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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 15  |  Issue : 2  |  Page : 308-311

Endocrown bridge: An alternate way to restore endodontically treated tooth


Department of Prosthodontics Crown and Bridge, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India

Date of Submission14-Jan-2020
Date of Decision05-Feb-2020
Date of Acceptance10-Mar-2020
Date of Web Publication21-Dec-2020

Correspondence Address:
Dr. Dipak Shinde
Department of Prosthodontics Crown and Bridge, Sharad Pawar Dental College, Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_9_20

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  Abstract 


Endocrown restorations are single unit prostheses fabricated from metal. These restorations are indicated for endodontically treated teeth, molars especially, that have significant loss of coronal structure. Endocrowns gain their retention from the coronal portion integrated into the apical projection that fills the pulp chamber space, and possibly the root canal entrances. In this case report a new style Fixed Partial Denture is introduced. Here mandibular second molar had compromised tooth structure and hence Endocrown was planned with the tooth. For replacement of missing first molar a three unit fixed partial prosthesis was planned. This unique three unit prosthesis had Endocrown on mandibular second molar and a full veneer crown on mandibular second premolar as an abutment fabricated in metal. This innovative design of Fixed Partial Denture is better suited in cases where there is compromised tooth structure and the tooth is strategically important and has to be retained.

Keywords: Endocrown bridge, endocrown, endodontically treated teeth, minimal intervention


How to cite this article:
Shinde D, Dubey SG, Borle AB, Dhamande M, Balwani T, Dafade A. Endocrown bridge: An alternate way to restore endodontically treated tooth. J Datta Meghe Inst Med Sci Univ 2020;15:308-11

How to cite this URL:
Shinde D, Dubey SG, Borle AB, Dhamande M, Balwani T, Dafade A. Endocrown bridge: An alternate way to restore endodontically treated tooth. J Datta Meghe Inst Med Sci Univ [serial online] 2020 [cited 2021 Jan 24];15:308-11. Available from: http://www.journaldmims.com/text.asp?2020/15/2/308/304270




  Introduction Top


The restoration of endodontically treated teeth (ETT) with compromised dentine core in the distal area of the oral cavity is often associated with difficulties in the planning, choice of restoration type, clinical, and laboratory procedures.[1] Endocrown is a conservative treatment modality for the restoration of ETT in which the walls of the pulp chamber can be used as retentive areas.[2] The restoration of ETT is a topic that has been widely and controversially discussed in dental literature.[3] ETTs are different from vital teeth both structurally and physically. Major changes that occur in ETT include loss of tooth structure either due to caries or trauma along with biomechanical alterations.[4] Postendodontic restoration of the treated tooth bought to preserve, protect, and reinforce the existing tooth structure, while maintaining the form, function, esthetics, and its solidarity to the maximal attainable levels.[2] 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.[5] Various options are available depending on the clinical presentation. The choice of prosthesis, whether to opt for partial or full coverage ultimately depends on the structural integrity of the tooth, esthetic considerations, and protective requirements.[6]

Endocrowns are considered as a better alternative to full crowns for the restoration of nonvital posterior teeth. They are especially indicated in those with minimal crown height but sufficient tooth structure available for stable and durable adhesive cementation (Roopak Bose Carlos et al., 2013). This article introduces a new approach in the fixed restorative treatment of utilization of endocrown as an abutment.


  Case Report Top


A 47-year-old female patient reported to the department of prosthodontics and crown and bridge with a chief complaint of missing teeth in the lower right back region of the jaw. Her past dental history revealed the extraction with the first molar on the mandibular right side 2 years ago, and root canal treatment done with second premolar and second molar on the same side. The radiographic findings revealed well-obturated canals with no evident periapical changes in the second premolar and second molar. The options for postendodontic restorations and restoration of missing tooth were discussed with the patient. However, the occlusal gingival height of the second molar was approximately 3 mm only [Figure 1]a and [Figure 1]b. Taking into consideration, the inadequate coronal height available a fixed partial denture (FPD) was planned with a new approach, consistency of endocrown restoration as an abutment on mandibular right second molar. Due to financial considerations, the choice of material for prosthesis was all metal restoration. The entire procedure was explained to the patient, and written consent was obtained.
Figure 1: (a) Preoperative clinical photograph. (b) Preoperative radiograph

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Procedure

Tooth preparation was done meticulously, keeping a single path of insertion for FPD [Figure 2]. Elastomeric impression was made using light and heavy consistency [Figure 3]. A double-mix single-stage impression technique was used to make an impression. The impression of the antagonist arch was made with irreversible hydrocolloid impression material. Provisional restoration was done with self-cure tooth molding material. The casts were poured [Figure 4] and sent to the laboratory. The “Endocrown Bridge” was fabricated [Figure 5]. In the next sitting, the provisional restoration was removed, and the pulp cavity and cavity margins were cleaned. The endocrown bridge was tried-in, and required adjustments were made. After that, cementation was done with luting consistency of glass-ionomer cement. Excess cement was removed using explorer and floss [Figure 6] and [Figure 7].
Figure 2: Tooth preparation

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Figure 3: Elastomeric impression was made using light and heavy consistency

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Figure 4: Maxillary and mandibular final cast

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Figure 5: The “Endocrown Bridge” was fabricated

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Figure 6: Excess cement was removed using explorer and floss

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Figure 7: Excess cement was removed using explorer and floss

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  Discussion Top


This case report describes an alternate way to retaining FDP consisting of an endocrown as a retainer on abutment, wherein residual coronal tooth structure was <4 mm. Minimally invasive preparations, with maximal tissue conservation, are now considered the gold standard for restoring ETT.[7]

There are minimal studies about endocrown being used as a retainer on endocrown on abutment teeth. Viktor Hadzhigaev et al. conducted a study on the clinical evaluation of three-unit FPD with endocrown preparation of the distal abutment tooth, and they concluded that both classic and endocrown retained FPD's made from laboratory composite resin, reinforced with fiber-reinforced concrete have a satisfactory performance for the 4-year evaluation period.

Literary evidences clearly depict that the prosthesis of choice for reconstructing or restoring an ETT is a tough call to make and is largely governed by the voluminous amount of tooth structure remaining after the root canal therapy.

A holistically sound and long-term sustainable restoration mandates reinforcement of the remaining healthy dental tissues, which can impart solidarity to tooth-restoration complex. In today's era esthetic and adhesive dentistry, endocrown serves as conservative and feasible alternative to conventional post and core crowns because it preserves root tissues and limits internal preparation of the pulp chamber to its anatomic shape. It is a prime indication in cases of molars with obliterated, short, dilacerated or fragile roots and when limited interocclusal space exists with the opposing dentition. However, a careful clinical examination is necessary to see to it that the depth of the pulp chamber should be at least 3 mm, and the cervical enamel margin should be more than 2 mm wide.[2] For dimensions less than these, endocrowns are contraindicated. Besides, endocrowns are indicated in cases where there are minimally subjected functional and lateral stresses on the tooth.[2] Different materials such as feldspathic, glass-ceramic, hybrid composite resin, and newest computer-aided design/computer-aided manufacturing all-ceramic blocks can be used for the fabrication of endocrowns. In this case report, however, all metals were fabricated, that was economically much viable and preferred by patient. 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. Furthermore, the preparation design is conservative compared to the traditional crown. Involvement of the biological width is minimal. In this case report, strengths and weaknesses of endocrown were weighed, and an alternate method of retainer for FPD was introduced. Within 6–8 months of follow-up period, the patient did not reported any discomfort or dislodgment. However, the longevity of such treatment alternative cannot be verified due to the lack of similar literature, so further long-term studies need to be performed.[7],[8],[9],[10],[11],[12]


  Conclusion Top


This innovative design of FPD is better suited in cases where there is less clinical crown height, and the tooth is strategically important and has to be retained for esthetic and function.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her intraoral 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 Top

1.
Deliperi S. Direct fiber-reinforced composite restoration in an endodontically-treated molar: A three-year case report. Oper Dent 2008;33:209-14.  Back to cited text no. 1
    
2.
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 Dent Med Sci 2017;16:29-33.  Back to cited text no. 2
    
3.
Sevimli G, Cengiz S, Oruç MS. Endocrowns: Review. J Istanbul Univ Fac Dent 2015;49:57-63.  Back to cited text no. 3
    
4.
Gade V, Gangrade A, Gade J, Patil S, Meshram P. Endocrown bridge: A unique dental prosthesis. A case report. Int J Curr Res 2017;9:46341-4.  Back to cited text no. 4
    
5.
Zarone F, Sorrentino R, Apicella D, Valentino B, Ferrari M, Aversa R, et al. Evaluation of the biomechanical behavior of maxillary central incisors restored by means of endocrowns compared to a natural tooth: A 3D static linear finite elements analysis. Dent Mater 2006;22:1035-44.  Back to cited text no. 5
    
6.
Gulabivala K. Restoration of the root-treated tooth. Stock C, walker R, Gulabivala K, ed. Endodontics, 3rd edn. Oxford, UK: Elsevier Mosby. 2004:279-306.  Back to cited text no. 6
    
7.
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.  Back to cited text no. 7
  [Full text]  
8.
Vyas R, Suchitra SR, Gaikwad PT, Gurumurthy V, Arora S, Shetty S. Assessment of Fracture Resistance Capacity of Different Core Materials with Porcelain Fused to Metal Crown: An in Vitro Study. J Contemp Dent Pract 2018;19:389-92. Available from: https://doi.org/10.5005/jp-journals-10024-2271. [Last accessed on 2019 Nov 07].  Back to cited text no. 8
    
9.
Shraddha R, Kambala S, Godbole S, Borle A, Jaiswal T. Comparative Evaluation of the Retentive Qualities of Three Different Post Systems Used for Endodontically Treated Teeth for Providing Restoration - An in Vitro Study. J Evol Med Dent Sci 2019;8:3754-8. Available from: https://doi.org/10.14260/jemds/2019/813. [Last accessed on 2019 Nov 07].  Back to cited text no. 9
    
10.
Kumar PG, Kamble RH, Shrivastav SS, Daigavane PS, Jadhav VV, et al. Radiographic Evaluation of Alveolar Bone Dimensions in the Inter-Radicular Area between Maxillary Central Incisors as 'Safe Zone' for the Placement of Miniscrew Implants in Different Growth Patterns-A Digital Volume Tomographical Study. J Evol Med Dent Sci 2019;8:3836-40. Available from: https://doi.org/10.14260/jemds/2019/831. [Last accessed on 2019 Nov 07].  Back to cited text no. 10
    
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Vinod SN, Belkhode V, Godbole SR, Nimonkar PV, Dahane T. Comparative Evaluation of the Effect of Chemical Disinfectants and Ultraviolet Disinfection on Dimensional Stability of the Polyvinyl Siloxane Impressions. J Int Soc Prev Community Dent 2019;9:152-8. Available from: https://doi.org/10.4103/jispcd.JISPCD_406_18. [Last accessed on 2019 Nov 07].  Back to cited text no. 11
    
12.
Rathi K, Rathi N, Thosar N, Baliga S. Modified Cantilever Bridge; A Novel Approach towards the Replacement of Missing Primary Anterior Teeth. Indian J Public Health 2019;10:176-8. Available from: https://doi.org/10.5958/0976-5506.2019.01261.0. [Last accessed on 2019 Nov 07].  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

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