A number of options are available in every clinical situation. The choice depends on the structural integrity of the tooth, esthetic, and protective requirements [1]. 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].
Restoration of Root Canal-Treated Teeth: An Adhesive Dentistry Perspective download.zip
This approach is highly indicated when an adhesive final restoration is planned;24 for example, in case of a localised deep margin where the remaining walls provide sufficient enamel for bonding (Fig. 2). More specifically, it allows for immediate dentine sealing (IDS) to be performed in freshly cut dentine just before relocating the margin and this prevents dentine contamination, enables bond maturation and enhances bond strength of the subsequent indirect restoration.26 A second IDS can be performed after completion of endodontic treatment to provide an immediate seal of the root canal obturation and optimise the cavity for the indirect restoration by blocking undercuts.24 Moreover, the supragingival location of the margin aids the subsequent procedures of impression taking and final cementation.24
Advances in adhesive dentistry and technologic developments with computer-aided design/computer-assisted manufacturing (CAD-CAM) technologies have resulted in new systems for dental restoration. Various machinable materials are used currently with CAD/CAM systems to fabricate restorations at the chairside. The CEREC 3 CAD/CAM system was introduced more than 15 years ago and it is the only system that can be used in both clinical practice and the laboratory.1
Given that there is still no consensus on the optimal way to restore ETT, and given that the retention of adhesive restorations is based mainly on adhesion and does not require macroretentive elements,35 the third null hypothesis, that there is no difference in the marginal adaptation of teeth restored with endocrowns or short or long posts, has to be accepted. Independent of post length, no relationship related to the percentage of continuous margin on both interfaces was found. It can be assumed that the three types of root retention could withstand intraoral masticatory forces to a similar degree.
The aim of this study was to review and summarize the in vitro and clinical data on the use of glass-fiber posts concerning recent changes in the philosophy, materials, and technology that have impacted significantly the art and science of endodontic post placement. Original scientific papers or reviews listed in the Medline or ISI Web of Science databases from 1981 to 2013 were searched electronically using the following key words: endodontically-treated teeth, glass-fiber post, dentistry, resin cement, silane, and adhesive. The literature supports the use of a post when the remaining coronal structure is insufficient to provide retention for the restoration. Concerning which post to select, glass-fiber posts offer two important advantages: the elastic modulus is similar to that of dentin, and these posts and the respective core build-ups are cemented by an adhesive technique. However, some issues remain unclear. Randomized controlled trials are needed to confirm whether the use of silane influences the bonding and whether self-adhesive resin cements constitutes a reliable clinical option. Overall, the use of fiber posts is an important clinical option in dentistry, but clinicians should be aware of the difficulties in achieving good adhesion within the root canal.
Original scientific papers or reviews listed in the Medline or ISI Web of Science databases from 1981 to 2013 were searched electronically using the following key words: endodontically-treated teeth, glass-fiber post, dentistry, resin cement, silane, and adhesive. Papers published in all languages were selected, and the most up-to-date or relevant references were chosen. Additionally, the cross-referencing of important papers identified those of historical value, which were also selected. Although papers written in all languages were considered, all the relevant studies were written in the English language. In order to discuss each item from the clinical use perspective, the results from the literature search were divided into the following six subcategories: reasons for the use of posts in dentistry; post selection criteria: glass-fiber posts; bonding systems; luting agents; post surface treatments; and critical clinical points.
The preservation of dental tissue has become possible especially with the spreading and the improvement of modern adhesive partial restorations. The merging of these concepts let clinicians to interrupt the cycle of defective restorations [31, 32] that is the cycle of a failed restoration substituted by a larger one, leading to more extensive restorations during years ending in root canal therapy and possibly an implant.
Adhesive dentistry allows to preserve and conserve sound tooth structure: full crown preparation could not be necessary anymore as long as mechanical retention could be substituted by adhesively bonded restoration to the remaining tooth structure [33], increasing the lifespan of the treated tooth. When it comes to an esthetic area, this approach should be definitely stressed. As dental clinicians, we should be aware that our restorations could not last forever [34]: it is mandatory to inform the patient about pros and cons of every treatment plan.
Noncarious cervical lesions (NCCLs) involve the loss of hard tissue from the cervical areas of teeth through processes unrelated to caries. NCCLs are nowadays a common pathology caused by changes in lifestyle and diet. The prevalence and severity of cervical wear increase with age. It is generally accepted that the lesions are not generated by a single factor but result from a combination of factors. Among the factors proposed to be related to the formation and progression of NCCLs are biocorrosion (erosion), friction (abrasion), and possibly occlusal stress (abfraction). The clinical appearance of NCCLs can vary depending on the type and severity of the etiologic factors involved. Practitioners should follow a checklist to achieve an accurate diagnosis of the etiology of multifactorial NCCLs. The successful prevention and management of NCCLs require an understanding of the etiology and risk factors, including how these change over time in individual patients. The decision to monitor NCCLs rather than intervene should be based on the progression of the lesions and how they compromise tooth vitality, function, and esthetics. Treatment options include techniques to alleviate dentin hypersensitivity and the placement of an adhesive restoration, eventually in combination with a root coverage surgical procedure. An adhesive restoration is considered the last treatment option for NCCLs. Based on their excellent esthetic properties and good clinical performance, there is a general indication to place composite restorations for NCCLs. The clinical performance of these restorations is highly product-dependent, particularly regarding the adhesive system used. The type of composite material seems to have no significant influence on the clinical performance of NCCL restorations in clinical trials. It is much more important that the operator carries out the clinical procedure correctly. Marginal degradation is frequently seen during aging. Yearly maintenance with the eventual repolishing of the restoration margins will lengthen the lifespan of the restorations. 2ff7e9595c
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