Endocrowns Clinical Performance and Patient Satisfaction: A Randomized Clinical Trial of Three Monolithic Ceramic Restorations

Abstract

Purpose:The purpose of this randomized, double-blind, clinical trial was to assess the survival of endocrowns made from three different monolithic ceramic materials, and to evaluate patient satisfaction. Materials and Methods: Fifty-three patients (sixty root canal treated molar teeth) were enrolled. Teeth were prepared to a flat butt-joint margin and randomly divided between three material groups: lithium disilicate-reinforced glass-ceramic, monolithic zirconia and polymer infiltrated hybrid ceramic. Predefined cementation protocols were used. Clinical assessment using modified United States Public Health Service (USPHS) criteria was carried out after two years by two independent clinicians blinded to the material used. Radiographic examination was conducted to check for the presence of caries, excess cement, and periapical infection. Statistical analysis was performed using the Kruskal Wallis and Wilcoxon signed-rank tests as well as the Kaplan-Meier survival estimate. Results: Forty-eight patients were available for assessment after 2 years (recall rate 90.6%). The overall Kaplan-Meier survival estimate among all groups was 90.9% with no statistically significant difference between the groups (p = 0.17). Three zirconia endocrowns debonded after 9, 10 and 13 months (82.4% survival rate), while 2 hybrid ceramic endocrowns chipped/fractured (89.5% survival rate). Lithium disilicate endocrowns had a 100% survival rate. The Kruskal Wallis test revealed no statistically significant difference between the groups in the USPHS criteria ratings and the radiographic assessment (P>0.05). Patient satisfaction ranged from 82.3% in the zirconia group to 100% in both the lithium disilicate and hybrid ceramic groups. Conclusions: Endocrowns provide a predictable option for the restoration of endodontically treated molar teeth in the short term. Lithium disilicate-reinforced ceramic had fewer complications and required less intervention compared with zirconia and hybrid ceramics. Long-term follow-up is required to substantiate these study results.

Biomechanical performance of endocrown and core‐crown restorations: A systematic review

“…Clinical follow ups of endocrowns in molar and premolars reported biomechanical failures such as fracture of the restoration, 41–44 adhesive failure/debond, 41,42,44,45 and the facture of the supporting tooth structure; 45,46 these data corroborate with failure patterns reported by the in vitro studies (Tables 3 and 4). Clinical studies reporting follow ups of endocrowns in anterior teeth were not identified.…”

The influence of Zircos‐E® etchant, silica coating, and alumina air‐particle abrasion on the debonding resistance of endocrowns with three different preparation designs

“…(Zou, Zhan, Xiang, & Li, 2022 ) However, it should be noted that in another study, an increased incidence of zirconia debonding was reported in comparison to lithium disilicate endocrowns, with three debonded zirconia endocrowns observed after 9, 10, and 13 months of clinical service out of 20 total restorations. (El‐Ma'aita, Abu‐Awwad, Hattar, & Devlin, 2022 ).…”

Present status and future directions: The restoration of root filled teeth

“…These were mainly observed through the central occlusal groove, indicating less fatigue resistance of these restorations (Saratti et al, 2021 ). Due to the lack of long‐term controlled clinical studies, lithium disilicate ceramics are currently the material of choice for endocrowns, primarily due to its reliable bonding to the resin cement and its long‐term stability (El‐Ma'aita et al, 2022 ).…”