FROM VIRTUAL TO REAL

ENDOCROWN
DR. ISLAM ZAKZOUK
Outline
WHAT WE'RE COVERING

Introduction
Definition
Indications & Contraindications
Advantages & Disadvantages
Materials
Cavity preparation
Chair-side restoration
Temporization
Try-in
Cementation
Clinical cases

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 when a posterior tooth has extensive
tissue damage associated with endodontic
treatment, it's it traditionally treated
through a cast-metal post and core, metal
post with build up or even a fiber post with
composite build-up. Whatever the
Endocrowns material but all of this is to help the
retention and improve the stability of the
indirect restoration. An endocrown is an
alternative that simplify the protocol in
resorative endodontically treated teeth.

The concept was firstly introduced by

pissis in 1995 .
What is Basically, endocrown is an overlay with an extension into the pulp

Endocrown ? chamber. In other words, it is a crown that extend to include the

pulp chamber in endodontically treated teeth, a crown with its
core part as a single unit.

It is a large ceramic block that fills the pulp chamber and is

adhesively cemented to the dental substrate. thereby achieving
macromechanical retention provided by the walls of the pulp
chamber and micromechanical retention by means of adhesive
bonding. This technique presents satisfactory long-term clinical
results in molars.
Indications :

successfully treated teeth 

Excessive coronal loss
Limited inter-occlusal space
Cavity depth at least 3mm &
cervical margin with 2 mm width
Short clinical crowns
Calcified root cananls

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Contraindications :

If the pulp chamber is shallow

( less than 3 mm )
If the cervical margin is less than 2 mm
wide for most of its circumference.
If adhesion can not be assured.

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 Advantages Disadvantages

Simple, easier to perform Risk of root fractures and debonding

No preparation for root dentin Limitations maybe restricted to
No post materials that provide adhesion.
Conservative preparation design Laborious upon removal or drilling
Reduce chairside time through it.

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 Materials

CAD/CAM Glass Zirconium

composites Ceramics dioxide

The more you bond,

the less you need the srength ..
Pascal Magne
 How to implement ?

Cavity Chair-side Cementation

preparation restoration Adhesive cementation
OCClusal, axial, cavity floor, Optic impression, designing,
finishing & polishing milling
Cavity Preparation :

The depth of the cavity at least 3mm

At least 2 mm thick cervical margin
No internal line angles
Flat pulpal floor whenever possible
Supragingival finish line is preferred

RPA SUMMER 2020

 The preparation is extremely
simple, requiring only :

The pulp chamber to be

divergent towards the occlusal
surface

The preparation margins

exhibit sharp well defined
termination at 90 degrees to
the outer surface

The interior angles are

rounded.

RPA SUMMER 2020

 Cavity Preparation

Occlusal reduction Axial preparation

The goal is to achieve an overall 2mm The goal is to eliminate the undercuts
occlusal reduction to protect the cusps in the access cavity

Cavity floor Finishing/polishing

The goal is to achieve a The goal is to eliminate any
thorough cleaning of the irregularities & sharp line angles
floor without abrasion or to reduces stresses
drilling the root dentin
Occlusal reduction

A proper occlusal reduction is the

keypoint for a good occlusal anatomy
of the restoration, so 2 mm occlusal
clearance is required.

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 Buttjoint margin or cervical sidewalk
with at least2 mm thickness

Wheel-shaped bur

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Axial preparation

The diamond points used to achieve these goals are

only positioned parallel to the long axis of the tooth
and automatically confer the ideal taper to the axial
walls of the pulp chamber and always result in
rounded internal angles

Ferrule or No Ferrule ?!

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 Ferrule NO Ferrule
A shoulder/deep chamfer Butt-joint margin encircles
encircles the tooth the  tooth
 Ferrule NO Ferrule
Encircling the entire tooth

Improve the mechanical

retention of the restoration
Improve stability and stress
distribution from the occlusal
functioan
only delimit the preparation
margins
lack of sufficient tooth structure

Additional benefit, but not at

the expense of the remnant
tooth structure

Not strictly necessary for

obtaining a high quality
preparation “ optional “.

OCCLUSAL REDUCTION
Refinement of the internal angles and rounding off the occlusal-axial angles along
the margins and within the axial walls of the chamber.

Then the steps are

repeated, with a
diamond point of
equal shape with
extra-fine granulation.

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Cavity floor

Cleaning the pulp chamber and its floor

thoroughly "no abrasion "no drilling of the dentin
but removing gutta percha from canals orifices
not exceeding 2 mm for better sealing of canals.

To seal or Not to seal ?!

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Making a filling with adhesive and composite,
in the region of canals orifices, alternatively it
may be kept exposed gutta percha. But, it is
preferable to make the filling in order to :

prevent contamination of the root canals in

the case of the temporary is dislodged
and/or leakage occurs 
block the undercuts in this area.

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Finishing & Polishing

Smoothing of the interior angles is performed initially

with fine-grained diamond points, with the same
format as the points already used during the
preparation.
Rounding off the occlusal-axial angles.
Refinement of the preparation surface, both along
the margins and within the axial walls of the
chamber.
Polishing is completed through using specially
shaped abrasive rubbers,

RPA SUMMER 2020

 Finishing & polishing
using
extra-fine diamond
points and
abrasive rubbers
Chair-side
restorations
Chairside CAD/CAM systems include a scanner, a
designing software and a milling device.

The conventional impression is replaced by a

digital optical impression, and in most cases,
the prosthetic restoration is manufactured on
the spot, which is a major time-saving
advantage.

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Try-in
If the first attempt of insertion was not successful and the
restoration can not be completely seated, check the
proximal region for presence of interference , detect it
using articulating paper, these regions are gently adjusted
with fine and extra fine diamond points until the
endocrown has obtained proper seating to the preparation
and therefore an optimal marginal adaptation.

The adjusted regions are then polished with special

rubbers to remove the cracks generated by the adjustment
and give it back its original shine and smoothness.

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Cementation :

The more you bond, the less you need the strength.
Pascal Magne
 Absolute isolation of the operatory
field is imperative.

Interesting tip:

Use two wooden wedges, one on each proximal

surface, before the cementation itself. The point is
the inversion of the wedges in order not to hinder
the insertion of the restoration. In this position, the
wedges will prevent excess cement from flowing
towards the interproximal spaces, facilitating the
finishing procedures and the removal of the
marginal excesses

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 Holding the restoration with
an adhesive device

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 The internal surface of the restoration
is etched with hydrofluoric acid for
the time recommended by the
manufacturer of the ceramic system
then rinse and dry.

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 Apply several layers of a silane agent to
the etched surface. “ almost for 60
seconds “

The preparation surface is etched with

phosphoric acid for approximately 15
seconds then rinse and remove the
excess moisture.

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 The preparation surface is etched with
phosphoric acid for approximately 15
seconds then rinse and remove the
excess moisture.

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 Multiple layers of a light cured
adhesive system are applied to
the tooth preparation surface.

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 A thin layer of the adhesive
should also be applied to the
ceramic surface previously
silanized.

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 A dual cued resin cement is
then applied to the internal
surface of the restoration,
which is placed into position
and seated with gentle finger
pressure.

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 a spatula for composites is
used to maintain slight
pressure on the restoration
while the adhesive device is
pulled and removed.Then , still
maintaining gentle pressure on
the restoration the gross
excess cement along the entire
margins is removed with
disposable brushes, spatulas
or with an explorer.

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 A tack cure is performed
for about 5 seconds to
keep the restoration in
position allowing for the
through removal of the
excess cement and
adhesive.

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 The wedges are removed
and all excesses are then
removed using dental floss
and abrasive strips. The
final light curing is applied
to the whole surfaces , 60
seconds per surface is
recommended.

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 remove the rubber dam ,
check the occlusal contacts
and adjust any premature
contacts using fine and extra
fine diamond points until
obtaining an acceptable
occlusal standard..

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Finally, the endocrown reveals a simple
and fast alternative treatment since it
leads to considerable clinical time
saving and can be used without damage
to the quality of the final result.

RPA SUMMER 2020

Clinical cases
Documentations are communication tools that can be used
as demonstrations, lectures, speeches, reports, and more.
It is mostly presented before an audience.

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Case 1
 Polyp
execution

and

access
opening
Clean cavity
RCT is going to be accomplished ..
Celtra Duo
was my
choice
Delivered
 Case 2
Preoperative situation
Cavity design
Margin determination
Proposal
 Case 3
Preoperative situation

PHOTOJOURNALISM
Presentations are communication tools that
can be used as demonstrations, lectures,
speeches, reports, and more.
RCT was initiated
while i was
fatigued
by the end
of the day ,,
Final preparation
 virtual
Endocrown
Virtual Vs Real
Ready for cementation
Finally seated ..
No more residual cement ..
Case 4
Cavity preparation
Virtual design
 Finally
cemented ..
Case 5
Optic impression
& proposal
 1 year recall
Good margin adaptation upon recall ..
Thank you
Dental Esthetic Club

www.dentalestheticszak.com

Dental Esthetics

@drislamzak

@dentalesthetics2

ESLAM S. ZAKZOUK