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

Abstract

This narrative review will focus on a number of contemporary considerations relating to the restoration of root filled teeth and future directions for research. Clinicians are now more than ever, aware of the interdependence of the endodontic and restorative aspects of managing root filled teeth, and how these aspects of treatment are fundamental to obtaining the best long-term survival. To obtain the optimal outcomes for patients, clinicians carrying out endodontic treatment should have a vested interest in the restorative phase of the treatment process, as well as an appreciation for the structural and biomechanical effects of endodontic-restorative procedures on restoration and tooth longevity. Furthermore, the currently available research, largely lacks appreciation of occlusal factors in the longevity of root filled teeth, despite surrogate outcomes demonstrating the considerable influence this variable has.Controversies regarding the clinical relevance of minimally invasive endodontic and restorative concepts are largely unanswered with respect to clinical data, and it is therefore, all too easy to dismiss these ideas due to the lack of scientific evidence.However, conceptually, minimally invasive endodontic-restorative philosophies appear to be valid, and therefore, in the pursuit of improved clinical outcomes, it is important that the efficacies of these treatment protocols are determined. Alongside an increased awareness of the preservation of tooth structure, developments in adhesive bonding, ceramic materials and the inevitable integration of digital dentistry, there is also a need to evaluate the efficacy of new treatment philosophies and techniques with well-designed prospective clinical studies.

Deep margin elevation—Present status and future directions

“…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.…”

Vertical root fracture resistance and crack formation of root filled teeth treated with or without minimally invasive endodontics

“…The teeth were loaded without considering the coronal access cavity to avoid confounding effects such as cuspal exure and coronal reinforcement by adhesive restorative materials [24,28,29]. The data could not support the intuitively obvious theory that MIE treated teeth are less susceptible to fracture [9][10][11][12].…”

“…Several authors suggested that minimally invasive endodontic (MIE) treatment, which consists of a small access cavity and minimal canal preparation, as well as adhesive-based approaches increase the fracture resistance of root lled teeth [9][10][11][12]. However, smaller access preparations made cleaning, disinfection and obturation more di cult [13,14] and did not necessarily improve the fracture susceptibility of root canal-treated teeth [14,15].…”

“…However, it remains controversial whether the selected le size and taper in uence crack formation [17,21] and fracture resistance [9,17,20], respectively, and whether a potential preparation-related root weakening can be tolerated with an adhesive root lling [22][23][24]. Furthermore, there is no clear evidence regarding the effects of MIE preparation and adhesive obturation technique on the clinical success rate of root lled teeth [2,10,11].…”

Biomimetics and the restoration of the endodontically treated tooth

“…Following the advent of CAD/CAM and adhesive methods, intracoronal restorations called "endocrowns" emerged as a possibility to reconstruct damaged posterior teeth [36]. Their advantages include good resistance and quick restoration, little preparation compared with posts and cores, no interference in the root with retention based on macromechanical fixation in the pulp chamber [37], similar or better longevity compared to traditional post/core systems [38,39], potential to increase fracture resistance of restorations [40,41], and stabilization of weakened tooth structures [42].…”