Extracoronal Restoration of

Endodontically Treated Teeth

siti sarah bt abdul sattar
group c
Overview
◦ Background
◦ Objectives
◦ Case report
i. Case outline
ii. Clinical exam & investigation
iii. Diagnosis & treatment plan
iv. Outcome
◦ Discussion
◦ Conclusion
◦ Recommendation
Background
• Endodontic treatment is carried out on teeth that are greatly affected by caries,
multiple restorations and trauma/fracture.
• Often times, these teeth are further weakened following root canal treatment
due to the endodontic access and instrumentation.
• One of the major causes of failures of these teeth is coronal fracture attributed
to the inadequate final restoration.
• Hence, extra coronal restorations are usually treatment of choice to maximize
the clinical longevity of these teeth following RCT.
Objectives
The main objectives of restoring endodontically treated
teeth are to preserve the integrity of the root canal filling
and to rebuild the tooth into a symptom-free, functional
contributor in the patient’s dentition.
Case Report

2. Clinical
1. Case outline examination &
investigations

3. Diagnosis &
4. Outcome
Treatment plan
Case Outline
A 34-year old Iranian lady

Chief complaint:
 Requests for crowns of upper right and left teeth.
 Felt some discomfort at the upper left region

History of complaint:
 Had root canal treatments done on both teeth several years ago in
Iran
 Felt some sharp edges at the upper left tooth
Medical history:
 Had orthognatic surgery done in 2011, was admitted to hospital for 2-3 days, no post-operative
complications
 Allergic to metoclopramide
 No serious illness, not taking any medication
No significant family history
Dental history:
 Had restorations, crowns done
 Had 18, 28, 38 and 48 extracted, no post-operative complications
2. Clinical examination & investigation
◦ Extraoral examination: face is symmetrical, competent lips, normal TMJ and mouth opening, non-
palpable lymph nodes.
◦ Intraoral examination:
 Site of complaint: Fractured amalgam on 27 (DO).
 Periodontium: Gingiva appears red and oedematous, with bleeding on probing.
 All the other soft tissues appear normal.
 BPE score:

2 1 3
2 2 3
Charting overview
◦ Multiple composite and amalgam restorations
◦ Root canal treatment of 16, 25, 27, 36 and 46
◦ Metal ceramic crowns on 36 and 46
◦ Vertical tooth fracture of 27 after endodontic treatment
Special Investigations
a) Dental panoramic radiograph
b) Periapical of 16
c)Periapical of 25
3) Diagnosis & Management
Definitive Diagnoses:
o Generalized chronic gingivitis
o Vertical fracture of 27 following endo treatment
Definitive Treatment Plan:
o Oral hygiene education
o Scaling and polishing
o Extraction of 27
o Metal ceramic crowns on 16 and 25
4)Outcome
◦ Metal ceramic crown on 16 has been issued, while metal ceramic on 25 is to be issued next week.
Discussion
◦ Endodontically treated teeth are at higher risk of fracture due to loss of strategic internal architecture.
Under occlusal load, the cusps of these teeth are deflected, and this process is more pronounced
following access cavity [1].
◦ A study by Hansen et al in 1990 concluded that root-treated posterior teeth restored with amalgam
without cuspal coverage are often associated with fracture [5].
◦ Another study by Aquilino et al states that when tooth type and caries at access were controlled, RCT
teeth that were not crowned after obturation were lost at a 6 times greater rate than RCT teeth crowned
after obturation [2].
◦ Interestingly, the most devastating fractures were found involving the 2nd maxillary molar, and accounted
for majority of extractions due to vertical tooth fracture [1].
◦ In post core cases with good endodontic treatment, the presence of gap between the post and remaining
root canal filling significantly affected the success rate [3].
◦ When the gap between post and root filling is wider than 2 mm, the clinical outcome is significantly
unfavourable [4].
Conclusion
◦ Teeth that have been root-treated with extensive loss of tooth structure is advised to be restored with
restorations with cuspal coverage to provide improve prognosis and prevent future problems.
Reference
◦ 1. Post Placement and Restoration of Endodontically Treated Teeth: A Literature Review Richard S.
Schwartz, DDS, and James W. Robbins, DDS, MA
◦ 2 . Aquilino SA, Caplan DJ. Relationship between crown placement and the survival of endodontically
treated teeth. J Prosthet Dent 2002;87:256–63.
◦ 3. The effect of the gap between the post restoration and the remaining root canal filling on the
periradicular status in a Turkish subpopulation
◦ 4. Moshonov J, Slutzky-Goldberg I, Gottlieb A, Peretz B. The effect of the distance between post and
residual gutta-percha on the clinical outcome of endodontic treatment. J Endod 2005; 31:177-9
◦ 5. Hansen, E.K., E. Asmussen, and N.C. Christiansen, In vivo fractures of endodontically treated
posterior teeth restored with amalgam. Endod Dent Traumatol, 1990. 6: p. 49-55
◦ 6. McComb D. (2008). Restoration of the endodontically treated teeth. Dispatch.