Reconstruction of a tooth with composite endocrown following root canal treatment

Dr Monika Dzieciatkowska investigates how much hard tissue is required to justify producing an endocrown.

Classic procedure versus contemporary evidence

This patient attended for root canal treatment and reconstruction of tooth LL6.

According to the classic procedure, following root canal treatment reconstruction includes a post and a crown. This, however, is associated with the excessive hard tissues removal on the lingual and labial surfaces (a composite restoration carried out on the distal surface prior to endodontic treatment was present on the distal surface).

Contemporary evidence supports this view; at the present time we consider that durability of non-vital teeth decreases along with the loss of hard tissue, ie, the greater the loss, the greater their susceptibility to breaking or fracturing.

This is why reconstruction techniques which allow for preserving the tooth’s hard tissues are of great interest.In this case, there is a sufficient amount of hard tissues to justify producing an endocrown. An endocrown is an onlay for a tooth undergoing endodontic treatment.

Sufficient retention

In this case, the preserved lingual and palatal walls and the deep tooth chamber provided sufficient retention for such a prosthetic solution. An endocrown may be produced from composite or mineral ceramic and, because of the slightly lower cost and ease of repair of any potential damage, the patient chose the composite endocrown.

We use a mini chamfer-type preparation from the lingual and labial sides to complete the preparation at a 90° angle. Such a preparation is also consistent with the prism course and ensures a good fusion of the bonding system with the enamel. We then smooth out the sharp edges.

We use a 40-micron diamond drill to complete the preparation. A photograph with a shade guide (one or two basic shades were chosen) and an impression made with a…