INDIRECT RESTORATIONS: Ceramic or resin composite onlays and endocrowns can also be used to restore endodontically treated teeth, Whereas overlays incorporate a cusp or cusps by covering the missing tissue, endocrowns combine the post in the canal, the core, and the crown in one component Both onlays and endocrowns allow for conservation of remaining tooth structure, whereas the alternative would be to completely eliminate cusps and perimeter walls for restoration with a full crown Ceramics are a material of choice for long-term esthetic indirect restorations because their translucency and light transmission mimic enamel,Onlays, overlays, and endocrowns can also be fabricated from resin composites processed in the laboratory Using various combinations of light, pressure, and vacuum, these fabrication techniques are claimed to{increase the. rsion ratc\of the polymer and consequently the mechanical properties of the restorative material.When we will use endocrowns mainly? 1. If no enough tooth structure coronally 2. Mainly if we don't have enough space for occlusion ENDOCROWNS Endocrown-type restorations are single prostheses fabricated from reinforced ‘amics that can be acid etched, indicated for endodontically treated molar teeth that have significant loss of coronal structure: Endocrowns are formed from a monoblock containin he coronal por tion . and ion that fills the pulp chamber spac integrated into the apical proje possibly the root canal entrances The endocrown will decrease the risk of fracture The endocrown is a total porcelain crown fixed to a depulped posterior tooth, which is anchored to the internal portion of the pulp chamber and to the cavity margins, thus obtaining macromechanical retention (provided by the pulpal walls), and microretention (by using adhesive cementation).» Endocrowns are especially indicated in cases of molars with short, obliterated, dilacerated, or fragile roots. They may also be used in situations of excessive loss of coronal dental tissue and limited interocclusal space, in which it is not possible to attain adequate thickness of the ceramic covering on the metal or ceramic substructures.FULL CROWNS: When a significant amount of coronal tooth structure has been lost by 4 full crown may be the caries, restorative procedures, and endodontics, restoration of choice To be successful, the crown and crown preparation together must meet five requirements: 1. The ferrule (dentin a: 2. The 3. The restoration must completely encircle the tooth. 1 wall height) must be at least 2 to 3 mm. walls must be parallel. 4. The margin must be on solid tooth structure. 5. The crown and crown preparation must not invade the attachment apparatus.It is an extension into the root canal space 2 to 4mm bBonding Ability Mannocci ef af reported that resin luting agents showed goodyadhesion to carbon fiber posts and glass fibér,posts. The adhesion to Zirconia posts%was found to be unsatisfactory It was also observed" that to improve aCe PMO) Milo mm UCT MmeT COR (0) | require any surface treatment \ as compared with the Zirconia post.Cementation The importance of the type of cement used for luting posts EK Waal overemphasized in the Oe Ocoee aesCementation Many factors should be taken into consideration PHO UCL teas Interactions with medicaments e Calcium hydroxide Interactions with irrigants e EDTA e NaOCl e Chlorhexidine e MTAD POCO RATE EL Cou EL MTA: cement used for perforations (microendodontic surgery) but MTAD is irrigant liquid with main propert, i ing fe (NaOQCL action for 48 hours) promoting healing of any radiolucenciesThe use of prefabricated posts and custom-made cores with composite simplifies the restorative procedure, because all steps can be completed chairside, and clinical success can be expected Dual-cure materigls provide the most reliable option for achieving good cement pol; alongithieIpostlength Although it is able to polymerize even in the complete absence of light, d -curing resins develop better mechanical properties when light irradiatedCementation = Zinc phosphate cement Polycarboxylate cement Glass ionomer cement Resin Composite cements Resin modified Glass lonomer Once mixed, the cement is delivered to the dowel space with a lentulo spiral, to ensure that all walls are coated. At the same time, the dowel and core are coated with a thin layer of cement. The restoration should slide slowly and easily into place with light finger pressure. Excess cement must escape coronally as the dowel nearly fills the dowel space.LUTING AGENTS There are several luting agents currently available to the dentist and they include: Zinc phosphate cement: OP Ohm UC Geran torlh 2) High solubility in the oral cavity. 3) Lack of true adhesion. 4) Adequate physical properties. 5) Ease of application. COB iroero ayesLUTING AGENTS Polycarboxylate Peer eer ee oem mmole 2) Undergoes plastic deformation after cyclic Orr 3) Less retentive in comparison to zine phosphate; (low compressive strength)LUTING AGENTS Glass ionomer cement 1) Provides a weak chemical bond.to dentin. 2) Fluoride release and anticariogenic effect. 3) Requires several days or even several weeks to reach it maximum strength so it’s unsuitable as a luting agent for posts._ LUTING AGEN etutois Bret) (1) 1) (connateLUTING AGLUTING AGENTS Adhesive resin cement 3. Resin cements have also been. suggested as a method to reinforce pulpless teeth, 4. Lowest solubility among all cements. 5. Highest compressive strength.7) CEMENTATION Five main groups of dental materials are used to cement posts zinc phosphate polycarboxylate, glass ionomers resin-modified glass ionomers composite resins Retention provided by luting cements: zinc polycarboxylate< GIC< adhesive resin cements phosphate <The Luting Method To Cement Posts OUT ries Ct Kot me Ce Eee COO MCee mS Cae post placement has a significant effect on post ara eThe Luting Method To Cement Posts - Spinning the cement into the canal with a Lentulo Spiral has been shown tobe the most Co iCur Momo HXte - Placement of the cement with a needle tube. is also effective as long as the tip of the needle ea MURDER tac PVM COS OM NCCC OMe T bi post is coated with the cement and placed in\the (EVIEThe Luting Method ToThe Luting Method To C th TMcotonays Oe lt4 ll avoid air OU meeTICLUTING METHOD © Place the luting agent on the post and also in the canal with a lentulospiral, a paper point, and an endodontic explorer. © After the luting agent is placed in the canal, the postis coated with the luting agent and insertedFAILURES IN POST & CORERemoval of existing posts for retreatment of a failed root canal filling. risky process- radicular fracture. If sufficient length of post is exposed coronally, the post can be retrieved with thin-beaked forceps. Vibrating the post firstwith an ultrasonic sealer will weaken brittle cement and facilitate removal. A thin sealer tip or specialposttemoval tip isPOST REMOVAL TECHNIQUES 1) Masserann technique Masserann developed and designed an instrument for extracting posts or rigid instruments that are broken deeply within the roots with minimum damage. The method involves gripping the object through a tube or trephine which acts as a tube-vice. This method is relatively harmless to the tooth and periodontium. The advantages of this technique are its simplicity, little generation of heat and elimination of excessive forces2) Eggler post remover , The Eggler device can be easily applied to anterior teeth and to most first premolar teeth, but its size prevents it from being used in most second premolars and virtually all molar teeth 3) Ultrasonic scalers For posts that extend into the pulp chamber, vibrations from the ultrasonic scaler are able to break the a cement bond between the canal and ry the post by touching the post with the ultrasonic tip.Gonon post removal technique Free the head of the post from the coronal tooth structure The high strength trephine is used to bore and gauge the protruding post to the exact size of a corresponding mandrel which is specially manufactured to thread the post The extracting pliers are fixed on the mandrel and jaws of the pliers are expanded by tightening the knurled knobINTERIM RESTORATION Interim restorations are those that provide structural integrity to the tooth while the tooth is undergoing endodontic treatment An interim restoration is expected to remain in situ providing a good seal until the endodontic treatment is completed and a definitive restoration can be provided. These interim restorations should help provide support for weakened cusps preventing fracture between appointments as well as a good coronal seal. Where the tooth’s coronal structure is severely compromised or a crack is suspected, copper rings or orthodontic bands may act as interim restorations Some have advocated the use of stainless steel orthodontic bands as interim restorations citing reduced cusp flexure often in premolar teeth and recommended that if one or more cusps are missing a band should be placed, In case of undermined enamel and tooth indicated for crowns (make occlusal reduction to stengthen the remaining tooth structure while doing the RCT in different sessions)» When metal bands are used, it is prudent to use chemically curing cements siene and that the as well as ensure that the margins allow optimum oral hys restoration is in keeping with the occlusion. It is not always possible to use metal bands around te rs due to aesthetic h in smile line such as premole considerations, although using a tooth coloured material to mask the buccal surface of the metal band have been described Using copper bands Using orthodontic bandsTEMPORARY RESTORATIONS Temporary restorations are those that occupy the access cavity and provide a good coronal seal between appointments. The overriding requirement is that they should provide an eff ctive and durable seal between appointments. Other desirable properties include ease of removal at the next appointment, inexpensive and UNHCR AESCHeprOpeMes, thus making it more obvious at the time of removal so that additional tooth structure is not removed at the subsequent re-entry appointment. An array of potential materials are available, including zinc-oxide/ calcium- sulphate-based materials (Cavit, Coltosol — Coltene Whaldent, Mahwah, NJ, USA), zinc-oxide-based reinforced intermediate restorative materials (IRM Dentsply Caulk, Milford, USA), GIC, resin modified GIC (RMGIC), ro reinforced GIC (Ketac Fil and Ketac Silver — 3M ESPE, Scefeld, Germany), a ite (TERM — Dentsply Maillefer Switzerland), amalgamThe combination of Cavit and IRM have been recommended for various r asons including cost, ease of use a d the fact that used together better dentine adaptation was seen when compared with IRM alone Cavit and IRM provided as good a seal as the original restoration when placed in access cavities through interim IRM restorations, am fillings and gold or metal ceramic crowns . - rer mate a pray Fling ‘ 4 “0 Germany by aM ES#E6) TEMPORIZATION/PROVISIONAL RESTORATION To prevent drifting of opposing or adjacent teeth, an endodontically treated tooth requires a proper provisional restoration immediately following completion of endodontics. Ifa cast post-and-core is made, 4h additional provisional restoration is needed while the post and core is being fabricated. This can be retained by fitting a wire (e.g. a paper clip or orthodontic wire) into the prepared canal. The restoration is then conveniently fabricated with autopolymerizing resin by the direct technique.