarding the amount of residual tooth tissues and the specific characteristics of the tooth

preparation. Some authors define an endocrown as a preparation with “a circular equigingival

butt margin and a central retention cavity of the entire pulp chamber” [2], others as “a total

porcelain crown fixed to depulped posterior tooth, which is anchored to the internal portion of

the pulp chamber and to the cavity margins”[17], while for Bernhart et al. [13], a preparation

with a height reduction of only 2 mm is considered as an endocrown, if the tooth is non vital

and there is at least a 2 mm of height retention in the pulp chamber. However, the amount of

residual tooth walls, the creation of a peripheral butt margin (which can promote a ferrule

effect) or the use of the pulp chamber cavity as macromechanical retention are variables

which could influence restoration retention and performance.

Since endocrown retention mainly lies on bonding, it is crucial to use prosthetic materials,

which can be resin bonded to tooth tissues. Clinical studies about endocrowns usually refer to

glass-ceramic materials, particularly feldspathic ceramic (Vita Mark II, Vita Zahnfabrik, Bad

4
Säckingen, Germany) manufactured with a computer-aided design and manufacturing (CAD-

CAM) process (Cerec system, Sirona, Benscheim, Germany) [15] [13] [14, 16], except Bindl

et al. who used In Ceram alumina or In Ceram spinell (Vita Mark II, Vita Zahnfabrik, Bad

Säckingen, Germany) [2]. Indeed glass-ceramic materials such as feldspathic ceramic are

etchable ceramics, which can effectively bond to resin cement through the application of

hydrofluoric acid and silane on their surface [18]. Currently, the range of materials available

for endocrowns also comprises lithium-disilicate reinforced glass-ceramics, which are popular

materials with an excellent short clinical background for single unit restorations [19] and a

higher flexural strength than feldspathic ceramic [17]. Yet, there are no clinical studies about

the use of lithium-disilicate glass-ceramic for endocrowns. On the other hand, CAD-CAM

composites appeared on the market a few years ago and are also recommended for single unit

bonded restorations. CAD-CAM composites constitute a growing family of materials, which

can be divided into two sub-classes: dispersed filler and Polymer Infiltrated Ceramic Network

(PICN) materials [20] [21]. Particularly, PICNs (Vita Enamic, VITA, Vita Zahnfabrik, Bad

Säckingen, Germany) represent a promising class of materials composed of a partially

sintered glass-ceramic block (75% vol.) secondarily infiltrated with dimethacrylate monomers,

which are polymerized under high temperature and high pressure [22]. Currently there are

very limited data about bonding properties and clinical behavior of current CAD-CAM

composites. Finally, immediate dentin sealing (IDS) with a bonding agent directly after tooth

preparation has been recommended for indirect bonded restorations [23-25]. It is intended to

improve bond strength, marginal adaptation and decrease bacterial leakage [26]. Those

arguments are based on in vitro studies and to author’s knowledge there are no clinical data

about IDS.

Consequently, the objectives of the present study were to (1) retrospectively evaluate the

documented cases of lithium-disilicate reinforced glass-ceramic, artisanal composite and

5
CAD-CAM composite endocrowns performed in the Department of Fixed Prosthodontics of

the University of Liège using the IDS procedure; (2) correlate failures with clinical

parameters such as residual tooth tissue amount, tooth preparation characteristics and occlusal

parameters.

Materials and methods

1. Study design

This is a retrospective record evaluation and a clinical examination of patients treated with

posterior endocrowns, using IDS in the bonding protocol. The study received approval from

the Ethics Committee of the University of Liège (Comité d’Ethique Hospitalo-Facultaire

Universitaire de Liège, number B7072201524093, reference 2015/46). The patients were

recruited in the Department of Fixed Prosthodontics of the University of Liege and were

treated by four experienced practitioners or pre-graduated students. Only cases documented

with photos and/or master casts highlighting the residual tooth tissue amount and the tooth

preparation characteristics were included in this study. 94 patients (n=137 endocrowns) were

recalled. They were informed of the purposes of the study and consent was obtained before

examinations. The endocrowns were performed during the follow-up period from July 2004

to July 2015.

2. Endocrown classification (Figure 1)

Three classes of endocrowns were established on the basis of residual tooth tissue amount

after preparation. Determination of the endocrown class was based on the analysis of clinical

pictures and/or master casts by two independent evaluators. In case of discrepancy, an

agreement was found between evaluators. Class 1 describes a tooth preparation where at least

6
two cuspal walls have a height superior to the half of their original height. Class 2 describes a

tooth preparation where maximum one cuspal wall has a height superior to the half of its

original height. Class 3 describes a tooth preparation where all cuspal walls are reduced for

more than the half of their original height (Figure 1). Moreover, the presence of a buccal

chamfer or an extension in the pulp chamber were registered.

3. Patient record registrations

Specific data were collected regarding the following parameters: sex, age, prosthetic material

brand, bonding protocol and associated products, and antagonistic teeth characteristics.

4. Clinical evaluation of restorations

Two independent evaluators clinically evaluated restorations following criteria of the World

Dental Federation (FDI) [27] [28]. Three dimensions, which represent 18 items, are

described: esthetic, functional and biological. The functional dimension includes the patient-

reported satisfaction. Each item is assessed on a 5-point Likert scale (1 corresponding to an

excellent restoration and 5 corresponding to a restoration that needs to be replaced). In case of

discrepancy, an agreement was found between evaluators to determine the final score. Scores

4 and 5 were considered as failure. Additionally, periodontal probing of the restored tooth was

performed in order to detect root fracture.

5. Endodontic evaluation

On the basis of pre-op and follow-up radiographs examination, the presence of a periapical

lesion before treatment and at follow-up was detected. The realization of an endodontic

retreatment before prosthodontic procedure was recorded. At follow-up, percussion pain of

the restored tooth was tested.

7
 6. Occlusal risk factors evaluation

Occlusal relationships were characterized as favorable or unfavorable based on the clinical

examination by the two independent evaluators. Class III or class II.2 malocclusion, anterior

or posterior crossbite, edge to edge or open bite, were considered as unfavorable occlusal

relationships. The presence of parafunctional habits was recorded if the patient related

grinding or clenching habits, masticatory muscle discomfort, or if abnormal wear facets were

observed on teeth. The use of an occlusal nightguard was noted. Finally, when a material

fracture was detected, the occlusal contact points and facets were examined in order to

determine whether the fracture was located on an occlusal contact or guidance.

7. Replica preparation and fractographic analysis

If a fracture of the prosthetic material was detected, a double-mix impression of the

endocrown surface was performed with a high- and a low-viscous A-silicone impression

material. The fractured surface was first cleaned with a cotton pellet and alcohol and was then

rinsed and thoroughly air-dried [29]. The replicas were produced using a quadrafunctional

hydrophilic siloxane impression material (Aquasil ULV, Dentsply De Trey, Konstanz,

Germany), the low viscosity material being syringed onto the fractured surface and over the

occlusal surface of the endocrown. The impressions were cast with filled polyurethane (Alpha

Die MF, Schütz, Rosbach, Germany). After setting, the model was sectioned to isolate the

restoration replica to be analyzed, which was gold-coated for scanning electron microscopy

(SEM). The fractographic analysis was performed using an Environmental Scanning Electron

Microscope with a Field Emission Gun (ESEM-FEG XL-30, FEI, Hillsboro, Oregon USA)

used in high vacuum mode. The interpretation of fracture patterns was based on the

descriptions by Scherrer et al. [29], particularly to determine the origin and direction of the

8
crack propagation.

8. Statistical analysis

Results are presented as means and standard deviations (SD) or as medians and quartiles (Q1

and Q3) for continuous variables and as frequency tables for categorical variables. Survival of

dental crowns was represented by Kaplan-Meier curve. Results were considered significant at

the 5% critical level (P < 0.05). Statistical calculations always used the maximum number of

data available and were carried out with the SAS (SAS Institute, Cary, NC, version 9.4)

package and R (version 3.2.3).

Results

1. Clinical data about patients, procedures and endocrowns

Among the 94 patients (n=137 endocrowns) recalled, 64 (n=99 endocrowns) agreed to

participate in the study. Among them, 38 were women. The mean age was 55.2 ± 12.6 years

with a range from 29 to 84 years at the time of examination. 8.1% of endocrowns were

performed by pre-graduated students. Data about repartition of restorations in function of

endocrown class, localisation and material brand are summarized in Table 1. Immediate

dentin sealing (IDS) procedure was performed in all cases with Optibond FL (Kerr, Bioggio,

Swiss), a 3-step etch-and-rinse bonding agent, which was polymerized on dentin directly after

preparation. All restorations were bonded with Variolink 2 (Ivoclar, Schaan, Liechtenstein)

following manufacturer recommendations and after air abrasion treatment of the IDS with

Cojet (3M, Saint-Paul, USA) followed by the application of Excite DSC (Ivoclar, Schaan,

Liechtenstein), a 2-step etch-and-rinse and dual cure bonding agent. Glass-ceramic restoration

intaglio was chair-side pretreated as follows: etched with 9.0% hydrofluoric acid (Ultradent,

9
Cologne, Germany) for 20 sec, rinsed with water, etched with phosphoric acid (Ultra-Etch,

Ultradent, Cologne, Germany) for one minute as an additional surface cleaning procedure,

rinsed with water, cleaned in an ultrasonic bath with 90° ethanol for 5 minutes, dried with an

air spray and recovered by a silane layer (Monobond S, Ivoclar, Schaan, Liechtenstein)

following manufacturer recommendations. PICN restorations were etched with hydrofluoric

acid for 60 sec, rinsed with water, cleaned in an ultrasonic bath with 90° ethanol for 5 minutes,

dried with an air spray and recovered by a Monobond S layer, as recommended by

manufacturer. Artisanal composite restorations (brand was unknown) were sandblasted with

Cojet, rinsed with water, cleaned in an ultrasonic bath with 90° ethanol for 5 minutes, dried

with an air spray and recovered by a Monobond S layer.

2. Restoration evaluation

After a mean observation period of 44.7 ± 34.6 months, the survival rate of endocrowns

(n=99) was 99.0 % and the success rate was 89.9 %. The estimated Kaplan–Meier survival

rate was 98.8% at 10 years and the estimated success rate was 54.9% at 10 years (Figure 2).

FDI rating of endocrowns is presented in Table 2. Ten failures were detected: they included

periodontal disease (n=3), endocrown debonding (n=2), minor chipping (n=2), caries

recurrence (n=2) and major fractures (n=1). Details about encountered failures are presented

in Table 3. Periodontal failures occurred in patients with general periodontitis. Among

debonded restorations, one was lost by the patient. The other one was located on an upper

molar with one missing root, which served as a support for a provisional removable prosthesis.

It was cleaned and bonded again using the protocol described previously. Due to the reduced

amount of each type of failure, statistical correlation with clinical parameters, such as tooth

preparation characteristics and occlusal risk factors, was not possible. Finally, 95.9% of

restorations were scored as clinically good or excellent by the patients (Table 2).

10
 3. Endodontic evaluation

Pre-op radiographs and data about endodontic retreatment procedure were available for 80

teeth. The presence a periapical lesion on pre-op radiographs was detected for 40.0% of those

teeth and the healing rate on follow up radiographs was of 42.1%. The realization of an

endodontic retreatment procedure was shown to induce a 60.0% healing rate of periapical

lesions observed on teeth, which were already depulped. Among all evaluated teeth, only one

tooth was symptomatic, i.e. slightly painful with percussion.

4. Occlusal risk factors

Data about the repartition of occlusal risk factors are detailed in Table 4, which shows that

48.4% of patients presented occlusal risk factors, 42.2% exhibiting parafunctional habits and

12.5% showing unfavorable occlusal relationships.

5. Fractographic analysis

The fractographic analysis was performed for 3 ceramic endocrowns. All fractures originated

from occlusal roughness corresponding to occlusal contact point.

Discussion

The analysis of tooth preparations through photos and/or master casts examination allowed

for the definition of three classes of endocrowns on the basis of residual tooth tissue amount

(Figure 3). This parameter, as well as the type of preparation regarding the presence of an

extension in the pulp chamber (92.0% of cases) or a ferrule effect (54.5% of cases), were

taken into account in results analysis. Yet, due to the reduced amount of failures, no statistical

11
correlation could be established with neither those factors, nor with occlusal risk. Indeed the

restorations demonstrated an excellent survival rate, which was shown to be 99.0% after a

mean observation period of 44.7 ± 34.6 months while the 10-year Kaplan-Meier estimated

survival rate was 98.8%. These very good findings confirm results of previous studies about

endocrowns, which are related to smaller sample size and/or observation time [2] [15] [14]

[13] [16]. They are also in line with the reported 5-year survival rates of all ceramic and

metal-ceramic single crowns [30] and, most of all, superior to the 5-year survival rates of post

and core based single crowns, which were reported to be limited to 50 % with titanium and

71.8% with fiber-reinforced posts [3]. Consequently, the present work supports the use of

endocrowns to restore endodontically treated posterior teeth, even in the presence of extensive

coronal tissue loss (75.8% of sample was composed of Class 3 restorations) and occlusal risk

factors (48.4% of sample). This high survival rate was associated with a high satisfaction rate

of patients regarding esthetics and function (95.9% of restorations were scored as clinically

good or excellent). The success rate was 89.9% and the 10-year Kaplan-Meier estimated

success rate was 54.9%, which is also comparable to other studies [2] [15] [14] [13] [16].

Encountered failures slightly differ from previous findings. Indeed biological failures were

more frequently observed in the present work while fractures and debonding were less present

than in other studies [2] [14] [13] [16].

Surprisingly, although the endocrown concept was introduced more than twenty years ago,

many practitioners still use posts and cores to restore endodontically treated posterior teeth

with extensive coronal loss. The post and core approach is intended to improve restoration

retention but it has been shown that this treatment option weakens tooth structure by

removing a significant amount of healthy coronal and radicular tooth tissues [31] [32] and that

titanium posts are associated to catastrophic failures and root fractures [3], more often than

reconstructions without posts [33] [34]. Those root fractures can lead to bone tissue loss and

12
jeopardize implant placement. Moreover, post placement induces a risk of root perforation [4]

[3], contamination of the endodontic system and failure related to the amount of adhesive

interfaces to create. Inconvenience of this classical approach also includes the need of

sufficient interocclusal space and several appointments, in addition to the increased cost. In

the present study, no root fracture was detected, while Bindl et al. [14] reported a 2.3% root

fracture rate after a mean observation time of 55 ± 15 months.

Despite the absence of post and the presence of occlusal risk factors, endocrowns only

showed 2.0% (n=2) of debonding. Those failures were related to Class 3 endocrowns and one

was in a particularly at risk situation, i.e. located on an upper molar with one missing root,

which served as a support for a provisional removable prosthesis. This failure was treated

repeating the bonding procedure and the endocrown survived, which is an important

advantage in comparison with post-based restorations, which induce catastrophic failures. It

must be noted that no debonding was observed on premolars (41.4% of endocrowns), while

those teeth can be submitted to non-axial occlusal loading during function, which can stress

the adhesive interface and could lead to more failures than molars, as observed by Bindl et al.

in 2005 [14] (Figure 4). The present data support the use of the IDS procedure [24] to

improve adhesion, which could contribute to the higher success rate than previous studies in

terms of debonding [14]. To author’s knowledge, they also constitute the first available

clinical data related to this procedure. Regarding the restorative material, lithium-disilicate

glass-ceramic (IPS empress 2 and IPS e.max press, Ivoclar Vivadent, Schaan, Lichtenstein)

was shown to be a good material for endocrown realization, exhibiting a fracture rate, which

was shown to be inferior to feldspathic ceramic in the same indication [13] [16], despite the

presence of occlusal risk factors. All fractures originated from occlusal contact points and

minor chipping could be polished, while only one major facture was observed in a patient

suffering from bruxism. Data regarding PICNs are promising but need to be further

13
investigated with respect to the small sample size and short background.

If debonding was not shown to be an issue with endocrowns, this was not the case either

regarding endodontic failures, since only one tooth (1.0%) was found to be slightly painful

with percussion and the radiological healing rate of periapical lesions at follow up and after

endodontic retreatment was of 42.1%.

Finally, most encountered failures, i.e. restorative material fracture from occlusal contact

point, caries recurrence and periodontal diseases can not be specifically attributed to the

endocrown approach. The higher failure rate than previous studies in terms of periodontal

disease and caries recurrence [14] [2] can be attributed to the inclusion of patients with

periodontal disease and high carious risk, as the absence of specific oral hygiene control

protocol [16] [2] [13].

Conclusions

Endocrowns were shown to constitute a reliable approach to restore severely damaged molars

and premolars, even in the presence of extensive coronal tissue loss (Class 3 endocrowns) or

occlusal risk factors, such as bruxism and unfavorable occlusal relationships. The excellent

survival rate (99.0% after 44.7 ± 34.6 months) and 10-year Kaplan-Meier estimated survival

rate (98.8%) were shown to be superior to existing data about post and core based single

crowns and were associated with a high satisfaction rate of patients. Due to the reduced

amount of failures, no statistical correlation could be established with clinical parameters,

such as endocrown class, type of preparation (presence of an extension in the pulp chamber or

a buccal chamfer) and occlusal risk factors. If debonding was not shown to be an issue, this

was not the case either regarding endodontic diseases while most encountered failures, i.e.

14
restorative material fracture, caries recurrence and periodontal diseases were not attributed to

the specific endocrown approach.

This minimally invasive treatment strategy presents several advantages in comparison with

the classical post and core approach: (1) tooth tissue preservation; (2) reduced risk of

catastrophic failures such as root fractures, root perforation and contamination of the

endodontic system and failures related to the amount of adhesive interfaces to create; (3) no

need of sufficient interocclusal space and several appointments, and decreased cost.

The present data support the use of the IDS procedure, which could contribute to the high

success rate in terms of debonding. Lithium-disilicate glass-ceramic was shown to be a

reliable material for endocrown realization while data regarding PICNs are promising but

need to be further investigated.

Finally, this work introduces a definition and classification of endocrowns with respect to the

residual tooth tissue amount after preparation and the retention potential offered by an

extension in the pulp chamber or a ferrule effect presence, which could influence restoration

behavior. These parameters should be taken into account in future studies.

15
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17
Captions

Table 1: Repartition of restorations in function of endocrown class, localisation and material

brand.

Table 2: FDI rating of endocrowns.

Table 3: Repartition of failures in function of endocrown class, localisation and the presence
of occlusal risk factors.

Table 4: Repartition of occlusal risk factors.

Figure 1: Classification of endocrowns, which was established on the basis of residual tooth
tissue amount after preparation. For Class 2 and 3, the presence of a buccal chamfer or an
extension in the pulp chamber were registered.

Figure 2: Kaplan-Meier success curve of endocrowns with 95% confidence limits.

Figure 3: Typical endocrown clinical case on tooth #36, documented with photos and master
casts highlighting the residual tooth tissue amount and the tooth preparation characteristics.
The restoration is a Class 3 endocrown, without a buccal chamfer and without an extension of
the preparation in the pulp chamber to act as macromechanical retention (a to c). The day of
tooth tissue preparation, immediate dentin sealing was performed and the pulp chamber was
filled with direct composite. The endocrown was performed in IPS empress 2 (Ivoclar-
Vivadent). From d) to f): clinical views the day of restoration placement. From g) to i):
clinical pictures and radiograph at 9-yr follow-up.

Figure 4: Class 2 endocrown clinical case on tooth #14, with a buccal chamfer and without an
extension of the preparation in the pulp chamber. The day of tooth tissue preparation,
immediate dentin sealing was performed and part of the pulp chamber was filled with direct
composite. The endocrown was performed in IPS e.max Press (Ivoclar-Vivadent). Tooth #15
is vital and was also restored with a lithium-disilicate glass-ceramic bonded restoration. From
a) to c): clinical views the day of restoration placement. d) and e): clinical views at 1-year
follow-up. The endocrown approach is particularly advantageous for premolars, since post
placement is risky with respect to root anatomy.

18
 % (n)

Endocrown class

Class 1 16.2 (16)

Class 2 8.1 (8)

Class 3 75.8 (76)

Pulp chamber anchorage 92.0 (69)

Ferrule 54.5 (54)

Localisation

Molars 56.6 (56)

Premolars 41.4 (41)

Canine 2.0 (2)

Material

Lithium disilicate glass-ceramic 84.8 (84)

(IPS empress 2 or IPS e.max Press,
Ivoclar Vivadent)
PICN (Enamic, Vita) 12.1 (12)

Artisanal indirect composite 3.0 (3)

Table 1 – Repartition of restorations in function of endocrown class, localisation and material

brand.

19
 Clinically Clinical Clinically Clinically Clinical Acceptable Unaccepta
Excellent ly Sufficient Unsatisfactor ly poor % ble
% (n) Good % (n) y % (n) % (n) %
% (n)
A. Esthetic 100 0
properties

Surface 67.3 (66) 26.5 6.1 (6)

luster (26)
Staining
a. surface 61.2 (60) 37.8 1.0 (1)
(37)
b. margin 52.0 (51) 42.9 5.1 (5)
(42)
Color
match and 55.1 (54) 28.6 16.3 (16)
translucen (28)
cy
Esthetic
anatomical 65.3 (64) 30.6 4.1 (4)
form (30)
B. 87.7 12.3
Functional
properties
Fracture of
material 95.9 (94) 1.0 (1) 1.0 (1) 2.0 (2)
and
retention
Marginal
adaptation 86.7 (85) 12.2 1.0 (1)
(12)
Approximal
anatomical
form
a. contact 74.5 (73) 16.3 6.1 (6) 3.1 (3)
point (16)

b. contour 77.6 (76) 17.3 2.0 (2) 3.1 (3)

(17)
Radiograp 84.9 (79) 12.9 2.2 (2)
hic (12)
examinatio
n
Patient’s 93.9 (92) 2.0 (2) 4.1 (4)
view
C. 95 5
Biological
properties
Postoperati
ve 90.8 (89) 8.2 (8) 1.0 (1)
sensitivity
and tooth
vitality
Recurrence
of caries, 91.8 (90) 5.1 (5) 1.0 (1) 1.0 (1) 1.0 (1)
erosion,
abfraction

20
Tooth 98.0 (96) 1.0 (1) 1.0 (1)
integrity
Periodontal
response 28.6 (28) 64.2 4.0 (4) 3.0 (3)
(63)
Adjacent
mucosa 79.6 (78) 20.4
(20)
Oral and
general 86.7 (85) 13.3
health (13)
Table 2 : FDI rating of endocrowns.

21
 Debonding Fracture Recurrence Periodontitis
(n) (n) of caries (n)
(n)
Failures 2 3 2 3

Endocrown class

Class 1 0 0 1 1

Class 2 0 1 0 1

Class 3 2 2 1 1

Pulp chamber anchorage 2 2 1 1

Ferrule 0 1 0 2

Localisation

Molars 2 2 2 3

Premolars 0 1 0 0

Canines 0 0 0 0

Occlusal risk factors

Parafunctionnal habits 1 2 1 1

With occlusal nightguard 1 1 0 1

Without occlusal nightguard 0 1 1 0

Unfavorable occlusal 0 0 0 0
relationships
With occlusal nightguard 0 0 0 0

Without occlusal nightguard 0 0 0 0

Table 3: Repartition of failures in function of endocrown class, localisation and the presence
of occlusal risk factors.

22
Table 4 – Repartition of occlusal risk factors.

Patients n = 64

Favorable Unfavorable
Occlusal relationships
n = 56 n=8
Yes No Yes No
Parafunctional habits
n = 23 n = 33 n=4 n=4

Occlusal nightguard Yes No Yes No Yes No No

n = 13 n = 10 n=3 n = 30 n=1 n=3 n=4

23
Figure 1
Figure 2
Figure 3

a) b) c)
d) e) f)
g) h) i)
Figure 4

a) b) c)
d) e)