Restorative difficulty evaluation system of endodontically treated teeth

Abstract

Objective: This article provides an updated overview of restorative procedures of endodontically treated teeth. Clinical considerations:The different techniques and procedures to restore an endodontic treated tooth were considered in the last decades. While they are generally performed using bonding procedures in combination with or without the placement of a post into the root to build up the abutment, there has been a lack of interest in restorative difficulties that can be faced. Failures are represented such as debonding of the post, fracture of the root, decementation, and/or fracture of the restoration, microleakage of the margins. Essentially, the presence of a sufficient failure is considered a key point of a long prognosis. Different clinical factors can directly influence the type of restoration and the longevity of the treatment. The restorative difficulty evaluation system (RDES) is proposed in this article. This new system is composed of eight different clinical factors that are divided into six levels of difficulties. The RDES is composed of 1. Endodontic complexity and outcome, 2. Vertical amount of coronal residual structure and dimension of the pulp chamber, 3. Horizontal amount of coronal residual structure, 4. Restoration marginal seal, 5. Local interdisciplinary conditions, 6. the complexity of the treatment planning, 7. Functional need, 8. Dental wear and esthetic need. Conclusion: This article reviews the RDES and outlines critical steps and tips for clinical success.Clinical significance: The RDES allows to any clinician to evaluate restorative difficulties when an endodontic treated tooth must be restored, combines clinical aspects that can involve from the single tooth to a full mouth rehabilitation.

Survival Rates of Endodontically Treated Posterior Teeth Restored with All-Ceramic Partial-Coverage Crowns: When Systematic Review Fails

“…Depending on the level of tooth-structure loss, the remaining number of walls, ferrule effect, type of restoration, and the root anatomy, a post might be necessary [ 1 , 51 ]. After the endodontic treatment, the ETT is restored with either direct restorations, full-coverage crowns, fixed partial dentures or partial-coverage crowns [ 11 , 31 , 52 , 53 ]. The decision for the definitive restoration depends on the remaining amount of tooth structure after the endodontic therapy, finances, longevity as well as mechanical properties of the restoration.…”

Research routes on awake bruxism metrics: Implications of the updated bruxism definition and evaluation strategies

“…In the STAB, as part of a bigger goal to implement and standardise metrics for bruxism as a whole, scores and ratings for both subject‐based (Domain A2) and instrumentally based (Domain A8) assessment for AB should be determined. Based on that, in line with similar approaches adopted for other fields of dentistry and medicine, a bruxism network can be visualised to phenotype the activity based on the aetiology and the potential consequences 139,140 . Based on the current evidence of an association between AB, TMDs, and psychological factors, 2,56 the possible bruxism network representation of a patient phenotype with high anxiety scores, poor stress coping skills, and high AB scores can be hypothesized in Figure 2, with a predominance of musculoskeletal complaints rather than damage to teeth and restorations.…”

“…Based on that, in line with similar approaches adopted for other fields of dentistry and medicine, a bruxism network can be visualised to phenotype the activity based on the aetiology and the potential consequences. 139,140 Based on the current evidence of an association between AB, TMDs, and psychological factors, 2,56 the possible bruxism network representation of a patient phenotype with high anxiety scores, poor stress coping skills, and high AB scores can be hypothesized in Figure 2, with a predominance of musculoskeletal complaints rather than damage to teeth and restorations. On the other hand, a possible phenotype of an individual with high levels of RMMA-SB and tooth wear, with low awake bruxism scores, is hypothesized in Figure 3.…”

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

“…The amount of residual coronal tooth structure and the tooth type are key factors in determining the need for a post. Post placement is recommended for root filled teeth with no remaining coronal walls (Naumann et al, 2018 ) and those with one remaining wall (Ferrari et al, 2022 ). Posterior teeth with adequate depth and shape within the pulp chamber for core retention can be reliably restored without posts (; Ferrari et al, 2019 ).…”