Restoration of Endodontically Treated Teeth – Dr. Rothman
Goal
Optimize the restoration potential of nonvital teeth
Many things to consider when restoring:
- Size
- Shape
- Number of canals
- Amount of teeth structure that remains
- Different techniques to restore teeth and know which options are best for use.
When a great loss of dental structure occurs due to caries or trauma, it is very difficult to obtain retention enough of a direct restoration on the dentin remaining. In this case, the treated teeth endodontically with large amount of crown lost clinic are usually taken care of with systems of pins and cores before the restoration is made. The procedure is more complicated when compared to the restoration of vitalized teeth. The non-vital teeth are more fragile due to loss of their structure. The remaining tooth structure weakens and ends up having a greater susceptibility to fracture. There is no scientific evidence for the claim that the dentin and enamel of a pulped tooth have physico-mechanical properties significantly lower than a vitalized tooth.
They can occur in post-trauma and post-endodontic treatment. Color change => intracanal medications. When the pulp is injured, an overflow of blood can disperse through the pulp chamber, leading to browning of the tooth. Internal whitening of treated teeth endodontically with relatively intact crowns offers a level of confidence and longevity relatively high.
Considerations to make include:
1- amount of remaining dental structure;
2- dental position and occlusal forces received;
3- restorative and aesthetic needs required in a particular case by a patient.
Intraradicular pins have as their main function the retention of direct or indirect restoration, not directly contributing to increase the resistance of the
dental remnant. During the rehabilitation of elements, non-vital dental implants, one must take into account their position in the arch, as factors such as aesthetics and are important within the treatment plan. Slight loss of structure can be restored using conservative manner with adhesive restoration. A pin offers little or no benefit on a structurally resistant anterior tooth and increases chances of a future irreversible failure, impossible to be restored.
Anterior teeth must withstand lateral forces and shearing.
The following are introductory processes
- Pin indication
- Changes in treated teeth endodontically
- Physical-mechanical changes
- Aesthetic Changes
- Treatment Plan
- Quantity of dental structure remaining
- Dental position and occlusal forces received
- Anterior teeth
Pulped molar teeth should receive cusp cover, but in most cases, do not need pins. Unless destruction coronary artery is extensive. Molars must basically resist the forces vertical. In molars that require the placement of pins, these should be placed in the widest channel and rectilinear, which is the palatine in maxillary molars and the distal in mandibular molars. Installation of more than one pin is rarely needed. They often have a single root canal with relatively small pulp chambers. For this reason, they need pins more often than molars. Premolars are more subject to lateral forces chewing than molars. When a premolar has more than one canal root, the option should be for installing the pin in the most calibrated channel, which is usually the palatine.
Contamination of the root canal system by saliva, often referred to as microleakage coronary artery disease, is a potential cause of endodontic. In addition, recurrent or fractured restorations can lead to recontamination of the root canal system. Periodontal condition of the dental element (s). Pin placement can induce stress additional internal root during installation or when the tooth is in function, half of the pin length should be rooted surrounded by bone crest to prevent the wedge effect. Properly sized pins offer better distribution of loads along the root. An unfavorable length can be corrected with crown augmentation procedures or even orthodontic extrusion. Clinical crown augmentation can also be useful for improve gingival zenith, the placement of a pin supported by sufficient alveolar bone can be difficult.
Orthodontic extrusion is the treatment option preferred if there is a suitable gingival contour, and the crown-root ratio will subsequently be enhanced. The fertile impact is vital for long-term success term when a pin is used. A template usually refers to a vertical tooth band with the gingival component of a crown preparation. Its making additions to certain retentions, but, mainly, it offers resistance and increases the longevity. A 1 mm high template can bend the fracture resistance in relation to restored teeth without ferule. Furthermore, when a tooth fracture occurs restored and with ferula, the patterns are more favourable. Most fractures of the teeth without a make the remainder impossible to restore. In some cases, particularly in anterior teeth, it is necessary to perform crown augmentation or extrusion orthodontic for a suitable template.
For a long time, fused metal cores were the only treatment options to restore
dental structures lost due to treatment endodontic. However, these pins have disadvantages, like:
- Lack of retention of the cementing agent
- Possibility of corrosion of the metal,
- Premolars
- Restoring needs and aesthetic
The titanium-based metal pins, which are more biocompatible than steel ones, minimize these negative factors, but do not eliminate them. That is why, with the goal of making teeth restoration endodontically treated using more pins both mechanically and aesthetically, non-metallic pins were developed so that tensions are transmitted to the structures in the most passive and homogeneous way possible, the intraradicular pin should have the same crown length.
In tooth with a very large coronary remnant short, 2/3 of the root length; Roots with bone loss, the pin should reach the half of the radiographic bone support. It is essential to emphasize the importance of maintaining the minimum 3.0 mm of gutta-percha remaining at the apex to not damage the apical seal. As for the thickness, the pin must not exceed 1/3 the width of the root, and the apical third of the pin should not have the diameter.