[Downloaded free from http://www.journaldmims.com on Wednesday, May 19, 2021, IP: 111.119.178.

132]

Case Report

Management of Endodontically Treated Teeth with Endocrown

Nikita Oswal, Manoj Chandak, Rajesh Oswal1, Manali Saoji
Department of Conservative, SPDC (DMIMS), Wardha, 1Department of Conservative and Endodontics, ACPM Dental College, Dhule, Maharashtra, India

Abstract
With multiple options available to restore an endodontically treated tooth, endocrowns represent a simple, conservative, and esthetic alternative
to conventional crowns. Endocrown is a one‑piece restoration, usually indicated in cases with decreased crown height. The preparation
comprises “sidewalk” as the cervical margin and a preparation into the pulp chamber that may or may not extend into the root canals. It prevents
interferences with periodontal tissues, due to the presence of supragingival position of the restoration margins. The rationale of this technique
is to use the surface area available in the pulpal chamber to assume the stability and retention through adhesive procedures. Principally,
endocrowns are full ceramic restorations. A case report is presented here, where a porcelain‑fused‑to‑metal endocrown was fabricated using
the similar protocols and clinical procedures.

Keywords: Endocrown, porcelain‑fused‑to‑metal prosthesis, postendodontic restoration

Introduction and Mörmann in 1999.[4] It is a total porcelain crown that is

Postendodontic restoration should preserve and protect the
existing tooth structure, while restoring satisfactory esthetics,
form, and function. The goal is to achieve minimally invasive
preparations with maximal tissue conservation for restoring
endodontically treated teeth (ETT). [1] This will help to
mechanically stabilize the tooth‑restoration complex and
increase surfaces available for adhesion . A number of options
are available in every clinical situation like post and cores,
postendodontic restoration followed by crown, etc. The choice
depends on the structural integrity of the tooth, esthetic,
and protective requirements. ETT carries a higher risk of
biomechanical failure than vital teeth and is a common problem
in restorative dentistry related to the fractures occurring in such
teeth.[1] Changes occurring in ETT include reduction in stiffness
and fracture resistance of ETT due to the loss of structural
integrity associated with caries, trauma and extensive cavity
preparation, as well as dehydration or physical changes in dentin.
In this perspective, endocrowns can be considered as a feasible
alternative to full crowns for restoration of nonvital posterior
teeth, especially those with minimal crown height but sufficient
tissue available for stable and durable adhesive cementation.[2]
Pissis was the forerunner of the endocrown technique and
has described it as the “monoblock porcelain technique.”[3]
Although the term endocrown was first coined given by Bindl
Access this article online
Quick Response Code:
Website:
www.journaldmims.com
luted to a root canal‑treated posterior tooth using all resin
cement. It is indicated in cases with excessive loss of tissue
of the crown when interproximal space is limited; traditional
rehabilitation with post and crown is not possible because of
inadequate ceramic thickness or calcified, curved, or short root
canals that make postapplication impossible.[5]
Case Report
A 23‑year‑old male   patient reported to the Department
of Conservative and Endodontics at Sharad Pawar Dental
College and Hospital with a chief complaint of pain in the
lower right back region of the jaw. On clinical evaluation,
grossly carious 46 was observed. Furthermore, the crown
height was approximately 3 mm. Radiographic evaluation
showed radiolucency involving the pulp. The treatment
plan formulated was root canal treatment with 46. Due to
the inadequate coronal height available conventional crown
and also the patient’s insistence for an esthetic crown,
Porcelain‑fused‑to‑metal (PFM) endocrown was planned as
Address for correspondence: Dr. Nikita Oswal,
B1, Vishwakarma Apartments, Near Alphonsa School, Sawangi (Meghe),
Wardha ‑ 422 001, Maharashtra, India.
E‑mail: nalunawat@gmail.com
This is an open access journal, and articles are distributed under the terms of the Creative
Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix,
tweak, and build upon the work non-commercially, as long as appropriate credit is given and
the new creations are licensed under the identical terms.
For reprints contact: reprints@medknow.com

DOI: How to cite this article: Oswal N, Chandak M, Oswal R, Saoji M.

10.4103/jdmimsu.jdmimsu_38_17 Management of endodontically treated teeth with endocrown. J Datta Meghe
Inst Med Sci Univ 2018;13:60-2.

60 © 2018 Journal of Datta Meghe Institute of Medical Sciences University | Published by Wolters Kluwer - Medknow
[Downloaded free from http://www.journaldmims.com on Wednesday, May 19, 2021, IP: 111.119.178.132]

Oswal, et al.: Endodontically treated teeth with endocrown

the fixed prosthesis as it would offer good esthetics and better
mechanical performance and also could be completed with
less cost and less clinical time. The complete procedure was
explained to the patient, and a written consent was taken from
the patient [Figure 1-5].
Procedure
Root canal treatment was completed in single visit. On the
second visit after the removal of temporary restoration,
occlusal tooth reduction was carried out with a diamond wheel
bur, holding it parallel to the occlusal surface. This ensured a
flat surface and also determined the precise position of cervical
margin. This form of occlusal reduction is termed as cervical
“sidewalk” or “walk around” preparation. Axial preparation
using a tapered bur included only removal of undercuts from
the access cavity. Cervical band was polished with polishing
bur to produce flat and polished surface, thereby providing a
cervical butt angle joint. The finished line appeared as a regular
line with a sharp edge. A 1‑mm gutta‑percha was removed
from the canals using a heated plugger. This gave access to
saddle‑like anatomy of floor. An occlusal divergence of 6
degrees was prepared for the cavity. After the completion of
tooth preparation impression was made with polyvinyl siloxane
silicone of light and putty consistency using a double‑mix
single‑stage technique. The conventional casting technique
was used for fabrication of the metal coping part of the
endocrown on the master cast. The ceramic buildup was carried
out with the layering technique incrementally. The finished
and polished endocrown was seated onto the master cast to
verify its marginal fit and accuracy before luting intraorally.
The endocrown was cemented intraorally using GIC luting
agent. The gross occlusal discrepancies were removed with the
articulating paper strips before cementation. Postcementation
radiographic view showed appropriate seating of the crown.
Follow‑up visits were scheduled at 24 h, biweekly, 3 and
6 months intervals.
Discussion
Minimally invasive preparations, with maximal tissue
conservation, are now considered the gold standard for
restoring ETT. The endocrowns strictly follow this rationale:
the preparation consists of circular equigingival butt‑joint
margin and central retention cavity.[6] In endocrown, the
internal portion of the cavity provides macromechanical

Figure 2: After obturation

Figure 1: Preoperative 46

Figure 3: After casting internal surface Figure 4: Prepared endocrown

Journal of Datta Meghe Institute of Medical Sciences University ¦ Volume 13 ¦ Issue 1 ¦ January-March 2018 61
[Downloaded free from http://www.journaldmims.com on Wednesday, May 19, 2021, IP: 111.119.178.132]
Oswal, et al.: Endodontically treated teeth with endocrown
Figure 5: Postcementation
retention while micromechanical retention is achieved by
adhesive cementation. Literature clearly depicts that the choice
of prosthesis for restoring an ETT is a tough call to make and
is principally directed by the voluminous amount of tooth
structure remaining after the root canal therapy. A sound and
long‑term maintainable restoration dictates reinforcement
of the remaining healthy dental tissues, which can impart
harmony to tooth‑restoration complex. In today’s era of esthetic
and adhesive dentistry, endocrown serves as a conservative
and feasible alternative to conventional post and core crowns
as it preserves root tissues and limits internal preparation of
the pulp chamber to its anatomic shape.
Many different materials are proposed for fabrication of
endocrowns such as feldspathic porcelain, glass ceramic,
hybrid composite resin, and recent computer‑aided design/
computer‑aided manufacturing all‑ceramic blocks. In the
present case report, conventional feldspathic PFM was
prepared on endodontically treated 46,[7] due to economic
constraints of the patient, but the protocols of tooth
preparation for an endocrown were rationally applied. This
was esthetically competent and economically much viable
for the patient. Furthermore, the preparation is conservative
as compared to the traditional crowns. Involvement of the
biological width is minimal. In comparison to the post and core
restorations, bonding surface offered by the pulpal chamber of
62 Journal of Datta Meghe Institute of Medical Sciences University ¦ Volume 13 ¦ Issue 1 ¦ January-March 2018
the endocrown is often equal or even superior to that obtained
from the bonding of a radicular post of 8 mm depth.
Conclusion
Endocrowns have been a feasible alternative to conventional
post‑core and fixed partial dentures in restoration of ETT
with extensive coronal tissue loss. Compared to traditional
methods, better esthetics and mechanical performance, low
cost and short clinical time are the advantages of endocrowns
and can be successfully used for restorations of teeth with
short clinical crowns.
Declaration of patient consent
The authors certify that they have obtained all appropriate
patient consent forms. In the form the patient(s) has/have
given his/her/their consent for his/her/their images and other
clinical information to be reported in the journal. The patients
understand that their names and initials will not be published
and due efforts will be made to conceal their identity, but
anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
1. Robbins JW. Restoration of the endodontically treated tooth. Dent Clin
North Am 2002;46:367‑84.
2. Christensen GJ. Posts: Necessary or unnecessary? J Am Dent Assoc
1996;127:1522‑4, 1526.
3. Pissis P. Fabrication of a metal‑free ceramic restoration utilizing the
monobloc technique. Pract Periodontics Aesthet Dent 1995;7:83‑94.
4. Bindl A, Mörmann WH. Clinical evaluation of adhesively placed
Cerec endo‑crowns after 2 years – Preliminary results. J Adhes Dent
1999;1:255‑65.
5. Chang CY, Lin YS, Chang YH. Fracture resistance and failure modes of
CEREC endocrowns and conventional post and core-supported CEREC
crowns. J Dent Sci 2009;4:110-7.
6. Van Meerbeek B, Perdigão J, Lambrechts P, Vanherle G. The clinical
performance of adhesives. J Dent 1998;26:1‑20.
7. Shah RJ, Lagdive S, Verma V, Shah S, Saini S. Rehabilitating
endodontically treated mandibular molar having inadequate coronal
length with “Endocrown” – A neoteric clinical approach. IOSR J Diagn
Med Sonography 2017;16:29‑33.