Pre-endodontic restoration of structurally compromised teeth: current concepts

Gavriil, Dimitrios; Kakka, Angeliki; Myers, Paul; ́Connor, Christopher J. O

doi:10.1038/s41415-021-3467-0

Cited by 13 publications

(11 citation statements)

References 68 publications

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“…Dental practitioners or patients may sometimes defer the provision of an indirect restoration after DME. For example, deep marginal defects ought to be restored prior to endodontic treatment to establish restorability and allow rubber dam isolation 63,64 . However, for a variety of reasons, indirect restorations are occasionally made with delay after endodontic treatment.…”

Section: Discussionmentioning

confidence: 99%

Deep margin elevation—Present status and future directions

Eggmann

Ayub

Conejo

et al. 2023

J Esthet Restor Dent

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Objective: Deep margin elevation (DME) is a treatment approach to relocate the cervical margin of teeth with subgingival defects to a supragingival position with a direct restoration to facilitate rubber dam isolation, impression taking, and bonding of indirect restorations. This article provides an overview of the current scientific evidence on DME and future directions for research. Overview:The review included 38 studies on DME, most conducted in vitro. These studies indicate that DME has no detrimental effect on the fracture resistance of restored teeth. Evidence on the impact of DME on marginal quality is conflicting, but most in vitro studies observed no negative effect. Clinical studies, most comprising small patient cohorts, demonstrated favorable restorative outcomes and suggest that DME restorations made with scrupulous care are compatible with periodontal health. Bleeding on probing may occur more frequently at sites with DME, though evidence on this is not unequivocal.Conclusions: Current evidence, based largely on laboratory studies and limited clinical data, supports DME as a viable approach to restore teeth with localized subgingival defects. However, further clinical studies with long-term follow-ups are required to provide corroborative evidence.Clinical Significance: Current evidence suggests that DME is a viable approach to restore teeth with localized subgingival defects as a possible alternative to surgical crown lengthening. Proper working field isolation, meticulous care in the bonding and buildup procedure, and biofilm removal through patient-performed oral hygiene and professional maintenance care are crucial. As scant clinical trial-based evidence is available today, further research is needed to evaluate the long-term performance of DME restorations and their impact on periodontal health.

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Section: Discussionmentioning

confidence: 99%

Deep margin elevation—Present status and future directions

Eggmann

Ayub

Conejo

et al. 2023

J Esthet Restor Dent

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“…In case the tooth has to be endodontically-treated, the residual tooth structure should be carefully examined to evaluate if the number, position and thickness of residual walls can guarantee adequate retention and resistance to the composite build-up. 7,16 If the residual tooth structure is evaluated as inadequate, fiber posts can be cemented to increase the biomechanical resistance to tangential forces of the tooth-restoration complex. 25 3.8 | Proximal matrix placement (distinctive step of PBUt)…”

Section: Caries Removal and Root Canal Treatmentmentioning

confidence: 99%

“…12,13 In step one, the subgingival margin is repositioned supragingivally, and in step two, a direct or indirect restoration is placed under improved isolation conditions. 7 In this technique, after improved moisture control and placement of the interproximal matrix, the margin of the cavity is relocated to a supragingival level using a direct composite resin material. Literature has highlighted the necessity for the matrix to be supported by sufficient buccal and lingual walls, to prevent extended elevation in buccal and lingual directions.…”

Section: Differences Between Pbut and Cervical Margin Relocation Tech...mentioning

confidence: 99%

“…4 Several treatment options have been proposed over time to enhance moisture control and restore teeth with massive subgingival defects, possibly allowing to prolong the lifespan of the dental element. 6,7 Originally, surgical crown lengthening, surgical extrusion and orthodontic forced eruption have been considered as the only possible strategies to expose the necessary amount of tooth structure to be isolated; however, due to their major drawbacks related to the potential biological invasiveness 8 as well as the longer treatment time risk of periodontal ligament and pulp damage 9,10 as well as being time-consuming procedures, their use has been advocated to be the last resort in case of inefficiency of previous more conservative approaches. 8,11 Viable alternative restorative approaches mainly involve deep margin elevation (otherwise known as cervical margin relocation), 12,13 doughnut technique, 14 and pre-formed ring technique (e.g., copper ring).…”

Section: Introductionmentioning

confidence: 99%

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Structurally compromised teeth. Part II: A novel approach to peripheral build up procedures

Fichera,

Mazzitelli,

Picciariello

et al. 2023

J Esthet Restor Dent

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ObjectiveTo introduce the “Peripheral Build‐Up technique – PBUt” as a foundation restoration strategy for structurally compromised teeth (SCT).Clinical ConsiderationsSeveral strategies have been proposed over time (cervical marginal relocation, doughnut, and preformed ring techniques) to enable the management of restorative procedures in challenging situations such as the presence of deep subgingival defects. The PBUt is a versatile, completely additive direct technique that share some strategical concepts with these techniques to approach critical clinical situations while supplying a wider field of application thanks to distinct operative expedients. The clamp insertion modality, the extension of the proximal wall and the matrix customization/stabilization strategies adopted in PBUt endorse the possibility to manage the most apical and peripheral border of the residual tooth structure when located up to >1.5 mm above the bone crest. The periodontal response has to be then monitored over time. Moreover, thanks to the peripheral and apically‐extended addictive approach, it allows a massive preservation of residual sound tooth structure and improves the resistance and retentive physical/geometrical features of the abutment tooth. The PBUt operative workflow is herein explained.Clinical SignificanceThe Peripheral‐Build‐Up technique (PBUt) advocates some innovative clinical restorative steps for the management of SCT with coronal and deep subgingival defects.

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“…Resin composites have been suggested as the materials of choice for immediate coronal sealing of nonvital teeth [6], due to their already consolidated characteristics, such as adhesion to dentin through the formation of a hybrid layer when used with adhesive systems, and reduced marginal leakage [7, 8]. In addition, resin composites have physical‐mechanical properties similar to dentin [9].…”

Section: Introductionmentioning

confidence: 99%

Effect of calcium hypochlorite and sodium thiosulfate on the bond strength to pulp chamber dentin: A laboratory investigation

Pauletto

Carlotto

Rosa

et al. 2023

European J Oral Sciences

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This study aimed to compare the effect of sodium hypochlorite (NaOCl) and calcium hypochlorite [Ca(OCl) 2 ] on the bond strength to pulp chamber dentin when followed or not by the use of sodium thiosulfate (Na 2 S 2 O 3 ). The pulp chamber of fifty human molars were divided into five groups (n = 10) according to the immersion protocol: 2.5% NaOCl; 2.5% NaOCl + 5% Na 2 S 2 O 3 ; 2.5% Ca(OCl) 2 ; 2.5% Ca(OCl) 2 + 5% Na 2 S 2 O 3 ; and 0.9% sodium chloride (NaCl; control). Subsequently, the samples were restored with resin composite. Three sticks each were obtained and subjected to microtensile testing. SEM/EDS analyses of the pulp chamber roof (n = 8) were carried out for mineral quantification. Elemental analysis data were investigated via one-way ANOVA and Tukey's post hoc, and bond strength data by post hoc pairwise comparisons using the Kruskal-Wallis test. Use of 2.5% NaOCl was associated with the lowest value of bond strength, while 2.5% Ca(OCl) 2 had similar bond strength to that of the 0.9% NaCl control. Using 5% Na 2 S 2 O 3 was able to increase the bond strength after 2.5% NaOCl, but not after 2.5% Ca(OCl) 2 . The group treated only with 2.5% Ca(OCl) 2 had a higher Ca/P ratio on the dentin surface. Dentin treated with Ca(OCl) 2 was not affected by Na 2 S 2 O 3 and showed bond strength similar to the 0.9% NaCl.

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Pre-endodontic restoration of structurally compromised teeth: current concepts

Cited by 13 publications

References 68 publications

Deep margin elevation—Present status and future directions

Deep margin elevation—Present status and future directions

Structurally compromised teeth. Part II: A novel approach to peripheral build up procedures

Effect of calcium hypochlorite and sodium thiosulfate on the bond strength to pulp chamber dentin: A laboratory investigation

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