An Innovative Treatment Approach Using Digital Workflow and CAD-CAM Part 1: The Restoration of Endodontically Treated Molars in Children

Abstract

Stainless steel crowns are the most popular restoration technique for young permanent first molars treated endodontically. However, these restorations are not aesthetically appealing and need to be replaced. Endocrowns constitute a reliable approach for restoring severely damaged molars and premolars. Intraoral scanners (IOSs) are well tolerated by children and are easily and quickly implemented. We present an innovative treatment approach for endodontically treated teeth in children, using a digital workflow with IOS and computer-aided design/computer-assisted manufacturing (CAD/CAM) fabrication of the restoration. The protocol involves a thorough diagnostic phase and comprehensive treatment planning. Among the factors to be considered are the child’s behavior, the parents’ cooperation and compliance, and initial preparation including inhalation sedation, effective local anaesthesia and the use of a rubber dam. Full attention should be given to 1–2 mm of ferruling by the endocrown, which should be appropriately prepared to accommodate endocrowns for molars. IOSs include scanning of the prepared tooth and its antagonist, and scanning of the bite. CAD-CAM preparation of the restoration is followed by restoration bonding and follow up. Digital workflow should be considered in the treatment of endodontically treated molars since the high accuracy of the scanning enables definitive restoration in young patients.

Comparing the trueness of seven intraoral scanners and a physical impression on dentate human maxilla by a novel method

“…An increasing number of dentists are purchasing and implementing intraoral scanners (IOS) for making optical impressions of oral soft and hard tissues as an alternative to traditional impressions, which are generally poorly tolerated by patients [1][2][3]. The area of application previously consisted mostly of quadrant imaging [4][5][6][7][8]. However, as systems become faster, more accurate, and easier to use [9,10], more clinicians are scanning complete arches and wide-spanning dental restorations [11][12][13].…”

Fracture resistance, failure mode and stress concentration in a modified endocrown design

“…The biomechanical properties of fiber posts are more comparable to that of dentine decreasing the risk of accidental root fractures [ 6 ], but building an adequate ferrule can necessitate crown lengthening leading to unfavorable crown to root ratio [ 7 ]. Developments in dental materials [ 8–10 ], computer-aided design/computer-aided manufacturing (CAD/CAM) technologies [ 11 , 12 ] and bonding systems [ 13 , 14 ] improve the application of endocrowns [ 15 , 16 ] to restore the ETT, that prevents the failures of posts [ 17 , 18 ]. Endocrown preparation preserves the dental structure, which has supragingival margins on peripheral enamel tissue enhancing adhesive capacity [ 19 ].…”

Comparison of fit accuracy between conventional and CAD/CAM‐fabricated band–loop space maintainers

“…In the literature, it has been reported that a digital impression obtained from intraoral scanners increases patient comfort by preventing the gag reflex 4 . CAD/CAM systems enable the fabrication of more precise dental restorations by eliminating extensive laboratory work and human‐based errors 9,10 . Together with these advantages, CAD/CAM systems offer fast, effective, and comfortable treatment options as an alternative to conventional treatments 5,8,10 …”

“…CAD/CAM systems enable the fabrication of more precise dental restorations by eliminating extensive laboratory work and human‐based errors 9,10 . Together with these advantages, CAD/CAM systems offer fast, effective, and comfortable treatment options as an alternative to conventional treatments 5,8,10 …”