Ahmed M.

Leithey Alameldin

Management of
Endodontically Treated Teeth
By
Dr. Ahmed M. Leithey Alameldin

Ahmed M. Leithey Alameldin

 Ahmed M. Leithey Alameldin

Dilemma of RCT teeth

• Remember that endodontic treatment is performed on teeth significantly affected
by:
» Large Carious lesions.
» Multiple repeated restorations.
» Fractures.
• Such teeth are further weakened by the RCT:
» Access cavity preparation.
» Mechanical preparation.
• That’s why RCT teeth are weaker and have lower prognosis than vital teeth.

• The ultimate goal when restoring RCT teeth is:

• Adequate retention of restoration.
• Maximum resistance to tooth fracture.

• The fragility of RCT teeth may lead to catastrophic tooth

fracture.
• This is particularly seen due to cuspal deflection of posterior teeth.
• Ex. MOD cavity in a premolar
• Large filling in a molar.

Ahmed M. Leithey Alameldin

 Ahmed M. Leithey Alameldin

• Teeth with large restorations and no cuspal coverage are more prone to catastrophic
tooth fracture.

• Maxillary bicuspids with MOD amalgam restoration showed highest rate of fractures!

• Maxillary bicuspids with MOD bonded restoration showed lower rate of fractures.

But only for 3 years!

After this they were just the same as amalgam restorations

The most critical for tooth survival is Cuspal coverage rather than a post and core restoration.

Ahmed M. Leithey Alameldin

 Ahmed M. Leithey Alameldin

• The purpose of a core, with or without a post is:

» Replace lost dentin.

» Internal support and retention for a crown.

» Resistance against cervical tooth fracture.

Ferrule effect

• A minimal height of 1.5-2 mm of sound tooth structure between the end of the core and the
margin of the crown is essential.

Ahmed M. Leithey Alameldin

 Ahmed M. Leithey Alameldin

Diagnosis and treatment

planning
• Post space preparation weakens the tooth that’s already been weakened by the
decay/fracture and the RCT.

• Don’t post unless indicated.

Anterior teeth
• No crown:

– If the access is conventional.

– Both marginal ridges are intact.

– Small-sized class III or IV.

Ahmed M. Leithey Alameldin

 Ahmed M. Leithey Alameldin

– No esthetic hindrance.

• Do a crown:

– Substantial loss of extra-coronal tooth structure ( < 50 %).

– The tooth is unesthetic.

• No crown no post

• If you are to crown, place a post.

Premolars
Post + Core + Cuspal coverage

Because of the small mesiodistal width, the occlusal load, direction of load, and cuspal deflection,
premolars usually need to receive a post and core and a crown following endodontic treatment.

Premolars have only one exception, in which no post and core and crown should be done, only a
direct composite restoration would be enough under the following conditions:

• No post, no crown:

– Minimal occlusal access cavity.

– Two marginal ridges are intact.

– At least 2.5 mm of thickness at the base of the cusp.

– Normal occlusal function.

Ahmed M. Leithey Alameldin

 Ahmed M. Leithey Alameldin

Molars
• No post, no crown:

1- If there are no missing walls (only an occlusal access cavity).

2- One or better two marginal ridges are intact (very small class II),
At least 2.5 mm of thickness at the base of the cusp,
Normal occlusal function.

• Post and core and cuspal coverage (or an Endocrown):

3- A destruction larger than mentioned above.

4- Bruxism.

Endocrown
Criteria
• Occlusal clearance of 2 mm.

• Pulp chamber depth (Cavuum) 3mm.

• Axial wall thickness 2 mm.

• Occlusal divergence 6-7 º .

• Butt-joint cervical band (margin or sidewalk)

Indications
• Molars with short crowns.

(Occlusal clearance would compromise retention)

• Molars with very cylinder roots

(risk of root perforation during post drilling)

Ahmed M. Leithey Alameldin

 Ahmed M. Leithey Alameldin

Choosing the post

Metal posts

• Stiff, they cause root fractures.

• Do wedging action.

• Shouldn’t be placed under all ceramic crowns.

• Don’t bond to composite core.

• Fiber posts can be placed in all teeth.

• When planning a composite core, it bonds better to fiber posts.

Ahmed M. Leithey Alameldin