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| CASE REPORT |
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| Year : 2018 | Volume
: 13
| Issue : 1 | Page : 60-62 |
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Management of endodontically treated teeth with endocrown
Nikita Oswal1, Manoj Chandak1, Rajesh Oswal2, Manali Saoji1
1 Department of Conservative, SPDC (DMIMS), Wardha, Maharashtra, India
2 Department of Conservative and Endodontics, ACPM Dental College, Dhule, Maharashtra, India
| Date of Web Publication | 10-Sep-2018 |
Correspondence Address:
Dr. Nikita Oswal
B1, Vishwakarma Apartments, Near Alphonsa School, Sawangi (Meghe), Wardha - 422 001, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jdmimsu.jdmimsu_38_17
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
How to cite this article:
Oswal N, Chandak M, Oswal R, Saoji M. Management of endodontically treated teeth with endocrown. J Datta Meghe Inst Med Sci Univ 2018;13:60-2 |
| Introduction | |  |
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 and Mörmann in 1999.[4] It is a total porcelain crown that is 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 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], [Figure 2], [Figure 3], [Figure 4], [Figure 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 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 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. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
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