Compromised roots: extraction or rehabilitation?

September 19, 2012

Compromised roots: extraction or rehabilitation?

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Title:	Compromised roots: extraction or rehabilitation?
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Article_Title:	Compromised roots: extraction or rehabilitation?
Authors:	Valeria Covrig, Mugur George Popescu, Claudiu Leucuta, Diana Doboş, Teodora Lupulescu
Affiliation:	Western University „Vasile Goldiş” of Arad, Faculty of Medicine, Pharmacy and Dental Medicine, Arad, Romania
Abstract:	When it comes to oral care, it is always advisable to evaluate and reevaluate situations in order to decide what treatment attitude needs to be adopted when facing difficult cases. When it comes to endodonticaly treated teeth where the prognostic is not very good, the question always arises: Extraction or Rehabilitation? For more than 100 years root-anchored posts have been used as support, in order to retain artificial crowns. Despite this, recent studies suggest that posts can be the cause of a weakening of the tooth resistance, therefore restorative procedures that help preserve pulp vitality and eliminate the need for posts are desirable. If endodontic therapy is unavoidable, the conservation of the remaining tooth structure is of great importance. When a post and core restoration is necessary for an artificial crown, the most indicated type is a custom cast post, since it is the most effective means of conserving tooth structure. When using this type of post the length and retention of them must not be compromised. The purpose of this study is to advocate the use of new techniques for the restoration of extensively damaged, endodonticaly treated teeth, as alternatives to the classical techniques. We have also suggested new ways of improving the post’s retention by using techniques for subminated root consolidation, adhesive cements and sandblasting the cast and prefabricated posts.
Keywords:	endodontic treatment, fragility, consolidation, corono-radicular device
References:	Albert FE, El-Mowafy OM. Marginal adaptation and microleakage of Procera AHCeram crowns with four cements. Int J Prosthodont 2004;17:529-535. Assif D, Feber A: Retention of dowel using a composite resin as a cementing medium, J Prosthet Dent 1982; 292-296. Bindl A, Mormann WH. An up to 5-year clinical evaluation of posterior In-ceram CAD/CAM core crowns. Int J Prosthodont 2002;15:451-456. Blatz MB, Sadan A, Blatz U. The effect of silica coating on the resin bond to the intaglio surface of Procera AHCeram restorations. Quintessence Int 2003; 34:542-547. Bowen RL, Cobb EN: A method for bonding to dentin and enamel, J Am Dent Assoc 1983; 107: 734-736. Craig RG, O’Brien WJ, Powers JM: Dental Materials, ed 4, St. Louis: Mosby, 1987: 10-27. Eissman HF, Radke RA: Postendodontic restoration; In Cohen S, Burns RC, eds. Pathways of the pulp, 4th ed. St. Louis: CV Mosby, 1987: 640-3. EJ Mowafy OM, Milenkovic M: Retention of paraposts cemented with dentin-bonded resin cements, OperDent 1994; 19:176-182 Fan P, Nicholls J: Load fatifue of five restoration modalities in structurally compromised premolars, Int. Prosthodont 1995; 8: 213-20 Filser F, Luthy H, Kocher P, Schdrer P, Gaukler LJ. Vollkeramischer Zahnersatz im Seitenzahnbereich. Quintessenz Zahntech 2002;28:48-60. Fradeani M, d’Amelio M, Redemagni M, Corrado M. Five-year follow-up wit Procera all-ceramic crowns. Quintessence Int 2005;36:105-113. Freedman G, Novak !M, Serota KS, Glassman GD: Intra-radicular rehabilitation: A clinical approach, Practical Periodont Aesthet Dent 1994; 6(5): 33-39. Galindo ML, Hagmann E, Marinello CP, Zitzmann NU. Klinische Langzeiterfahrungen mit Procera- AHCeram-Vollkeramikkronen. Schweiz Monatsschr Zahnmed 2006; 116:804-809. Hagmann E, Marinello CP, Zitzmann NU. Bruchfestigkeit von Procera AHCeram in Abhängigkeit des Gerüstdesigns – Eine In-vitro-Untersuchung. Schweiz Monatsschr Zahnmed 2006; 116:25-32. Hatzkirioakos AH, Reisis Gl, Tsingos N: A 3-year postoperative clinical evaluation of posts and cores beneath existing crowns, J Prosthet Dent 1992; 67:454-8. Hemmings KW, King PA, Setchel DJ: Resistance to torsional forces of various post and core designs, J Prosthet Dent 1991; 66:325-9. Hummel M, Kern M. Durability of the resin bond strength to the alumina ceramic Procera. Dent Mater 2004;20:498-508. Mendoza DB, Eakle WS: Retention of posts cemented with various dentinal bonding cements, J ProsthetDent 1994; 72: 591-4. Naert I, van der Donck A, Becker L Precision of fit and clinical evaluation of all-ceramic full restorations follov.e-: between 0.5 and 5 years. J Oral ReranH 2005;32:51-57. Raigrodski AJ. Contemporary materials and technologies for all-ceramic fixer partial dentures: a review of the literature . Prosthet Dent 2004;92:557-562. Reinhardt J, Chan D, Boyer D: Shear bond strenghts of proprietary dentin bonding agents [abstract 622], J Dent Res 1986:; 65:238 Standlee JP, Caputo AA, Hanson EC: Retention of endodontic dowels: Effects of cement, dowel lenght, diameter and design, J ProsthetDent 1978; 39: 400-405. Suarez MJ, Gonzalez de Villaumbrcs: -Pradies G, Lozano JF. Comparison c~ the marginal fit of Procera AllCeram crowns with two finish lines. Int J Prosthodont: 2303;16:229-232. Trope M, Maltz DO, Tronstand L: Resistance to fracture of resotred endodontically treated teeth, Endodont Dent Traumatol 1985; 1:108-11. Torbjorner A, Karlsson S, Odman PA: Survival rate and failure characteristics for two posts design, J Prosthet Dent 1995; 73: 439-44. Ulusoy M, Toksavul S. Fracture resistance r five different metal framework resigns for metal-ceramic restorations. – J Prosthodont 2002;15:571-574. Wagner WC, Chu TM. Biaxial flexural rrength and indentation fracture “cughness of three new dental core re-amics. J Prosthet Dent 1996;76:140-’44. Walter MH, Wolf BH, Wolf AE, Boening KW.Six-year clinical performance of all-ceramic crowns with alumina cores. Int J. Prosthodont 2006;19:162-163. Wood KC, Berzins DW, Luo Q, Thompson GA, Toth JM, Nagy WW. Resistance to fracture of two all-ceramic crown materials following endodontic access. J Prosthet Dent 2006;95:33-41. Wagnild GW, Muller Kl: The restoration of the endodontically treated tooth, In Cohen, S Burns RC (eds) Pathway of the pulp, ed. 6, St. Louis: Mosby-Year book, 1994:604-631 Zitzmann NU. Die zahnärztlich- prothetische Versorgung des zahnlosen Patienten unter besonderer Berücksichtigung implantatgetragener Rekonstruktionen. Habilitationsschrift Universität Basel, Basel: KBM, 2004
Read_full_article:	pdf/21-2011/21-2-2011/SU21-2-2011Covrig.pdf
Correspondence:	Covrig Valeria, Western University “Vasile Goldis” of Arad, Faculty of Medicine, Pharmacy and Dental Medicine, Department of Dental Prosthetics, Str. Feleacului nr. 1, 310396, Arad, Romania, Tel. +40-(257)-212204, Fax. +40-(257)-285813, email: covrig.valeria@gmail.com

	Read full article
Article Title:	Compromised roots: extraction or rehabilitation?
Authors:	Valeria Covrig, Mugur George Popescu, Claudiu Leucuta, Diana Doboş, Teodora Lupulescu
Affiliation:	Western University „Vasile Goldiş” of Arad, Faculty of Medicine, Pharmacy and Dental Medicine, Arad, Romania
Abstract:	When it comes to oral care, it is always advisable to evaluate and reevaluate situations in order to decide what treatment attitude needs to be adopted when facing difficult cases. When it comes to endodonticaly treated teeth where the prognostic is not very good, the question always arises: Extraction or Rehabilitation? For more than 100 years root-anchored posts have been used as support, in order to retain artificial crowns. Despite this, recent studies suggest that posts can be the cause of a weakening of the tooth resistance, therefore restorative procedures that help preserve pulp vitality and eliminate the need for posts are desirable. If endodontic therapy is unavoidable, the conservation of the remaining tooth structure is of great importance. When a post and core restoration is necessary for an artificial crown, the most indicated type is a custom cast post, since it is the most effective means of conserving tooth structure. When using this type of post the length and retention of them must not be compromised. The purpose of this study is to advocate the use of new techniques for the restoration of extensively damaged, endodonticaly treated teeth, as alternatives to the classical techniques. We have also suggested new ways of improving the post’s retention by using techniques for subminated root consolidation, adhesive cements and sandblasting the cast and prefabricated posts.
Keywords:	endodontic treatment, fragility, consolidation, corono-radicular device
References:	Albert FE, El-Mowafy OM. Marginal adaptation and microleakage of Procera AHCeram crowns with four cements. Int J Prosthodont 2004;17:529-535. Assif D, Feber A: Retention of dowel using a composite resin as a cementing medium, J Prosthet Dent 1982; 292-296. Bindl A, Mormann WH. An up to 5-year clinical evaluation of posterior In-ceram CAD/CAM core crowns. Int J Prosthodont 2002;15:451-456. Blatz MB, Sadan A, Blatz U. The effect of silica coating on the resin bond to the intaglio surface of Procera AHCeram restorations. Quintessence Int 2003; 34:542-547. Bowen RL, Cobb EN: A method for bonding to dentin and enamel, J Am Dent Assoc 1983; 107: 734-736. Craig RG, O’Brien WJ, Powers JM: Dental Materials, ed 4, St. Louis: Mosby, 1987: 10-27. Eissman HF, Radke RA: Postendodontic restoration; In Cohen S, Burns RC, eds. Pathways of the pulp, 4th ed. St. Louis: CV Mosby, 1987: 640-3. EJ Mowafy OM, Milenkovic M: Retention of paraposts cemented with dentin-bonded resin cements, OperDent 1994; 19:176-182 Fan P, Nicholls J: Load fatifue of five restoration modalities in structurally compromised premolars, Int. Prosthodont 1995; 8: 213-20 Filser F, Luthy H, Kocher P, Schdrer P, Gaukler LJ. Vollkeramischer Zahnersatz im Seitenzahnbereich. Quintessenz Zahntech 2002;28:48-60. Fradeani M, d’Amelio M, Redemagni M, Corrado M. Five-year follow-up wit Procera all-ceramic crowns. Quintessence Int 2005;36:105-113. Freedman G, Novak !M, Serota KS, Glassman GD: Intra-radicular rehabilitation: A clinical approach, Practical Periodont Aesthet Dent 1994; 6(5): 33-39. Galindo ML, Hagmann E, Marinello CP, Zitzmann NU. Klinische Langzeiterfahrungen mit Procera- AHCeram-Vollkeramikkronen. Schweiz Monatsschr Zahnmed 2006; 116:804-809. Hagmann E, Marinello CP, Zitzmann NU. Bruchfestigkeit von Procera AHCeram in Abhängigkeit des Gerüstdesigns – Eine In-vitro-Untersuchung. Schweiz Monatsschr Zahnmed 2006; 116:25-32. Hatzkirioakos AH, Reisis Gl, Tsingos N: A 3-year postoperative clinical evaluation of posts and cores beneath existing crowns, J Prosthet Dent 1992; 67:454-8. Hemmings KW, King PA, Setchel DJ: Resistance to torsional forces of various post and core designs, J Prosthet Dent 1991; 66:325-9. Hummel M, Kern M. Durability of the resin bond strength to the alumina ceramic Procera. Dent Mater 2004;20:498-508. Mendoza DB, Eakle WS: Retention of posts cemented with various dentinal bonding cements, J ProsthetDent 1994; 72: 591-4. Naert I, van der Donck A, Becker L Precision of fit and clinical evaluation of all-ceramic full restorations follov.e-: between 0.5 and 5 years. J Oral ReranH 2005;32:51-57. Raigrodski AJ. Contemporary materials and technologies for all-ceramic fixer partial dentures: a review of the literature . Prosthet Dent 2004;92:557-562. Reinhardt J, Chan D, Boyer D: Shear bond strenghts of proprietary dentin bonding agents [abstract 622], J Dent Res 1986:; 65:238 Standlee JP, Caputo AA, Hanson EC: Retention of endodontic dowels: Effects of cement, dowel lenght, diameter and design, J ProsthetDent 1978; 39: 400-405. Suarez MJ, Gonzalez de Villaumbrcs: -Pradies G, Lozano JF. Comparison c~ the marginal fit of Procera AllCeram crowns with two finish lines. Int J Prosthodont: 2303;16:229-232. Trope M, Maltz DO, Tronstand L: Resistance to fracture of resotred endodontically treated teeth, Endodont Dent Traumatol 1985; 1:108-11. Torbjorner A, Karlsson S, Odman PA: Survival rate and failure characteristics for two posts design, J Prosthet Dent 1995; 73: 439-44. Ulusoy M, Toksavul S. Fracture resistance r five different metal framework resigns for metal-ceramic restorations. – J Prosthodont 2002;15:571-574. Wagner WC, Chu TM. Biaxial flexural rrength and indentation fracture “cughness of three new dental core re-amics. J Prosthet Dent 1996;76:140-’44. Walter MH, Wolf BH, Wolf AE, Boening KW.Six-year clinical performance of all-ceramic crowns with alumina cores. Int J. Prosthodont 2006;19:162-163. Wood KC, Berzins DW, Luo Q, Thompson GA, Toth JM, Nagy WW. Resistance to fracture of two all-ceramic crown materials following endodontic access. J Prosthet Dent 2006;95:33-41. Wagnild GW, Muller Kl: The restoration of the endodontically treated tooth, In Cohen, S Burns RC (eds) Pathway of the pulp, ed. 6, St. Louis: Mosby-Year book, 1994:604-631 Zitzmann NU. Die zahnärztlich- prothetische Versorgung des zahnlosen Patienten unter besonderer Berücksichtigung implantatgetragener Rekonstruktionen. Habilitationsschrift Universität Basel, Basel: KBM, 2004
*Correspondence:	Covrig Valeria, Western University “Vasile Goldis” of Arad, Faculty of Medicine, Pharmacy and Dental Medicine, Department of Dental Prosthetics, Str. Feleacului nr. 1, 310396, Arad, Romania, Tel. +40-(257)-212204, Fax. +40-(257)-285813, email: covrig.valeria@gmail.com

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