Int Endodontic J - 2022 - Mannocci - Present Status and Future Directions The Restoration of Root Filled Teeth

Received: 8 June 2022
| Accepted: 5 July 2022
DOI: 10.1111/iej.13796
REVIEW ARTICLE
Present status and future directions: The restoration of root

filled teeth
Francesco Mannocci1 | Kerstin Bitter2 | Salvatore Sauro3 | Paolo Ferrari4 |

Rupert Austin5 | Bhavin Bhuva1
1
Department of Endodontics, Faculty Abstract
of Dentistry, Oral and Craniofacial
This narrative review will focus on a number of contemporary considerations relat-
Sciences, King's College London,
London, UK ing to the restoration of root filled teeth and future directions for research. Clinicians
2
Department of Operative and are now more than ever, aware of the interdependence of the endodontic and re-
Preventive Dentistry, Charité - storative aspects of managing root filled teeth, and how these aspects of treatment
University Medicine Berlin, Berlin,
Germany are fundamental to obtaining the best long-term survival. To obtain the optimal out-
3
Departamento de Odontología, comes for patients, clinicians carrying out endodontic treatment should have a vested
Facultad de Ciencias de la Salud, interest in the restorative phase of the treatment process, as well as an appreciation
Universidad CEU-Cardenal Herrera
for the structural and biomechanical effects of endodontic-restorative procedures
Valencia, Alfara del Patriarca, Spain
4
Department of Operative Dentistry,
on restoration and tooth longevity. Furthermore, the currently available research,
University of Parma, Parma, Italy largely lacks appreciation of occlusal factors in the longevity of root filled teeth, de-
5
Department of Prosthodontics, Faculty spite surrogate outcomes demonstrating the considerable influence this variable has.
of Dentistry, Oral and Craniofacial
Controversies regarding the clinical relevance of minimally invasive endodontic and
Sciences, King's College London,
London, UK 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.
Correspondence
However, conceptually, minimally invasive endodontic-restorative philosophies ap-
Francesco Mannocci, Department of
Endodontics, Faculty of Dentistry, pear to be valid, and therefore, in the pursuit of improved clinical outcomes, it is im-
Oral and Craniofacial Sciences, King's portant that the efficacies of these treatment protocols are determined. Alongside an
College London, Floor 25, Tower Wing,
Guy's Hospital, London SE1 9RT, UK.
increased awareness of the preservation of tooth structure, developments in adhesive
Email: [email protected] 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.
KEYWORDS
crown, dentine bonding, endocrowns, onlay, post, root filled teeth
Bhavin Bhuva is the main author.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided
the original work is properly cited.
© 2022 The Authors. International Endodontic Journal published by John Wiley & Sons Ltd on behalf of British Endodontic Society.
Int Endod J. 2022;55(Suppl. 4):1059–1084. wileyonlinelibrary.com/journal/iej | 1059

|
13652591, 2022, S4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/iej.13796, Wiley Online Library on [17/05/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
1060 PRESENT STATUS AND FUTURE DIRECTIONS: RESTORATION
I N T RO DU CT ION quality, it seems logical that these should be considered

together for root filled teeth to have optimal outcomes.
Root filled teeth may fail due to either biological or However, there remains great conjecture as to the ‘thresh-
structural reasons. Causes of failure include persistent olds’ of dentine removal which are capable of impacting
or recurrent endodontic disease, unrestorable caries, re- tooth survival. Furthermore, the ‘critical’ areas for den-
storative failure, irretrievable cusp or crown fracture, tine removal (i.e., the peri-cervical dentine) have been
vertical root fracture or periodontal disease. Whilst end- described but not validated (Clark & Khademi, 2010). A
odontic research is replete with clinical studies on the recent study using chairside computer-aided design and
success rate of root canal treatment, it is acknowledged manufacturing (CAD/CAM) technology to measure re-
that structural failure is the most common reason for sidual tooth volume failed to demonstrate the inferior
the extraction of root filled teeth (Al-Nuaimi et al., 2020; survival of structurally compromised teeth that had un-
Nagasiri & Chitmongkolsuk, 2005). As a result, there dergone root canal retreatment (Al-Nuaimi et al., 2017).
has been increasing interest in the structural and biome- However, when the loss of tooth structure was retrospec-
chanical effects of root canal treatment and subsequent tively analysed within a multifactorial analysis, which
post-endodontic restorative procedures on restoration and also considered endodontic status, periodontal status, as
tooth survival. well as several local and general factors, inferior tooth sur-
vival was more evident in teeth with greater loss of tooth
structure (Al-Nuaimi et al., 2020).
Present status for the restoration of root There is a lack of defined guidance on the most appro-
filled teeth priate definitive restoration following the completion of
root canal treatment, in particular, which teeth require
The endodontic-restorative interface is currently, and im- cuspal coverage (Sequeira-Byron et al., 2015) and the opti-
portantly, a ‘hot’ topic within the endodontic community, mal type of restoration (i.e., full coverage crown or onlay).
whilst philosophies and techniques that facilitate dentine Furthermore, dilemmas relating to the timing of place-
preservation are very much in ‘vogue’. The frequency of ment of the definitive restoration (Pratt et al., 2016) are still
publications in relation to minimally invasive endodontic- commonplace. The rapid evolution of new adhesive and
restorative techniques over recent years highlights the ceramic materials (Signore et al., 2009), as well as digital
belief that residual tooth structure is a key determinant scanning and fabrication technology (Alves de Carvalho
in tooth survival, whilst the results of such in vitro stud- et al., 2018) provide clinicians with much greater choice
ies demonstrate the challenges of reaching tangible con- for the restoration of root filled teeth. Digital techniques
clusions from the inconsistent results obtained (Plotino have become increasingly popular, yet there are few stud-
et al., 2017; Silva, Cabral, et al., 2021a; Silva, Versiani, ies to validate these techniques. Dentine bonding has also
et al., 2021b). However, it is certainly noteworthy to wit- rapidly developed, but there is a lack of clarity on the op-
ness the level of interest in minimally invasive endodontic- timal materials and techniques for both creating the ideal
restorative concepts, despite the apparent lack of clinical bonding substrate, as well as the bonding protocol itself.
data to validate these techniques (Silva et al., 2022). Interestingly, dentine bonding advancements have facili-
Therefore, research has focused on the impact of ‘min- tated a drive to exploit the apparent benefits of these tech-
imally invasive access cavity’ preparations on the fracture niques and materials with relevance to emerging concepts
resistance of root filled teeth, as a surrogate measure for such as deep margin elevation, post luting and the adhe-
tooth survival (Marinescu et al., 2020; Saberi et al., 2020; sive bonding of ceramic restorations. A renewed interest
Santosh et al., 2021). Proponents of minimally invasive in endocrowns has been driven by the apparent virtues of
endodontic techniques cite that the dentine removal, pri- adhesive bonding which can be achieved with appropriate
marily in the peri-cervical region, associated with ‘tradi- isolation, restoration and dentine substrate preparation
tional’ access cavity and root canal preparation procedures together with well-executed adhesive cementation.
may predispose the residual tooth structure to the crown The rationale for post placement in root filled teeth is
and/or root fracture (Clark & Khademi, 2010). still poorly understood and highly subjective. Little con-
A criticism of both historical and contemporary re- sensus on when a post should be used to facilitate core
search is that the endodontic and restorative procedures retention exists (Eckerbom & Magnusson, 2001). The in-
are often considered as separate entities, rather than col- novation of adhesively based post systems (i.e., fibre) has
lectively. Based on the strength of arguments for mini- changed the requirements for post dimensions, as well
mally invasive ‘intra-coronal’ endodontic procedures and as those for post preparation. These techniques can now
the scientific evidence demonstrating the importance of be employed within a minimally invasive philosophy and
‘extra-coronal’ tooth structure of adequate quantity and in conjunction with the use of adhesive bonding, permit
|
MANNOCCI et al. 1061
a greater unity between the endodontic and restorative
Randow & Glantz, 1986)

phases of treatment.
Loss of proprioception
A recent literature review on the restoration of root
Rathkamp, 1955;
(Loewenstein &
filled teeth (Bhuva et al., 2021), provides a detailed dis-
cussion of the clinical factors influencing the survival
of post-endodontic restorations and teeth following root
canal treatment in vivo. Therefore, the purpose of this nar-
rative review is to discuss the current status of a number
of contemporary concepts and techniques for the resto-
definitive restoration
Effect of preparation for
filling materials and

ration of root filled teeth and consider directions for fu-
(Reeh et al., 1989)
techniques (Fuss
ture research.
Effect of root canal
et al., 2001)
S E A RC H ST RAT EGY
For this narrative review, an unrestricted literature search

was performed by four evaluators using specified key-
Root canal preparation (Hansen &

words in the PubMed database. Eligibility criteria for in-
medicaments (Grigoratos
cluded studies required the full text to be available, and
et al., 2001; Marending

to be in the English language, with a publication date up
Effect of irrigants and

Asmussen, 1993)
to May 2022. Keywords relating to the restoration of root
filled teeth were searched using Medical Subject Heading
et al., 2007)
(MeSH) terms. An additional manual search of references
in the included papers was also carried out to identify po-
tentially relevant research. Following the initial screening
process, the abstracts of the included papers were read
and considered for the suitability, and where relevant, the
1989; Pantvisai & Messer, 1995)
Access cavity preparation (Reeh,
full text was retrieved.
Collagen alteration (Driscoll

STRUCT UR AL AN D et al., 2002; Reddington
BI O M EC H A N ICAL CH ALLE N G ES
Structural and biomechanical factors affecting root filled teeth.
et al., 2003)
O F RE STO RIN G ROOT FILLE D
T E ET H
The structural and biomechanical considerations which

affect root filled teeth are complex and diverse and should
be considered alongside operative and patient factors
restorative procedures (Ikram
(Helfer et al., 1972; Sedgley &

to caries, fracture or previous
Structural integrity Loss of sound tooth volume due
(Bhuva et al., 2021; Table 1).

Changes in free water content
These factors, in combination, affect restoration and

tooth survival, however, it is not possible to quantify the
relative contribution of each variable. That said, it appears
that the loss of sound tooth structure is the most critical
Messer, 1992)
et al., 2009)
contributory factor. Evidence also exists for the impact of

the ferrule effect (Ferrari et al., 2012), and in combination,
the level of root canal treatment difficulty, residual tooth
structure, as well as the medical and dental status of the
patient (Al-Nuaimi et al., 2020).
The magnitude of changes to the biomechanical
Biomechanical
properties of dentine that result from loss of vitality, and

TABLE 1
effects
the effects of endodontic and restorative procedures,

have not been clearly validated. However, a reduction in
the free or unbound water content within the porosities
|
found in the dentine matrix and dentinal tubules them- Several laboratory studies have demonstrated im-
selves has been cited as an important reason for the proved biomechanical properties of dentine following
diminished viscoelastic properties of root filled teeth the incorporation of biopolymeric nanoparticles (Enrich-
(Kishen & Asundi, 2005; Kishen & Vedantam, 2007; Yan Essvein et al., 2021; Li et al., 2020). Proanthocyanidin-
et al., 2017). With the loss of vitality, and a reduction functionalized hydroxyapatite nanoparticles (nHAP_PA)
in hydration within the dentine matrix, the size and or- have been used to remineralize and stabilize the collagen
ganization of the collagen fibrils are altered, resulting matrix of dentine (Enrich-Essvein et al., 2021). In this
in loss of plasticity and increased stiffness of the den- study, it was demonstrated that the 1 min application of
tine structure (Kishen, 2015). It has been suggested that 15% nHAp_PA increased the flexural strength (MPa) of
fully hydrated dentine provides a mechanism to hydrau- the included samples. Using nanoindentation, a labora-
lically dissipate undesirable occlusal and nonocclusal tory study assessed the elastic modulus and hardness of ex
forces away from the root dentine (Pashley, 1990); in vivo root dentine samples that had been treated with pho-
the absence of this plasticity, the tooth structure be- todynamically (photodynamic activated) cross-linked chi-
haves more as a brittle, than tough material (Kishen & tosan nanoparticles (CSnps; Li et al., 2020). This process
Asundi, 2005). These alterations confer increased resid- has been reported to produce rapid cross-linking within
ual strain and reduced microhardness and resistance to the collagen arrangement, initiated by exposure to a pho-
cyclical fatigue, resulting in an increased risk of root tosensitizer with a specific wavelength (Chan et al., 2007;
fracture (Arola & Reprogel, 2005; Nadeau et al., 2019; Wollensak & Iomdina, 2009). Essentially, the microtissue
Patel et al., 2022). engineering of the root canal dentine substrate is the result
It is noteworthy to consider the conflicting find- of CSnps forming a conditioning layer (Kishen et al., 2008,
ings of studies where no changes to the viscoelastic 2016) after which polyanionpolycation ionic complexes
properties of dentine of root filled teeth have been are formed (Kishen et al., 2008). The nanoparticles act
observed (Papa et al., 1994; Sedgley & Messer, 1992). as hydrophilic space fillers between the collagen fibrils,
Methodological factors could explain the conflicting effectively acting as a plasticizer (Li & Kishen, 2018),
results obtained in these laboratory studies. For exam- thereby improving the flexibility and associated biome-
ple, the root filled specimens used in a study by Sedgley chanical characteristics of the treated dentine (Madhavan
and Messer (1992) were stored in saline prior to testing. et al., 2010; Shrestha et al., 2011).
This prior storage protocol may have permitted rehydra- Naturally occurring collagen cross-linking agents rich
tion and potential re-establishment of the viscoelastic in proanthocyanidin have also shown some promise in
properties of the included dentine samples. Similarly, improving the viscoelastic properties of dentine (Castellan
Papa et al. (1994) stored the extracted teeth in alumin- et al., 2011). The results of this study showed that grape
ium foil until the experimental testing was performed. It and cocoa seed extracts were capable of improving the
has been shown that under normal conditions, 80–85% elastic modulus of dentine by stabilizing collagen matri-
of dentinal free water loss occurs within 2 h (Jameson ces through exogenous cross-linking.
et al., 1993). Therefore, the lack of difference observed The use of nanopolymeric filler particles to induce col-
in the biomechanical performance of root filled teeth in lagen cross-linking and inhibit structural degradation is
these studies can potentially be explained by the hydra- an interesting area of research that might be applied to
tion status of the included samples at the time of testing root filled teeth to help overcome some of the deleterious
(Patel et al., 2022). effects of loss of unbound water within porosities in the
In view of the increased propensity for root filled teeth dentine matrix. Further laboratory and clinical research
to undergo microcracks and root fractures, the develop- should be carried out to evaluate these exciting concepts.
ment of micro-tissue engineering processes to enhance
the biomechanical properties of dentine offers exciting,
albeit currently unrealized, potential (Li et al., 2020; STUDY HETEROGENEITY AND
Rashidi et al., 2014). Research relating to this area ap- C HALLENGES FOR RESEARCH
pears to focus on two key areas (Li et al., 2020). First, RELATING TO THE RESTORATIO N
the induction of additional molecular collagen cross- OF ROOT FILLED TEETH
links using synthetic and/or natural chemicals could
help to overcome some of the undesirable consequences The lack of well-controlled prospective studies relat-
of loss of vitality (Fawzy et al., 2012; Sung et al., 1999). ing to the restoration of root filled teeth is primarily
Furthermore, biopolymeric nanofillers can be infiltrated due to the unique anatomical, structural and biome-
into the dentine matrix to improve its viscoelastic proper- chanical considerations for each tooth, as well as the
ties (Kishen et al., 2016). difficulty in both quantifying and standardizing both
|
the assessment methodology and operative protocols which may be as low as 28% (Fokkinga et al., 2007), re-
with respect to tooth volume loss. In addition to these ducing the meaningfulness of the findings.
considerations, the ‘elephant in the room’ appears to A further consideration for interpreting clinical data
be the effect of occlusal factors on the survival of root which is based primarily on retrospective analysis is the
filled teeth, which is understandably poorly studied, yet impact of clinical bias in relation to the choice of definitive
may significantly influence the biomechanical perfor- restoration (Bhuva et al., 2021). It is more than conceiv-
mance of root filled teeth. The observations provided able that clinicians may elect not to place indirect resto-
by studies on the survival of root filled teeth in rela- rations on teeth with compromised prognoses, whether
tion to tooth location in the arch (Creugers et al., 2005; that be for periodontal, restorative or endodontic consid-
Fokkinga et al., 2007) and the number of proximal con- erations. This is one of the most fundamental features of
tacts (Aquilino & Caplan, 2002; Caplan et al., 2002; prospective study design, which ensure that selection bias
Caplan & Weintraub, 1997), appears to demonstrate a of this type is minimized.
noticeable advantage for nonterminal teeth and those
with proximal contacts (Alley et al., 2004; Aquilino &
Caplan, 2002). The most striking observation made by C URRENT PERSPECTIVES ON
Aquilino and Caplan (2002) was that the failure rate for RESIDUAL TOOTH STRUCTUR E
second molars was markedly greater than for any other
tooth type, suggesting that the occlusal and nonocclusal Evaluating, and more importantly, comparing outcomes
forces imparted on these teeth were likely to be a key of clinical studies relating to root filled teeth is extremely
factor in their inferior survival. challenging. Several criteria have been used to assess the
A further indicator of the relevance of occlusal forces residual tooth structure; the lack of consistency in the as-
is the prevalence of cracked teeth in relation to tooth lo- sessment tools across studies makes it very difficult, if not
cation reported in the scientific literature, with terminal impossible, for systematic reviews or meta-analyses to
teeth most frequently affected (Kang et al., 2016; Leong combine these data. Furthermore, most of the assessment
et al., 2020). Furthermore, terminal cracked teeth have criteria a qualitative rather than quantitative, and there-
been shown to have the poorest prognoses of any, suggest- fore highly prone to bias and subjectivity. The residual
ing the same occlusal factors which were responsible for tooth structure has been classified qualitatively and quan-
causing the crack initially will also affect the long-term titively in several ways.
post-treatment survival (Kang et al., 2016; Sim et al., 2016;
Tan et al., 2006). More than ever, the prevalence of cracked
teeth is being acknowledged, and whilst this is at the fore- Ferrule effect
front of endodontic case assessment, there is still a con-
siderable under-diagnosis of cracked teeth due to a lack In vitro studies relating to the impact of the ferrule effect
of utilization of magnification and coaxial illumination. on the fracture resistance of root filled teeth have shown
It is the authors' opinion that the use of magnification the improved performance of teeth with adequate su-
with coaxial lighting is incorporated into undergraduate pramarginal tooth structure (Ichim et al., 2006; Juloski
dental training so that from an early stage, students can et al., 2012; Ma et al., 2009; Sorensen & Engelman, 1990).
diagnose, prognosticate, and treat cracked teeth through However, clinical outcomes show great variability, al-
experiential learning. though there is still a trend towards improved survival
A major limitation of many clinical studies relating with increased ferrule effect (Cagidiaco et al., 2008;
to the survival of root filled teeth is the relatively short Creugers et al., 2005; Ferrari et al., 2007; Schmitter
recall period (3– 5 years). To compare treatment mo- et al., 2007; Setzer et al., 2011). The outcomes observed
dalities over this time scale makes it difficult to make in clinical studies are further complicated by the inclu-
meaningful insights into longevity. However, it should sion of post-retained restorations (Naumann et al., 2018).
also be acknowledged that both prospective and retro- There are several other factors that need to be considered
spective studies have demonstrated that the majority when evaluating the results of clinical research, which in-
of restorative, endodontic and/or terminal complica- clude the definition of the ferrule effect in terms of height
tions of root filled teeth occur within the first 3 years (Schmitter et al., 2007) and thickness (Cloet et al., 2017),
of initial treatment (Al-Nuaimi et al., 2020; Salehrabi as well as retrospective study design (Setzer et al., 2011).
& Rotstein, 2004). This finding is even more relevant Due to the difficulties in standardizing prospective re-
for teeth undergoing root canal retreatment (Kwak search, it is not possible to determine tangible conclusions
et al., 2019). The results of studies with longer recall pe- on the influence of the ferrule effect on the survival of
riods are often adversely impacted by poor recall rates, root filled teeth. Meta-analyses of the available data infer
|
evidence for the benefit of the ferrule effect in premolar The existing studies which have used digital scan-
teeth, whilst it is not possible to draw such strong determi- ning, show some correlation between inferior survival
nations for molar teeth (Skupien et al., 2016). and teeth with less than 30% residual tooth volume (Al-
Nuaimi et al., 2017, 2020). The results also provide some
interesting insight in respect of more compromised teeth
Number of residual walls being more susceptible not only to structural but also to
endodontic failure (Al-Nuaimi et al., 2017).
An alternative technique to assess the residual tooth Future research should be directed towards quan-
structure which has been used in clinical studies is by titative tooth structure assessment during endodontic-
evaluation of the residual walls (Cagidiaco et al., 2007; restorative procedures. As CAD-CAM scanning evolves,
Dammaschke et al., 2013; Mannocci et al., 2002), which it will hopefully be possible to measure intra-coronal vol-
may be assessed in terms of the number (Cagidiaco umetric tooth structure changes, particularly within the
et al., 2008; Ferrari et al., 2012) or percentage (Creugers peri-cervical region of the tooth. It is the authors' opin-
et al., 2005; Fokkinga et al., 2008; Schmitter et al., 2007). ion that studies assessing the survival of restorations and
There is significant heterogeneity in what defines a resid- teeth do not take into consideration of occlusal factors
ual wall, and as is the case for the ferrule effect, clinical sufficiently within the study design or analysis. Whilst
findings are again affected by confounders. However, de- tooth location (Aquilino & Caplan, 2002) and the number
spite the limitations of largely retrospective research, the of proximal contacts (Aquilino & Caplan, 2002; Caplan
number of residual walls does appear to be an important et al., 2002; Caplan & Weintraub, 1997) have been studied,
variable for the survival of root filled teeth. Teeth with no- the details of occlusion for the included tooth, such as in-
or only one residual wall appear to have reduced survival volvement in excursive/protrusive contacts, the presence
rates when compared to those with more than one wall of working/nonworking side interferences and identifica-
(Dammaschke et al., 2013; Ferrari et al., 2012; Nagasiri & tion of parafunctional habits could also be included in the
Chitmongkolsuk, 2005). preoperative assessment.
Residual tooth volume DENTINE SUBSTRATE

MODIFICATION AND ADHESIVE
Although there is currently limited clinical data relating BONDING
to the impact of residual tooth volume on the survival of
root filled teeth, recent studies have utilized digital CAD- The fundamental concepts of adhesive bonding include
CAM scanning To assess the impact of this variable on the the micromechanical adhesion of composite restora-
survival of root filled teeth (Al-Nuaimi et al., 2017, 2020). tions via etching of enamel, and the creation of an in-
With this methodology, the issues relating to the variabil- terdiffusional interface of bonding resin and dentine.
ity of interpretation and assessment of the ferrule effect These protocols have been applied, with no substantial
and residual walls are overcome, as all measurements differences, to root filled teeth and those with vital pulps
are volumetrically accurate, permitting standardization, alike. Currently, three-step dentine bonding agents re-
not only within the studied sample but also across other main the gold standard in terms of achieving long-term
studies. bonding to dentine (Sauro & Pashley, 2016). Their use
One of the most striking benefits of digital scanning is based on the application of a hydrophilic primer to
is that residual tooth volume measurements can be made etched dentine, to penetrate the dentinal tubules and
to encompass the ferrule effect/remaining walls in all di- the demineralized collagen fibrils, prior to the applica-
mensions and at the same time, the residual coronal den- tion of a hydrophobic adhesive based on bisphenol A-
tine. It is the authors' opinion that these nonsubjective, glycidyl methacrylate (Bis-GMA) and triethylene glycol
measurable, reproducible and tangible measurements dimethacrylate (Carvalho et al., 1996). Nevertheless,
should be utilized further for future prospective clinical such bonding strategies remain technique-sensitive, as
outcome studies. Philosophies such as minimally invasive clinicians tend to over-dry the dentine, causing the col-
endodontic and restorative techniques could potentially lapse of collagen fibrils and a consequent lack of resin
be studied clinically with the use of digital scanning, and infiltration within the hybrid layer (Kanca, 1996). The
furthermore, the potential critical regions for tooth struc- clinical consequences of a lack of infiltration, are mar-
ture removal during endodontic- restorative procedures ginal discolouration, degradation of the hybrid layer and
were identified. microleakage, which may then progress into secondary
|
caries (Pashley, 1991; Söderholm, 2007), and potentially dentine-substitute materials (Irie et al., 2004) may atten-
cause re-infection of root filled teeth. Moreover, early uate the polymerization stresses generated at the dentine-
degradation of the hybrid layer is even more evident in bond interface, reducing the risk of gap formation,
the now widely used fifth generation of adhesive systems microleakage and secondary caries (Sampaio et al., 2011;
(i.e., self-priming adhesives), which were developed by Sauro et al., 2018). This is of particular importance when
combining the primer and adhesive into one solution, nonaxial stresses are generated during parafunction (e.g.,
to reduce the number of steps necessary to complete the bruxism), and which in turn, may significantly affect the
bonding procedure, from three to two (Van Meerbeek integrity of the bonding interface (Khvostenko et al., 2015;
et al., 2003). Toledano et al., 2015).
In the early 2000s, sixth-generation adhesive systems The use of air-abrasion systems in combination with
were developed and identified as ‘self-etching (SE) prim- aluminium oxide or bioactive glasses to prime dentine
ers and adhesives’, Such adhesive systems do not require following endodontic treatment, and prior to restorative
dentine acid-etching with phosphoric acid due to the pres- procedures, will help to remove root filling material/
ence of specific functional acidic monomers (i.e., 10-MDP: sealer residues and provide smoother dentine walls with
10-methacryloxydecyl-dihydrogen-phosphate) within the rounded internal line angles; this may reduce the stress
formulation of the primer. Such functional monomers can concentration along the bonding interface due to a re-
demineralize and prime enamel and dentine substrates duced C-factor (Banerjee, 2013; Spagnuolo et al., 2021)
simultaneously, which can then be subsequently bonded and also reduce crack propagation and the probability of
using separate solvent-free, relatively hydrophobic adhe- fatigue failure (Ayad et al., 2011). Furthermore, when per-
sives (Pashley et al., 2011; Van Meerbeek et al., 2003). forming dentine air-abrasion using bioactive glass, a ‘bio-
The latest adhesives are known as ‘all-in-one’ and/or reactive’ smear layer is produced on the dentine surface,
‘universal’ adhesives. These combine etchant, primer and which is then incorporated within the bonding interface
adhesive in a single solution and can be used both with created using resin-modified glass ionomer cements or
phosphoric acid etching pre-treatment and as self-etching SE adhesives. Such bioactivity is due to the hydrated sil-
adhesives (Pashley et al., 2011; Perdigão et al., 2013). Both ica Si(OH)4 produced by bioglasses when in contact with
self-etching primers and all-in-one adhesives are exten- water or saliva, and may stop the degradation processes
sively used in the bonding of composite restorations and at the bonding interface (Sauro, Watson, Thompson, &
cores in root filled teeth, and also in the bonding of fibre Banerjee, 2012b; Sauro, Watson, Thompson, Toledano,
and metal posts. et al., 2012a). The bio-reactive layer condensates within
To the best of authors' knowledge, none of the changes the demineralized dentine collagen (Pashley, 1991) fos-
to the dentine and enamel substrates that have been as- silizing the dentine proteases (e.g., metalloproteinases
sociated with loss of vitality or root canal treatment pro- (MMPs)) and serving as a template for the precipitation of
cedures have resulted in a change of bonding strategy. Ca2+ and PO43− which may remineralize and protect the
This applies to the loss of free water content (Helfer hybrid layer. Moreover, the alkaline pH generated by bio-
et al., 1972) and collagen alteration (Driscoll et al., 2002; active glasses, may also have antibacterial properties and
Reddington et al., 2003) which arguably both contribute reduce the risk of secondary caries (Bauer et al., 2019).
to the increased fracture susceptibility of root filled teeth. Other methods advocated to preserve the durability
More recently, several strategies have been suggested to of dentine-bonded interfaces include the pre-treatment
improve bonding to the dentine of root filled teeth, in (1 min) of acid-etched dentine using chlorhexidine (2%
particular, the use of cross-linked chitosan nanoparticles CHX) before bonding. Indeed, in vitro (Yiu et al., 2012)
was found to reduce the degradation of dentinal collagen and in vivo (Carrilho et al., 2007) studies have demon-
and improve the stability of the adhesive interface (Xiong strated that CHX may inhibit the action of several types
et al., 2020). of MMPs, as well as dentinal cysteine cathepsins, which
Several promising strategies have been advocated to cause degradation of the hybrid layer (Scaffa et al., 2012).
reduce the stress concentration at the bonding interface Quaternary ammonium compounds (QACs) can be
that usually occurs during the light-curing of resin com- employed to reduce the enzyme-mediated collagen degra-
posites, all of which have the potential to increase the lon- dation within the hybrid layer. These are molecules with
gevity of both direct and indirect composite restorations. lower molecular weight than CHX, which may easily infil-
Unfortunately, to the best of authors' knowledge, none trate the demineralized dentine, leading to a more reliable
of these strategies have gone past initial clinical trials anti-MMP effect within the hybrid layer (Pupo et al., 2014).
(Nikolaenko et al., 2004). Benzalkonium chloride is a QAC with potent antibacterial
The use of ‘stress- absorption’ resin flowable liners properties that have been advocated as a potential anti-
or glass-ionomer cements employed as the base and/or proteolytic agent to be used before bonding procedures
|
(Sabatini & Patel, 2013). However, CHX was found to isopropyl alcohol to sequester any accessible free eugenol
be more efficient in inhibiting MMPs and cathepsin-K (Tian et al., 2021; Figure 1).
than 2% benzalkonium chloride (Imazato et al., 2006). The placement of composite resin materials within the
Moreover, light-curable QAMs such as methacryloyloxy- root canal space and the pulp chamber is complicated by
dodecylpyridinium bromide have also shown encouraging the limited access for both restoration placement and light
results in reducing the proteolytic degradation of dentine- transmission. This may lead to void formation and/or in-
bonded interfaces, as well as, inhibiting bacterial growth complete polymerization of the composite resin materials.
and reducing the risk of secondary caries (Sauro, Watson, Employing a minimally invasive endodontic philosophy
Thompson, & Banerjee, 2012b). A further useful approach will make composite core placement even more challeng-
to reducing the proteolytic action of MMP-2 and MMP-9 is ing (Figure 2). This has been highlighted in studies demon-
based on the use of materials able to release fluoride (F−) strating that the percentage of voids observed within the
ions (Feuerstein et al., 2007). composite restoration is greatest in teeth with minimal
Whilst the above considerations for adhesive bonding access cavities (Pereira et al., 2021; Silva et al., 2020). In
may not have been shown to influence clinical outcomes, these studies, it was also demonstrated that the use of
it is important to appreciate that optimal bonding may be bulk-fill, rather than conventional composites, led to less
more relevant to modern treatment concepts such as min- void formation. The development of bulk-fill materials
imal preparation onlay restorations, adhesive post cemen- has been rapid, with the manufacturers of these materials
tation and deep margin elevation. reporting increment depths of up to 10 mm, thereby, facil-
itating much shorter procedural times.
To permit larger increments of material to be placed,
COM P O S I T E R E SIN M AT E R IALS the manufacturers of bulk-fill materials have used sev-
eral strategies to increase the depth of cure which include
Composite resin is frequently used as both a definitive reducing filler content (Ilie et al., 2013) and increasing
restorative and core material following root canal treat- particle size (Ilie et al., 2013) and the addition of pho-
ment. The development of self-adhesive resins and bulk- toinitiators. Furthermore, the shrinkage of these mate-
fill materials, for placement within the pulp chamber, has rials has been reduced by incorporating shrinkage stress
provided greater applicability and reduced technique sen- modulators into the compositions (Isufi et al., 2016). For
sitivity (Hayashi et al., 2019). example, SDR (Dentsply Sirona) utilizes a modulator that
There are a number of challenges to placing composite interacts with the camphorquinone photoinitiator during
resin materials for core, or definitive restoration, specific polymerization to reduce the speed of elasticity modulus
to root filled teeth. Importance of removing remnants development. Although the depth of cure of bulk-fill ma-
of root filling materials and sealer residues (Mannocci terials is good, it should also be considered that curing
et al., 2008) is paramount. The use of fine ultrasonic tips light intensity will diminish with distance. As the base of
with copious water spray may be of great benefit for this an endodontic cavity may be several millimetres from the
purpose. Angled, endodontic microsurgical tips may be light source, it may be prudent to consider smaller initial
of particular use in minimally invasive access cavities in increments to offset the increased curing distance (Prati
molar teeth, as they can be used to clean the undercuts
within the pulp chamber (Chan et al., 2022).
A further consideration is the use of eugenol-based
root canal sealers and/or temporary materials. This
phenolic compound has been reported to have a detri-
mental effect on the adhesion of resin materials to den-
tine (Menezes et al., 2008; Schwartz et al., 1998). Resin
composites polymerize by the addition of free radicals.
However, this process may be inhibited by eugenol
(2-methoxy-4-allyphenol) and is capable of penetrating
into root canal dentine (Kielbassa et al., 1997). In addi-
tion to the use of ultrasonics, and as discussed earlier, air-
F I G U R E 1 Pulp chamber preparation following completion of
abrasion may be a useful adjunct to improve the dentine the endodontic treatment and prior to placement of composite resin
substrate prior to bonding. Furthermore, if eugenol-based core. The dentine surface has been cleaned with ultrasonics, after
root canal sealer and/or temporary materials have been which alcohol has been used to sequester residual eugenol from the
used, polymerization inhibition of any composite resin pulp chamber. Air-abrasion in combination with aluminium oxide
materials may be reduced by rinsing the dentine with or bioactive glasses may also be used.
|
(a) (b) (c) (d)
(e) (f)
F I G U R E 2 The placement of core materials in minimally invasive access cavities presents a challenge (a–d) preoperative periapical
radiograph, intra-operative images and post-treatment radiograph of minimally invasive root canal treatment of 21. Predictable light
transmission for use of conventional composite resin was not possible during core placement so a dual-cure material was used in this case
(e, f) ‘restoratively-driven’ access during root canal treatment of 16. The diligent use of magnification, an elongated delivery tube to place the
composite resin (e.g., Accudose; Centrix) permitted placement of the restoration without void formation.
et al., 1999; Rueggeberg et al., 1993). As a result, with the there is insufficient literature on the influence of interme-
exception of dual-cure compositions, bulk-fill composite diate lining materials (Alomari et al., 2001).
materials should not ideally be used in increments exceed- The use of flowable composites or RMGIC as liners or
ing 4–5 mm. dentine substitution materials, has been reported to pro-
A problem for all composite resin materials at the mi- vide a ‘stress-absorption’ effect at the bonding interface
croscopic level is gap formation at the bonding interface (Irie et al., 2002, 2004) and to decrease gap formation,
(Benetti et al., 2015). Gaps can occur for several reasons, microleakage and deterioration over time (Kakaboura
such as insufficient adhesion at the tooth-restoration in- et al., 2007; Sampaio et al., 2011; Figures 3 and 4).
terface due to polymerization shrinkage, adhesive resin Moreover, it has been recently reported that the use of
degradation as a result of insufficient light-curing, fatigue modern ion- releasing materials such as conventional
caused by ageing, differences in the thermal expansion RMGIC or RMGIC- based composite (ACTIVA restor-
coefficient of the tooth substrate and composite resin, or ative; Pulpdent) used as dentine replacement materials
insufficient material placement (Moszner et al., 2008). may preserve the in vitro bonding performance of modern
Hayashi et al. (2019) demonstrated that light-cured universal adhesives bonded to dentine (Sauro et al., 2019;
bulk- fill resin composites had varying degrees of gap Slimani et al., 2021). However, further studies are required
development and shrinkage within a 4-mm deep cavity to validate their use.
(Figure 3). Furthermore, it has been reported that high- Practical considerations for the use of bulk-fill ma-
viscosity bulk-fill composites are associated with greater terials include the placement and pooling of the adhe-
gap formation volumes than low-viscosity bulk-fill mate- sive bonding resin. Fine microbrushes (Microbrush X;
rials (Oglakci et al., 2019). The authors also demonstrated Young Innovations Europe GmbH) are useful for this
that using an resin- modified glass- ionomer cement purpose, as are paper points, which may also be used to
(RMGIC) liner reduced gap formation volume signifi- absorb surplus bonding agents. The length of the deliv-
cantly in high- viscosity bulk-fill composites. Although ery tip of proprietary composite compules may not be
manufacturers claim that bulk-fill composites have less of adequate length to reach the base of the access cav-
polymerization shrinkage than traditional composites, ity, increasing the risk of void formation. This may be
|
F I G U R E 3 Dye-assisted confocal microscopy of resin-dentine interfaces created using different bonding and restorative procedures
performed in class 1 cavities subsequent root canal treatment in vitro. (a) Single-projection images of the resin-dentine interface created by
the application of a bulk-fill composite (Filtek One Bulk-Fill; 3M ESPE AG) following the use of a universal adhesive (Scotchbond Universal;
3M ESPE AG) in self-etching (SE) mode. It is possible to see a clear gap between the dentine (d) and the adhesive/composite (Ad/C) most
likely due to polymerization shrinkage, which has caused the debonding in adhesive mode (b). (c) Further images of resin-dentine interface,
following conventional composite (Filtek Supreme XTE; 3M ESPE AG) placement with the use of a universal adhesive in SE mode. Once,
again it is possible to see a clear gap between the dentine (d) and the adhesive/composite (Ad/C) due to polymerization shrinkage. (d)
Single-projection images of resin-dentine interface created by the application of a flowable ‘bioactive’ restorative composite (ACTIVA
Restorative; Pulpdent) following the use of a universal adhesive in SE mode. In this case, gap formation between the dentine (d) and the
adhesive/composite (Ad/C) is much less evident. This may be due to the mechanical and compositional characteristics of the material (i.e.,
resin-modified glass ionomer cement containing modified calcium phosphates), which are proposed to create less stress on the bonding
interface, particularly when left undisturbed for a couple of minutes prior to light-curing.
(a) (b)
F I G U R E 4 Dye-assisted confocal microscopy of resin-dentine interfaces created using an experimental self-etching adhesive applied on
dentine previously air-abraded with bioactive zinc-doped bioglass powder after 3 months of storage in artificial saliva. (a): Single-projection
images of resin-dentine interface that was immersed in 0.5 wt% calcium-chelating dye solution 26 (Xylenol Orange; Sigma–Aldrich) after
maintaining the specimens for 3 months in artificial saliva (AS). It is possible to observe, especially at higher magnification (b), the presence
of a clear calcium-based mineral deposition within the resin-dentine interface and inside the dentine tubules induced by the bioactive glass.
|
overcome using elongated needle delivery tubes (e.g., bonding below the cementoenamel junction is that the
Accudose; Centrix); these can either be filled with the marginal seal will be entire with dentine and/or cemen-
desired material or placed over the proprietary compule tum. Achieving these objectives with optimal isolation is a
to provide deeper access. technique-sensitive challenge (Van Meerbeek et al., 2005).
Despite concerns that relate to composite bonding in It is therefore fundamental to understand the importance
general, bulk-fill composite materials should still be con- of developing the necessary skills in isolation, matrix
sidered a good choice for post-endodontic core placement, placement and bonding protocols to optimize outcomes,
due to their favourable properties and handling. moreover, when these objectives cannot be fulfilled, surgi-
cal crown lengthening may be a valid alternative.
Clinical data relating to the performance of teeth re-
DE E P M A RGIN E LE VAT ION stored with DME techniques are lacking, with a sys-
tematic review on the subject highlighting that existing
The occurrence of subgingival proximal margins due research is almost entirely limited to in vitro studies and
to caries or previous restorative procedures is a com- clinical case reports (Juloski et al., 2018). There are lim-
mon clinical challenge encountered during endodontic- ited clinical studies on the long-term outcomes of DME,
restorative procedures. The ‘threshold’ for deeming a and the results should be interpreted with caution due
tooth unrestorable varies significantly amongst clinicians. to the lack of data specific to root filled teeth. A study by
It is critical that the restorability of a tooth is established Bresser et al. (2019) followed 197 indirect restorations
prior to endodontic treatment to avoid difficulties later in (including 45 endodontically treated teeth) with DME up
the treatment process. Embedded in convention, there has to 12 years, with a mean follow-up of 57.7 months. The
often been a dissociation between the endodontic and re- cumulative 12-year survival rate was determined to be
storative phases of treatment, leading to poor treatment 95.9%, with the majority of failures due to recurrent car-
planning decisions, poor asepsis during root canal treat- ies. However, a significantly higher incidence of tooth and
ment and suboptimal restoration placement. Moreover, restoration fractures occurred in root filled teeth when
teeth that have undergone root canal treatment may later compared with those with vital pulps. Further case series
be deemed unrestorable. However, it is promising to see have demonstrated excellent survival rates between 5 and
emerging trends, not only in clinicians increasingly taking 21 years (Dietschi & Spreafico, 2019; Ghezzi et al., 2019),
holistic ‘ownership’ of both the endodontic and restora- however, the included numbers are small, and therefore,
tive aspects of treatment but also in the level of difficulty should be interpreted with caution.
of cases being undertaken. It is the authors' opinion that A concern regarding the DME technique is the potential
restorative treatment should be an integral part of the violation of the biological width (Broadbent et al., 2006)
skillset of clinicians undertaking endodontic treatment. and the associated risk of periodontal inflammation and
Historically, the management of subgingival restor- attachment loss (Kamin, 1989). Results in relation to the
ative margins has involved crown lengthening procedures impact of DME on periodontal health demonstrate con-
which comprise surgical osseous and soft tissue reposi- flicting results (Ferrari et al., 2018; Sarfati & Tirlet, 2018).
tioning to establish supragingival margins, and to permit Ferrari et al. (2018) assessed the health of the periodon-
definitive restoration without impinging on the biological tal tissues of 35 posterior teeth restored with either the
width. However, these procedures require an additional DME technique or shoulder preparation after 12 months.
surgical procedure, time and cost to the patient, and will They found a significantly higher incidence of bleeding on
reduce the bone support of both the treated and neigh- probing in the DME group, and this was most prevalent in
bouring teeth. Furthermore, the procedure can often be teeth where the distance between the cavity margin and
complicated in the interproximal region by a lack of ade- the crestal bone was 2 mm or less. However, other authors
quate space between the adjacent teeth. have reported favourable periodontal responses to DME
An alternative approach to managing the restoration (Ghezzi et al., 2019; Sarfati & Tirlet, 2018). A further study
of deep interproximal margins is the deep margin eleva- demonstrated no differences in clinical or histological
tion (DME) or cervical margin relocation concept which findings of the periodontal tissues adjacent to the DME
was first described by Dietschi and Spreafico (1998). This when compared with untreated controls (Bertoldi et al.,
involves the relocation, or elevation, of the subgingival 2020). There is also differing opinion on the acceptable
margin to a more coronal position using direct composite depth of the DME, and specifically, the proximity of the
resin. The fundamentals of this procedure rely on optimal restoration margin to the connective tissue and the crestal
rubber dam isolation, the use of appropriate and innova- bone (Castelo-Baz et al., 2021; Ghezzi et al., 2019; Sarfati
tive matrix systems/techniques and an optimal bonding & Tirlet, 2018). Proponents of DME have suggested that
strategy (Magne, 2021). One of the main concerns with the technique may be utilized at any depth in relation to
|
the crestal bone, as long as optimal rubber dam isolation vital pulps was not specified. It was found that for pos-
can be achieved (Ghezzi et al., 2019), and that a shorter terior teeth, densely sintered alumina (Procera; Nobel
long junctional epithelial attachment can be maintained Biocare, Zürich-Flughafen, Switzerland) and reinforced
without inducing periodontal attachment loss. Intuitively, glass ceramic crowns (IPS Empress, IPS. e.max; Ivoclar
in cases with deep proximal caries, attachment loss to the Vivadent, Schaan, Liechenstein; Figure 5) performed sim-
base of the carious lesion has already occurred, and where ilarly to metal ceramic crowns. Glass ceramic (DICOR;
the alternative of surgical crown lengthening will lead to Dentsply Sirona) and In Ceram (Vita Zahnfabrik) crowns
further attachment loss, it appears sensible that this may had lower survival rates when placed on premolar and
be a valid technique. However, it is necessary for prospec- molar teeth. Posterior all ceramic crowns had more fail-
tive clinical research to validate the long-term stability of ures than anterior all ceramic crowns. The most common
DME in root filled teeth. modes of failure for all ceramic crowns collectively were
Techniques such as DME should be considered neces- ceramic chipping, framework fractures and loss of vitality
sary skills for those carrying out endodontic-restorative (biological failure). The cumulative 5-year survival rates
treatment. The ability to isolate and restore deep margins were 95.7%, 96.6%, 94.6% and 96% for metal ceramic, leu-
will permit the retention of many previously condemned cite or lithium disilicate reinforced glass ceramics, glass
teeth. By restoring these areas prior to performing the end- infiltrated alumina and densely sintered/alumina crowns,
odontic treatment, several objectives are achieved; these respectively. The authors concluded that leucite, lithium
include restorability being established, attainment of op- disilicate reinforced glass ceramic or alumina-based oxide
timal isolation during the endodontic treatment and ease all ceramic crowns could be recommended as an alterna-
of preparation of the definitive restoration. Importantly, tive to gold-based metal ceramic crowns for both anterior
the use of DME will also facilitate both the preparation and posterior teeth. Feldspathic and silica-based ceramics
and adhesive luting of indirect restorations with subgin- were associated with higher failure rates when used for
gival proximal margins, which otherwise, would need to the restoration of posterior teeth. Furthermore, layered
be restored with conventionally cemented indirect res- zirconia-based crowns were considered inferior due to
torations, which in turn require greater tooth reduction loss of retention and fracture of the ceramic veneering.
(Juloski et al., 2018). However, in other studies zirconia crowns were shown to
have equivocal veneering fractures to other restorations
and remain a popular choice with clinicians (Laumbacher
A L L C E RA MIC CROW N S AN D et al., 2021; Figure 6).
O NL AY S A prospective study assessed the longer-term survival
and complication rates for lithium disilicate e.max crowns
The evolution of all ceramic materials for the provision of (Teichmann et al., 2017). The authors assessed the 10-year
indirect restorations has led to their routine use for both outcomes for 106 all ceramic crowns and observed rela-
root filled teeth, and those with vital pulps. These materi- tively low survival and chipping-free rates of 86.1% and
als provide huge aesthetic advantages but with little com- 83.4%, respectively. In this study, there were fairly even
promise to restoration strength and longevity. Numerous proportions of restorations that were adhesively and con-
materials have been developed to produce all ceramic ventionally luted; a rubber dam was used for cementation
restorations; these include conventional or traditional where possible. It was observed that the 5-year chipping
feldspathic porcelain, aluminous porcelain, glass infil- rate was relatively high and it may be that the cementation
trated alumina, zirconia, glass ceramic, reinforced glass process is relevant to the biomechanical performance of
ceramic (leucite and lithium-disilicate) and densely sin- these restorations.
tered alumina. Unfortunately, there is a sparsity of data, A key attribute of all ceramic restorations is that they
with little available research assessing the performance can be adhesively bonded to dentine, although this re-
of all ceramic restorations specifically on root filled teeth quires appropriate substrate preparation (D'Arcangelo
(Dioguardi et al., 2021); this should be considered highly et al., 2014), and disciplined bonding protocol (Santos Jr
relevant to the interpretation of the results of the available et al., 2009) and good moisture control with a rubber dam.
studies (Morimoto et al., 2016). Adhesive cementation permits minimal preparation tech-
A systematic review evaluating the survival and com- niques to be employed, such that there is less reliance on
plication rates of various all ceramic and metal ceramic creating resistance and retention form within the residual
crown restorations found that they showed comparable tooth tissue. This facilitates both the preservation of re-
survival rates at 5 years (Sailer et al., 2015). A total of 9434 sidual tooth structure and the restoration of compromised
all ceramic and 4663 metal ceramic crowns were included, teeth that may not be possible with conventional prepa-
however, the number of root filled teeth and those with ration techniques and materials. Furthermore, using an
|
(a) (b) (c)
(d) (e) (f)
F I G U R E 5 Lithium disilicate ceramic onlay (IPS e.max, Ivoclar Vivadent) placement following root canal retreatment of 36 (a, b)
preoperative occlusal view and long-cone periapical radiograph (c) cleaned and prepared dentine surface prior to deep margin elevation and
core placement (d) completed core and onlay preparation (e, f) post-treatment occlusal view and postoperative periapical radiograph.
(a) (b) (c) (d)
(e) (f) (g)
(h) (i) (j)
F I G U R E 6 Zirconia crown (Lava; 3M ESPE AG) replacement 25 and crown placement 24 following root canal retreatment (a, b)
preoperative occlusal view and long-cone periapical radiograph (c) completed root canal retreatment and dentine surface preparation (d, e)
pre-endodontic build up, fibre post and core placement (f) completed full-coverage crown preparations (g) crowns prior to cementation (h, i)
finished restorations with postoperative occlusal and buccal views (j) follow-up periapical radiograph at 10 years.
adhesively bonded technique there is less requirement for have increased in popularity in recent times, in line with
intra-coronal core retention, and as such, the use of posts. minimum intervention endodontic- restorative philoso-
It is for these reasons, that indirect onlay restorations phies. However, as discussed earlier in this review, it is
|
imperative to acknowledge the differences in bonding with a minimally invasive access cavity preparation con-
for root filled teeth when compared with those with vital cept. It may be argued that for such restorations, the ad-
pulps, due to the ultrastructural differences in the dentine ditive value of improved bonding to the residual tooth
substrate and free water content (Abo-Hamar et al., 2005; structure achieved by retaining occlusal enamel, may in
Öztürk et al., 2013; Rosa et al., 2015), as well as the effects itself, be justification for a minimally invasive endodontic-
of the endodontic procedures themselves (Abad-Coronel restorative philosophy.
et al., 2019). The impact of these considerations has not
been determined in clinical studies.
There is a considerable lack of data relating to the per- C AD - C AM RESTORATIONS
formance of all ceramic onlays, rather than full coverage
crowns, on root filled teeth. However, Ferrari et al. (2019) CAD-CAM cuspal coverage restorations have significant
carried out a randomized clinical trial, evaluating the sur- potential to expedite the restoration of root filled teeth
vival of lithium-disilicate onlays on root filled premolar through same- visit chairside restoration, however to
and molar teeth with a 3 year follow-up period. The pa- date, evidence is lacking as to whether CAD-CAM res-
rameters of the onlay preparations were standardized by toration per se improves treatment outcomes (Carvalho
the authors with occlusal reduction limited to 1.0–1.5 mm. et al., 2018). As is the case for all indirect restorations, the
Restoration and tooth survival rates of 93.3% for premo- available data does not specifically detail the performance
lars, and up to 100% for molars with 50% or more coronal of CAD-CAM restorations on root filled teeth. Thus, there
residual tooth structure (after preparation) were demon- is a need for prospective well-designed clinical trials to
strated. There were no significant differences observed in answer key questions about the relative outcomes and op-
relation to tooth type (premolars or molars) or fibre post timal protocol for the CAD-CAM restoration of root filled
placement, although the failure risk was slightly higher teeth. A systematic review followed 2916 single-unit CAD-
for premolars. Despite the prospective and randomized CAM indirect restorations for a mean period of 7.0 years
study design, the limitations of the relatively short obser- (Alves de Carvalho et al., 2018). Of the included restora-
vation period and the exclusion of patients with heavy oc- tions, 1826 were either onlays or inlays, with an estimated
clusal contacts and/or evidence of parafunctional habits 5-year survival rate of 90.9%.
should be taken into consideration. There are three key outstanding questions regarding
An observational study carried out by a single operator the adoption of CAD-CAM technology. First, adopting
in private practice assessed the long-term survival of 2392 a CAD-CAM-based workflow can lead to bias amongst
pressed acid-etched e.max lithium disilicate glass ceramic clinicians towards prescribing indirect rather than direct
complete and partial coverage restorations in posterior restorations, given the relatively high financial outlay in-
teeth (Malament et al., 2021). Of these restorations, 1782 volved in purchasing the scanning and/or milling hard-
were full-coverage crowns, whilst 610 were onlay designs. ware. This influence on decision-making may not always
All restorations were etched with hydrofluoric acid, and lead to superior outcomes for root filled teeth. Mannocci
then silanated, at the time of cementation. The estimated et al. (2002) demonstrated that post- endodontic fibre
cumulative survival at 16.9 years for all restorations was post-retained composite restorations were as successful at
96.49%, with no significant differences observed between 3 year in class II premolar cavities, as those restored with
the full coverage crowns and onlays. Unfortunately, the full coverage crowns. However, in many cases, an indirect
authors do not provide any information on the numbers restoration with cuspal coverage provides better outcomes
of root filled or those with vital pulps included in the (Pratt et al., 2016). The second question is regarding tim-
study. However, the number of restorations included, as ing, as the key advantage to being gained from CAD-CAM
well as the relatively long follow-up is useful for evaluat- is that restorations can be completed expediently after
ing patient-centered outcomes. Interestingly, there was endodontic treatment, perhaps even at the same visit as
no difference in survival when the restorations had a the root canal treatment (Figure 7). Whilst evidence is
thickness of less than 1 mm. Other studies have suggested lacking on single-visit endodontic-restorative treatment
that lithium disilicate ceramic onlays may have adequate there is retrospective data showing that timely indirect
fracture resistance in thicknesses of 0.5–1.0 mm (Guess restoration provides better outcomes; Pratt et al. (2016)
et al., 2013). This is an important observation, which re- reported that teeth that were restored with crowns more
quires further investigation to ascertain whether more than 4 months after root canal treatment were almost 3
conservative preparations may be considered to maximize times more likely to get extracted compared when com-
the preservation of residual tooth structure. Such minimal pared with teeth that received crowns within 4 months of
preparations would also facilitate the possibility of greater root canal treatment. The third key question is regarding
enamel bonding, particularly when used in conjunction the material choice for CAD-CAM restorations, namely
|
(a) (b) (c)
(d) (e) (f) (g)
(h) (i) (j)
F I G U R E 7 Lithium disilicate onlay (IPS e.max CAD) placement following root canal treatment of symptomatic 38 (a, b) preoperative
occlusal view and long-cone periapical radiograph (c) completed root canal treatment and dentine surface preparation (d) completed
core and onlay preparation (e–g) the onlay is fabricated using computer-assisted design and manufacturing (CAD-CAM) (h, i) finished
restoration with postoperative occlusal view and follow-up periapical radiograph (j).
ceramic versus hybrid composite/ceramic. Hybrid com- surface polish and colour instability (Douglas, 2000). In
posite is becoming increasingly popular due to its optimal recent times, the new formulations of so-called ‘resin-
machining properties, however, prospective data on CAD- matrix ceramics’ for CAD-CAM combine the advanta-
CAM hybrid ceramic restorations for root filled teeth are geous properties of ceramics, such as colour stability and
lacking. The primary mode of failure of CAD/CAM resto- durability, with those of composite resin, such as low
rations is fracture; reasons for fracture of ceramic resto- abrasiveness and improved flexural properties. These ma-
rations may include low flexural strength of the material, terials have been sub-classified as polymer-infiltrated ce-
subsurface flaws of CAD-CAM ceramics produced during ramic networks (e.g., VITA Enamic; VITA Zahnfabrik) or
machining, insufficient polishing of the occlusal surfaces resin-based composites (e.g., Cerasmart; GC Corporation;
after adjustment and parafunctional habits, with equiva- Spitznagel et al., 2018). Despite the evolution of these
lent rates being shown for hybrid ceramics in early data materials, concerns remain as to their long-term wear
(Lu et al., 2018). However, a key issue with CAD-CAM hy- and fracture resistance, as well as marginal discolora-
brid ceramics is their failure in full crown scenarios, due tion (Albelasy et al., 2020; Tekçe et al., 2016). In particu-
to the excessive hoop stresses that occur, and therefore, lar, there is concern regarding their strength in areas of
many manufacturers limit their indications for partial high functional and nonfunctional stresses (Morimoto
coverage restorations and contra-indicate their use for full et al., 2016). However, significant advantages of these
coverage crowns (Bomfim et al., 2020). resin materials are the ease of fabrication and the ability
to service the restorations intra-orally.
The long-term survival of indirect composite resto-
I N D I R ECT COM POSIT E R E SIN rations has not been evaluated; a recent systematic review
RESTO RAT I O N S has highlighted the need for longer-term prospective re-
search (Fathy et al., 2022). The success and survival of
Resin composite materials for indirect restoration con- 103 CAD- CAM adhesively bonded polymer- infiltrated
sist of a polymeric matrix reinforced by fillers which may ceramic network posterior onlays and inlays were pro-
be inorganic (ceramic, glass or glass ceramic), organic or spectively followed for 3 years (Spitznagel et al., 2018).
composite (Ferracane, 2011). Unfortunately, the original The authors reported a survival rate of 95.6% and a suc-
resin blocks suffered from increased resin wear, loss of cess rate of 82.4% for onlay restorations at the end of
|
the follow-up period. The main complications observed structure and the tooth type are key factors in determin-
were deterioration in marginal adaptation and colour, ing the need for a post. Post placement is recommended
together with increased surface roughness; the majority for root filled teeth with no remaining coronal walls
of the teeth in this study were those with vital pulps. The (Naumann et al., 2018) and those with one remaining
medium-term survival of indirect composite resin onlays wall (Ferrari et al., 2022). Posterior teeth with adequate
placed on root filled teeth has been retrospectively as- depth and shape within the pulp chamber for core re-
sessed by Chrepa et al. (2014). A total of 189 restorations tention can be reliably restored without posts (; Ferrari
(31 premolars and 159 molars) were evaluated over a me- et al., 2019). Biomechanical considerations lead to the
dian follow-up time of 37 months. Restoration survival assumption that posts are more frequently needed for
was reported to be 96.8% at the end of the follow-up pe- maxillary anterior teeth due to the higher risk of me-
riod. The findings of this study appeared to show a lower chanical failure in this region (Schmitter et al., 2011;
complication rate in respect of marginal adaptation and Torbjörner & Fransson, 2004). However, a recent meta-
discolouration. Overall, these studies demonstrate excel- analysis revealed similar failure rates with short-to
lent medium-term outcomes, which are equivocal, but medium-term follow-up of post-and core restorations
the time-dependent trends of marginal breakdown are a in anterior and posterior teeth (Garcia et al., 2019).
concern for long-term restoration stability and as such, Avoiding excessive post space preparation to maximize
further evaluation is required. the preservation of dentine is a key principle in modern
post-endodontic restoration. Adapting the post to the ex-
isting parameters of the shaped root canal rather than
P O ST S creating a post space to accommodate a specific post is
preferable, as extensive post space preparation affects the
Root canal posts primarily provide retention for the stability of the restored root filled tooth (Lang et al., 2006).
coronal restoration of substantially compromised root In teeth with round root canals, the use of prefabricated,
filled teeth. Even with the improvement of adhesive conically shaped and adhesively luted root canal posts,
luting techniques, the contribution to the stability of ideally without further post space preparation, is recom-
the root by adhesively placed root canal posts remains mended (Figure 8). Up to now, there is no clinical evi-
questionable and is predominantly considered for the dence that the post material's rigidity affects the survival
restoration of weakened traumatized maxillary anterior of root filled teeth or the occurrence of root fractures
teeth with thin dentinal walls (Krastl et al., 2021; Ree & (Figueiredo et al., 2015; Martins et al., 2021). Outcome
Schwartz, 2017). The amount of residual coronal tooth data for post-retained restorations varies with respect to
(a) (b) (c) (d) (e)
(f) (g) (h) (i)
(j) (k) (l)
F I G U R E 8 Zirconia crown (Lava; 3M ESPE AG) replacement following root canal retreatment 21 (a–c) preoperative buccal views
and long-cone periapical radiograph (d–f) removal of cast post and root canal retreatment (h–j) internal bleaching followed by fibre post,
composite core placement and thereafter, crown preparation (k) completed crown cementation (l) radiographic follow-up at 3 years.
|
the amount of residual tooth structure, preparation of a facilitate the adaption of prefabricated posts in cases with
ferrule design and final restoration (Bhuva et al., 2021), nonuniform or greatly enlarged root canals (Grandini
showing approximately 90% survival in the medium et al., 2003). Poor adaption of the post to the root canal pa-
term (5–7 years) for teeth restored with fibre posts (Wang rameters results in both a greater and less homogeneous
et al., 2019; Figure 9). However, one randomized clinical thickness of the resin cement layer, increasing the risk of
trial demonstrated a significant drop in the survival rate void inclusion, irregular contraction during polymeriza-
after 8 years leading to a cumulative survival probability tion and possible post dislodgement. Furthermore, a high
of 58.7% for teeth restored with fibre posts and 74.2% for resin cement thickness increases stress concentration in-
titanium posts after 11 years (Naumann et al., 2017). side the resin cement and decreased bond strength val-
Adaption of posts to the anatomy of unprepared, ir- ues in vitro (Dal Piva et al., 2017; Dal Piva et al., 2018),
regular shaped or flattened root canals can be achieved whilst relining of fibre posts results in increased bond
with customized and relined fibre posts or the use of fibre strength in laboratory tests (de Souza et al., 2016; Farina
bundles. In the case of customized formed fibre posts, et al., 2016; Macedo et al., 2010). However, data for the
glass fibres are embedded in an interpenetrating poly- fracture resistance of root filled teeth restored with relined
mer network (IPN) of PMMA and Bis-GMA (everStick; posts, remains inconclusive, even in vitro (Silva, Cabral,
Vallittu, 2009); such posts reveal higher fracture resistance et al., 2021a; Silva, Versiani, et al., 2021b) and clinical data
than prefabricated solid fibre posts in vitro (Fokkinga is still lacking. Furthermore, fibre post relining increases
et al., 2004). However, ageing affected bond strengths and the clinical time needed for post-endodontic restoration
surface nanohardness of the adhesive layer between com- and creates another interface between the composite re-
posite and the polymerized fibre- reinforced composite lining and root canal dentine.
structure, indicating possible degradation effects depend- Fibre bundles consist of clusters of 4–12 flexible pre-
ing on the monomer system used (Khan et al., 2018; Khan fabricated glass fibres, each with a diameter of 0.3 mm.
et al., 2019). Clinical data from teeth treated with such This design allows the bundle to be inserted after the ad-
custom-shaped posts are inconclusive. One study demon- hesive and composite have been applied, resulting in a
strated lower success rates for customized fibre posts flexible approach to evenly distribute the bundle across
compared to solid fibre posts following 6 years of clinical the canal, especially in the case of irregularly shaped anat-
service (Ferrari et al., 2012), whilst a further study showed omy. Previous studies demonstrated that bundled fibre
similar 5-year survival rates for cast gold posts and cores, posts exhibited intracanal adhesion as well as fracture re-
solid fibre posts and customized fibre posts (Fokkinga sistance comparable to that measured for solid fibre posts
et al., 2007). (Bitter et al., 2019; Kul et al., 2020; Sturm et al., 2021)
The relining of fibre posts with resin composite modi- but with more homogeneous stress distribution (Yanik &
fication using the root canal space has been suggested to Turker, 2022). Root filled maxillary central incisors with
(a) (b) (c)
(d) (e) (f)
F I G U R E 9 Lithium disilicate onlay (IPS e.max CAD) placement following root canal retreatment of 25 (a, b) preoperative occlusal view
and long-cone periapical radiograph (c) fibre post prior to cementation and core placement (d) completed core and onlay preparation with
distal deep margin elevation (e, f) final CAD-CAM restoration with postoperative occlusal view and follow-up periapical radiograph.
|
mesial and distal class III cavities restored with direct post-retained crown restorations were shown (Al-
composite demonstrated comparable fracture resistance Dabbagh, 2021), indicating that endocrowns are a reliable
to those restored with solid and bundled glass fibre posts, treatment option for compromised root filled molars and
and increased resistance compared to those restored with- premolars. Recommendations for the preparation design
out posts (Comba et al., 2021). In the case of weakened include a depth of 3 mm for the central retention cavity
and flared root canals in immature teeth a combination of with a divergence angle of 6–12° for more homogenous
adhesively placed solid and bundled fibre posts contrib- stress distribution (Abtahi et al., 2022; Tribst et al., 2021).
uted to fracture strength and stress distribution in vitro The cervical margin width should be at least 2 mm, and
(Santos et al., 2022). prepared flat or slightly bevelled (Zheng et al., 2022).
To date, no evidence exists that a specific post mate- Different materials have been used for the fabrication
rial or the rigidity of the post affects the outcome of post- of endocrowns using CAD-CAM technology. Lithium dis-
retained restorations. Posts mainly provide retention for ilicate ceramic has been recommended frequently for this
the coronal restoration and are therefore indicated in teeth purpose, due to its favourable physical properties, good
with extensive loss of coronal tooth structure. Substance aesthetics and its predictable bonding to tooth tissue.
preservation plays a key role in the survival probability of However, hybrid ceramics or CAD-CAM resin composites
root filled teeth, and therefore, extensive post space prepa- have a lower elastic modulus which is closer to that of den-
ration should be avoided, and the posts should be adapted tine. Such hybrid materials could act as a stress absorber
to the shaped root canal space rather than the other way and reduce stress peaks within the root-dentine and the
round. In cases of irregular-shaped or extremely flared restoration-tooth interfaces, under clinical loads (Gresnigt
root canals adhesively placed customized fibre posts, as et al., 2016; Rocca et al., 2016). A recent systematic review
well as fibre bundles, can be used as an alternative option. of in vitro studies demonstrated that CAD-CAM resin
composites had similar, increased, fracture resistance
when compared to lithium disilicate ceramics, with less
E N D O C ROWN S catastrophic failures also (Beji Vijayakumar et al., 2021).
However, finite element analyses revealed stress concen-
Restorations that contribute to the structural integrity of trations proportional to the elastic modulus of the resto-
root filled teeth, and preserve as much tooth structure as ration material, with a higher stress concentration within
possible, improve long-term prognosis. Preparation of a the lithium disilicate ceramic, and less stress reaching the
‘ferrule design’ is of utmost importance to prevent tooth cement layer and residual tooth structure (He et al., 2021).
or root fracture of post-endodontic crown restorations in Conversely, CAD- CAM resin composites demonstrated
severely compromised teeth (Juloski et al., 2012; Magne a more uniform stress distribution but higher stress
et al., 2017; Naumann et al., 2018). Ideally, this requires concentration inside the cement layer and surrounding
a minimum of 4–5 mm of supracrestal tooth tissue to pro- tooth structure, which may lead to debonding (Yildirim
vide a 2 mm ferrule preparation and secure a biological et al., 2021). Fractographic analyses of clinically failed
width of 2–3 mm, however, this is clinically not always composite resin-based endocrowns revealed a break-up of
available. Consequently, root filled teeth exhibiting sig- the composite structure with reduced mechanical proper-
nificant tooth structure loss may require surgical crown ties due to degradation processes and crack propagation
lengthening or orthodontic extrusion. Surgical crown leading to fracture events. These were mainly observed
lengthening can critically alter the crown-to-root ratio, through the central occlusal groove, indicating less fatigue
which contributes to stress and strain concentrations resistance of these restorations (Saratti et al., 2021). Due to
within the root dentine, and subsequently may negatively the lack of long-term controlled clinical studies, lithium
affect the fracture load behaviour and long-term reliabil- disilicate ceramics are currently the material of choice
ity of the post-endodontic restoration (Avila et al., 2009; for endocrowns, primarily due to its reliable bonding to
Gegauff, 2000; Tada et al., 2015). Therefore, endocrowns the resin cement and its long-term stability (El-Ma'aita
are a conservative approach for the restoration of root et al., 2022).
filled teeth without the need for post-space or ferrule de- Endocrowns present a viable treatment option for
sign preparation. root filled premolars and molars. These restorations per-
Recent systematic reviews and meta-analyses demon- mit the preservation of residual tooth structure, as post
strate high success rates for endocrowns in molars (72– space preparation and placement, as well as preparation
99%) and in premolars (68–100%) with a follow-up range of a ferrule design, are avoided. Adequate adhesive lut-
of 3–19 years, revealing no significant difference between ing, including proper isolation of the prepared tooth, are
tooth types (Thomas et al., 2020). Comparable survival a prerequisite for this treatment alternative and its long-
and success rates for endocrowns and conventional term survival probability. Based on the currently available
|
literature, lithium-disilicate ceramics appear to be the ma- AUTHOR CONTRIBUTIONS

terial of choice for endocrown restorations. All authors contributed to conceptualization, methodol-
ogy, data curation, writing, review and editing.
CON C LUS I ON S ETHICS STATEMENT

None.
The evidence- base for post- endodontic restorative
decision-making remains complex and unclear. However, CONFLICT OF INTEREST
the interdependency of endodontic and restorative treat- The authors have stated explicitly that there are no con-
ment is clearly established. Clinicians should consider flicts of interest in connection with this article.
both aspects of treatment equally, to give their patients the
best outcomes. Moreover, engrained in the initial treat- DATA AVAILABILITY STATEMENT
ment planning process should be the final restorative plan None
for the tooth being treated.
As well as appreciating the importance of residual ORCID
tooth structure, it is imperative to understand the rel- Bhavin Bhuva https://orcid.org/0000-0002-5413-9134
evance of tooth location and the number of proximal
contacts on the survival of root filled teeth, and thereby, REFERENCES
plan the post- endodontic restoration appropriately. Abad-Coronel, C., Naranjo, B. & Valdiviezo, P. (2019) Adhesive sys-
Therefore, it is also important to consider the prognosis tems used in indirect restorations cementation: review of the
of the teeth adjacent to that being treated, as their pre- literature. Dentistry Journal, 7, 71.
Abo-Hamar, S.E., Hiller, K.A., Jung, H., Federlin, M., Friedl, K.H.
mature loss may influence its survival. It is fundamen-
& Schmalz, G. (2005) Bond strength of a new universal self-
tally important for clinicians who undertake endodontic
adhesive resin luting cement to dentin and enamel. Clinical
treatment to have a good understanding of how occlusal Oral Investigations, 9, 161–167.
factors, and parafunctional stresses, may affect progno- Abtahi, S., Alikhasi, M. & Siadat, H. (2022) Biomechanical behav-
sis. The occlusion of each patient should be assessed ior of endocrown restorations with different cavity design and
prior to embarking on treatment, to identify and manage CAD-CAM materials under a static and vertical load: a finite
possible contributory factors, particularly in the case of element analysis. Journal of Prosthetic Dentistry, 127, 600.e1–
cracked teeth. 600.e8. https://doi.org/10.1016/j.prosdent.2021.11.027
Albelasy, E.H., Hamama, H.H., Tsoi, J.K.H. & Mahmoud, S.H. (2020)
The available evidence indicates that for posterior
Fracture resistance of CAD/CAM occlusal veneers: a system-
teeth, contemporary indirect techniques such as all ce-
atic review of laboratory studies. Journal of the Mechanical
ramic crowns, onlays and endocrowns are as predictable Behavior of Biomedical Materials, 110, 103948.
as metal ceramic crowns. However, prospective studies Al-Dabbagh, R.A. (2021) Survival and success of endocrowns: a
with longer follow-up periods are required to validate the systematic review and meta- analysis. Journal of Prosthetic
performance of these restorations. In addition, particu- Dentistry, 125, 415.e1–415.e9.
larly as dental materials evolve, the minimum required Alley, B.S., Kitchens, G.G., Alley, L.W. & Eleazer, P.D. (2004) A com-
thickness of ceramics and composite materials, as well as parison of survival of teeth following endodontic treatment per-
formed by general dentists or by specialists. Oral Surgery, Oral
cementation protocols require clarification for clinicians
Medicine, Oral Pathology, Oral Radiology and Endodontology,
to provide the best outcomes. 98, 115–118.
The validity of minimal intervention and/or biomi- Al-Nuaimi, N., Patel, S., Austin, R.S. & Mannocci, F. (2017) A pro-
metic endodontic-restorative concepts and techniques spective study assessing the effect of coronal tooth structure
has not been proven in clinical studies. However, this loss on the outcome of root canal retreatment. International
does not mean that these concepts should be dismissed. Endodontic Journal, 50, 1143–1157.
Indeed, surrogate measures from existing research sug- Al-Nuaimi, N., Ciapryna, S., Chia, M., Patel, S. & Mannocci, F. (2020)
A prospective study on the effect of coronal tooth structure loss
gest that there is a need for randomized clinical trials
on the 4-year clinical survival of root canal retreated teeth,
evaluating the long-term survival of root filled teeth
and retrospective validation of the dental practicality index.
restored with these techniques. Clearly, how these are International Endodontic Journal, 53, 1040–1049.
carried out, remains a challenge. The use of digital scan- Alomari, Q.D., Reinhardt, J.W. & Boyer, D.B. (2001) Effect of liners
ning offers an exciting opportunity for accurate volu- on cusp deflection and gap formation in composite restorations.
metric assessment of residual tooth structure which Operative Dentistry, 26, 406–411.
could be utilized to offer tangible qualitative data for Alves de Carvalho, I.F., Marques, S., Araújo, F.M., Azevedo, L.F.,
survival analysis which can then be conveyed to patients Donato, H. & Correia, A. (2018) Clinical performance of CAD/
CAM tooth- supported ceramic restorations: a systematic
to facilitate decision making.
|
review. The International Journal of Periodontics & Restorative custom made posts affects the 3-year survival of endodontically
Dentistry, 38, e68–e78. treated premolars. American Journal of Dentistry, 21, 179–184.
Aquilino, S.A. & Caplan, D.J. (2002) Relationship between crown Caplan, D.J. & Weintraub, J.A. (1997) Factors related to loss of root
placement and the survival of endodontically treated teeth. canal filled teeth. Journal of Public Health Dentistry, 57, 31–39.
Journal of Prosthetic Dentistry, 87, 256–263. Caplan, D.J., Kolker, J., Rivera, E.M. & Walton, R.E. (2002)
Arola, D. & Reprogel, R.K. (2005) Effects of aging on the mechanical Relationship between number of proximal contacts and sur-
behavior of human dentin. Biomaterials, 26, 4051–4061. vival of root canal treated teeth. International Endodontic
Avila, G., Galindo-Moreno, P., Soehren, S., Misch, C.E., Morelli, T. & Journal, 35, 193–199.
Wang, H.L. (2009) A novel decision-making process for tooth Carrilho, M.R., Geraldeli, S., Tay, F., de Goes, M.F., Carvalho, R.M.,
retention or extraction. Journal of Periodontology, 80, 476–491. Tjäderhane, L. et al. (2007) In vivo preservation of the hybrid
Ayad, M.F., Maghrabi, A.A., Saif, R.E. & García-Godoy, F. (2011) layer by chlorhexidine. Journal of Dental Research, 86, 529–533.
Influence of tooth preparation burs on the roughness and bond Carvalho, R.M., Pereira, J.C., Yoshiyama, M. & Pashley, D.H. (1996) A
strength of adhesives to human dentin surfaces. American review of polymerization contraction: the influence of stress de-
Journal of Dentistry, 24, 176–182. velopment versus stress relief. Operative Dentistry, 21(1), 17–24.
Banerjee, A. (2013) Minimal intervention dentistry: part 7, min- Carvalho, M.A., Lazari, P.C., Gresnigt, M., Del Bel Cury, A.A.
imally invasive operative caries management: rationale and & Magne, P. (2018) Current options concerning the
techniques. British Dental Journal, 214, 107–111. endodontically-treated teeth restoration with the adhesive ap-
Bauer, J., Silva E Silva, A., Carvalho, E.M., PVC, F., Carvalho, C.N., proach. Brazilian Oral Research, 32, e74.
Manso, A.P. et al. (2019) Dentin pretreatment with 45S5 and Castellan, C.S., Bedran-Russo, A.K., Karol, S. & Pereira, P.N. (2011)
niobophosphate bioactive glass: effects on pH, antibacterial, Long-term stability of dentin matrix following treatment with
mechanical properties of the interface and microtensile bond various natural collagen cross-linkers. Journal of the Mechanical
strength. Journal of the Mechanical Behavior of Biomedical Behavior of Biomedical Materials, 4, 1343–1350.
Materials, 90, 374–380. Castelo-Baz, P., Argibay-Lorenzo, O., Muñoz, F., Martin-Biedma, B.,
Beji Vijayakumar, J., Varadan, P., Balaji, L., Rajan, M., Kalaiselvam, Darriba, I.L., Miguéns-Vila, R. et al. (2021) Periodontal response
R., Saeralaathan, S. et al. (2021) Fracture resistance of resin to a tricalcium silicate material or resin composite placed in
based and lithium disilicate endocrowns. Which is better? –a close contact to the supracrestal tissue attachment: a histomor-
systematic review of in-vitro studies. Biomaterial Investigations phometric comparative study. Clinical Oral Investigations, 25,
in Dentistry, 8, 104–111. 5743–5753.
Benetti, A.R., Havndrup-Pedersen, C., Honoré, D., Pedersen, M.K. Chan, B.P., Hui, T.Y., Chan, O.C. et al. (2007) Photochemical cross-
& Pallesen, U. (2015) Bulk-fill resin composites: polymerisa- linking for collagen-based scaffolds: a study on optical proper-
tion contraction, depth of cure, and gap formation. Operative ties, mechanical properties, stability, and hematocompatibility.
Dentistry, 40, 190–200. Tissue Engineering, 13, 73–85.
Bertoldi, C., Monari, E., Cortellini, P., Generali, L., Lucchi, A., Chan, M.Y.C., Cheung, V., Lee, A.H.C. & Zhang, C. (2022) A litera-
Spinato, S. et al. (2020) Clinical and histological reaction of ture review of minimally invasive endodontic access cavities –
periodontal tissues to subgingival resin composite restorations. past, present and future. European Endodontic Journal, 7, 1–10.
Clinical Oral Investigations, 24, 1001–1011. Chrepa, V., Konstantinidis, I., Kotsakis, G.A. & Mitsias, M.E. (2014)
Bhuva, B., Giovarruscio, M., Rahim, N., Bitter, K. & Mannocci, F. The survival of indirect composite resin onlays for the resto-
(2021) The restoration of root filled teeth: a review of the clin- ration of root filled teeth: a retrospective medium-term study.
ical literature. International Endodontic Journal, 54, 509–535. International Endodontic Journal, 47, 967–973.
Bitter, K., Falcon, L., Prates Soares, A., Sturm, R., von Stein-Lausnitz, Clark, D. & Khademi, J. (2010) Modern molar endodontic access and
M. & Sterzenbach, G. (2019) Effect of application mode on bond directed dentin conservation. Dental Clinics, 54, 249–273.
strength of adhesively Luted glass-fiber bundles inside the root Cloet, E., Debels, E. & Naert, I. (2017) Controlled clinical trial on
canal. Journal of Adhesive Dentistry, 21, 517–524. the outcome of glass fibre composite cores versus wrought
Bomfim, D.I., Rahim, N.M. & Austin, R.S. (2020) Biomechanical posts and cast cores for the restoration of endodontically
planning for minimally invasive indirect restorations. British treated teeth: a 5-year follow-up study. International Journal of
Dental Journal, 229, 425–429. Prosthodontics, 30, 71–79.
Bresser, R.A., Gerdolle, D., van den Heijkant, I.A., Sluiter-Pouwels, Comba, A., Baldi, A., Saratti, C.M., Rocca, G.T., Torres, C.R.G.,
L.M., Cune, M.S. & Gresnigt, M.M. (2019) Up to 12 years clinical Pereira, G.K.R. et al. (2021) Could different direct restoration
evaluation of 197 partial indirect restorations with deep margin techniques affect interfacial gap and fracture resistance of end-
elevation in the posterior region. Journal of Dentistry, 91, 103227. odontically treated anterior teeth? Clinical Oral Investigations,
Broadbent, J.M., Williams, K.B., Thomson, W.M. & Williams, 25, 5967–5975.
S.M. (2006) Dental restorations: a risk factor for periodon- Creugers, N.H., Mentink, A.G., Fokkinga, W.A. & Kreulen, C.M.
tal attachment loss? Journal of Clinical Periodontology, 33, (2005) 5- year follow- up of a prospective clinical study on
803–810. various types of core restorations. International Journal of
Cagidiaco, M.C., Radovic, I., Simonetti, M., Tay, F. & Ferrari, M. Prosthodontics, 18, 34–39.
(2007) Clinical performance of fibre post restorations in end- Dal Piva, A.M.O., Tribst, J.P.M., Souza, R. & Borges, A.L.S. (2017)
odontically treated teeth: 2-year results. International Journal Influence of alveolar bone loss and cement layer thickness on
of Prosthodontics, 20, 293–298. the biomechanical behavior of endodontically treated maxil-
Cagidiaco, M.C., García-Godoy, F., Vichi, A., Grandini, S., Goracci, lary incisors: a 3-dimensional finite element analysis. Journal
C. & Ferrari, M. (2008) Placement of fibre prefabricated or of Endodontics, 43, 791–795.
|
Dal Piva, A.M.O., Tribst, J.P.M., Borges, A.L.S., Bottino, M.A. & Ferracane, J.L. (2011) Resin composite—state of the art. Dental
Souza, R.O.A. (2018) Do mechanical advantages exist in relin- Materials, 27, 29–38.
ing fiber posts with composite prior to its cementation? Journal Ferrari, M., Cagidiaco, M.C., Goracci, C., Vichi, A., Mason, P.N.,
of Adhesive Dentistry, 20, 511–518. Radovic, I. et al. (2007) Long- term retrospective study of
Dammaschke, T., Nykiel, K., Sagheri, D. & Schafer, E. (2013) the clinical performance of fibre posts. American Journal of
Influence of coronal restorations on the fracture resistance of Dentistry, 20, 287–291.
root canal-treated premolar and molar teeth: a retrospective Ferrari, M., Vichi, A., Fadda, G.M., Cagidiaco, M.C., Tay, F.R.,
study. Australian Endodontic Journal, 39, 48–56. Breschi, L. et al. (2012) A randomized controlled trial of end-
D'Arcangelo, C., Zarow, M., De Angelis, F., Vadini, M., Paolantonio, M., odontically treated and restored premolars. Journal of Dental
Giannoni, M. et al. (2014) Five-year retrospective clinical study of Research, 91, S72–S78.
indirect composite restorations luted with a light-cured composite Ferrari, M., Koken, S., Grandini, S., Cagidiaco, E.F., Joda, T. &
in posterior teeth. Clinical Oral Investigations, 18, 615–624. Discepoli, N. (2018) Influence of cervical margin relocation
de Souza, N.C., Marcondes, M.L., da Silva, D., Borges, G.A., Junior, (CMR) on periodontal health: 12-month results of a controlled
L.B. & Spohr, A.M. (2016) Relined fiberglass post: effect of trial. Journal of Dentistry, 69, 70–76.
luting length, resin cement, and cyclic loading on the bond to Ferrari, M., Cagidiaco, E.F., Goracci, C., Sorrentino, R., Zarone, F.,
weakened root dentin. Operative Dentistry, 41, e174–e182. Grandini, S. et al. (2019) Posterior partial crowns out of lithium
Dietschi, D. & Spreafico, R. (1998) Current clinical concepts for disilicate (LS2) with or without posts: a randomized controlled
adhesive cementation of tooth-colored posterior restorations. prospective clinical trial with a 3-year follow up. Journal of
Practical Periodontics and Aesthetic Dentistry, 10, 47–54. Dentistry, 83, 12–17.
Dietschi, D. & Spreafico, R.C. (2019) Evidence-based concepts and Ferrari, M., Pontoriero, D.I.K., Ferrari Cagidiaco, E. & Carboncini,
procedures for bonded inlays and onlays. Part III. A case se- F. (2022) Restorative difficulty evaluation system of endodonti-
ries with long-term clinical results and follow-up. International cally treated teeth. Journal of Esthetic and Restorative Dentistry,
Journal of Esthetic Dentistry, 14, 118–133. 34, 65–80.
Dioguardi, M., Alovisi, M., Troiano, G., Caponio, C.V., Baldi, A., Feuerstein, O., Matalon, S., Slutzky, H. & Weiss, E.I. (2007)
Rocca, G.T. et al. (2021) Clinical outcome of bonded partial in- Antibacterial properties of self-etching dental adhesive sys-
direct posterior restorations on vital and non-vital teeth: a systems. Journal of the American Dental Association, 138, 349–354.
tematic review and meta-analysis. Clinical Oral Investigations, Figueiredo, F.E., Martins-Filho, P.R. & Faria, E.S.A.L. (2015) Do
25, 6597–6621. metal post-retained restorations result in more root fractures
Douglas, R.D. (2000) Color stability of new- generation indirect than fiber post-retained restorations? A systematic review and
resins for prosthodontic application. The Journal of Prosthetic meta-analysis. Journal of Endodontics, 41, 309–316.
Dentistry, 83, 166–170. Fokkinga, W.A., Kreulen, C.M., Vallittu, P.K. & Creugers, N.H.
Driscoll, C.O., Dowker, S.E., Anderson, P., Wilson, R.M. & Gulabivala, (2004) A structured analysis of in vitro failure loads and fail-
K. (2002) Effects of sodium hypochlorite solution on root den- ure modes of fiber, metal, and ceramic post-and-core systems.
tine composition. Journal of Materials Science: Materials in International Journal of Prosthodontics, 17, 476–482.
Medicine, 13, 219–223. Fokkinga, W.A., Kreulen, C.M., Bronkhorst, E.M. & Creugers, N.H.
Eckerbom, M. & Magnusson, T. (2001) Restoring endodontically (2007) Up to 17-year controlled clinical study on post-and-cores
treated teeth: a survey of current opinions among board- and covering crowns. Journal of Dentistry, 35, 778–786.
certified prosthodontists and general dental practitioners in Fokkinga, W.A., Kreulen, C.M., Bronkhorst, E.M. & Creugers, N.H.
Sweden. International Journal of Prosthodontics, 14, 245–249. (2008) Composite resin core-crown reconstructions: an up to
El-Ma'aita, A., A Al-Rabab'ah, M., Abu-Awwad, M., Hattar, S. & 17-year follow-up of a controlled clinical trial. International
Devlin, H. (2022) Endocrowns clinical performance and patient Journal of Prosthodontics, 21, 109–115.
satisfaction: a randomized clinical trial of three monolithic ce- Fuss, Z., Lustig, J., Katz, A. & Tamse, A. (2001) An evaluation of
ramic restorations. Journal of Prosthodontics, 31, 30–37. endodontically treated vertical root fractured teeth: impact of
Enrich-Essvein, T., Rodríguez- Navarro, A.B., Álvarez- Lloret, P., operative procedures. Journal of Endodontics, 27, 46–48.
Cifuentes-Jiménez, C., Bolaños-Carmona, M.V. & González- Garcia, P.P., Wambier, L.M., de Geus, J.L., da Cunha, L.F., Correr,
López, S. (2021) Proanthocyanidin-functionalized hydroxyapa- G.M. & Gonzaga, C.C. (2019) Do anterior and posterior teeth
tite nanoparticles as dentin biomodifier. Dental Materials, 37, treated with post- and-core restorations have similar fail-
1437–1445. ure rates? A systematic review and meta-analysis. Journal of
Farina, A.P., Chiela, H., Carlini-Junior, B., Mesquita, M.F., Miyagaki, Prosthetic Dentistry, 121, 887–894.e4.
D.C., Randi Ferraz, C.C. et al. (2016) Influence of cement type Gegauff, A.G. (2000) Effect of crown lengthening and ferrule place-
and relining procedure on push-out bond strength of fiber posts ment on static load failure of cemented cast post-cores and
after cyclic loading. Journal of Prosthodontics, 25, 54–60. crowns. Journal of Prosthetic Dentistry, 84, 169–179.
Fathy, H., Hamama, H.H., El-Wassefy, N. & Mahmoud, S.H. (2022) Ghezzi, C., Brambilla, G., Conti, A., Dosoli, R., Ceroni, F. &
Clinical performance of resin-matrix ceramic partial coverage Ferrantino, L. (2019) Cervical margin relocation: case series
restorations: a systematic review. Clinical Oral Investigations, and new classification system. International Journal of Esthetic
23, 1–6. Dentistry, 14, 272–284.
Fawzy, A.S., Nitisusanta, L.I., Iqbal, K., Daood, U. & Neo, J. (2012) Grandini, S., Sapio, S. & Simonetti, M. (2003) Use of anatomic post
Riboflavin as a dentin crosslinking agent: ultraviolet a versus and core for reconstructing an endodontically treated tooth: a
blue light. Dental Materials, 28, 1284–1291. case report. Journal of Adhesive Dentistry, 5, 243–247.
|
Gresnigt, M.M., Ozcan, M., van den Houten, M.L., Schipper, L. & Juloski, J., Köken, S. & Ferrari, M. (2018) Cervical margin relocation
Cune, M.S. (2016) Fracture strength, failure type and Weibull in indirect adhesive restorations: a literature review. Journal of
characteristics of lithium disilicate and multiphase resin Prosthodontic Research, 62, 273–280.
composite endocrowns under axial and lateral forces. Dental Kakaboura, A., Rahiotis, C., Watts, D., Silikas, N. & Eliades, G. (2007)
Materials, 32, 607–614. 3D-marginal adaptation versus setting shrinkage in light-cured
Grigoratos, D., Knowles, J., Ng, Y.L. & Gulabivala, K. (2001) Effect of microhybrid resin composites. Dental Materials, 23, 272–278.
exposing dentine to sodium hypochlorite and calcium hydrox- Kamin, S. (1989) The biologic width--periodontal-restorative rela-
ide on its flexural strength and elastic modulus. International tionship. Singapore Dental Journal, 14, 13–15.
Endodontic Journal, 34, 113–119. Kanca, J., 3rd. (1996) Wet bonding: effect of drying time and dis-
Guess, P.C., Schultheis, S., Wolkewitz, M., Zhang, Y. & Strub, J.R. tance. American Journal of Dentistry, 9, 273–276.
(2013) Influence of preparation design and ceramic thicknesses Kang, S.H., Kim, B.S. & Kim, Y. (2016) Cracked teeth: distribution,
on fracture resistance and failure modes of premolar partial characteristics, and survival after root canal treatment. Journal
coverage restorations. Journal of Prosthetic Dentistry, 110, of Endodontics, 42, 557–562.
264–273. Khan, A.A., Al-Kheraif, A.A., Mohamed, B.A., Perea-Lowery, L.,
Hansen, E.K. & Asmussen, E. (1993) Cusp fracture of endodontically Sailynoja, E. & Vallittu, P.K. (2018) Influence of primers on the
treated posterior teeth restored with amalgam: teeth restored properties of the adhesive interface between resin composite
in Denmark before 1975 versus after 1979. Acta Odontologica luting cement and fiber-reinforced composite. Journal of the
Scandinavica, 51, 73–77. Mechanical Behavior of Biomedical Materials, 88, 281–287.
Hayashi, J., Espigares, J., Takagaki, T., Shimada, Y., Tagami, J., Khan, A.A., Mohamed, B.A., Al-Shamrani, S.S., Ramakrishnaiah,
Numata, T. et al. (2019) Real-time in-depth imaging of gap R., Perea-Lowery, L., Sailynoja, E. et al. (2019) Influence of
formation in bulk-fill resin composites. Dental Materials, 35, monomer systems on the bond strength between resin compos-
585–596. ites and polymerized fiber-reinforced composite upon aging.
He, J., Zheng, Z., Wu, M., Zheng, C., Zeng, Y. & Yan, W. (2021) The Journal of Adhesive Dentistry, 21, 509–516.
Influence of restorative material and cement on the stress dis- Khvostenko, D., Salehi, S., Naleway, S.E., Hilton, T.J., Ferracane, J.L.,
tribution of endocrowns: 3D finite element analysis. BMC Oral Mitchell, J.C. et al. (2015) Cyclic mechanical loading promotes
Health, 21, 495. bacterial penetration along composite restoration marginal
Helfer, A.R., Melnick, S. & Schilder, H. (1972) Determination of the gaps. Dental Materials, 31, 702–710.
moisture content of vital and pulpless teeth. Oral Surgery, Oral Kielbassa, A.M., Attin, T. & Hellwig, E. (1997) Diffusion behavior of
Medicine, and Oral Pathology, 34, 661–670. eugenol from zinc oxide–eugenol mixtures through human and
Ichim, I., Kuzmanovic, D.V. & Love, R.M. (2006) A finite element bovine dentin in vitro. Operative Dentistry, 22, 15–20.
analysis of ferrule design on restoration resistance and distri- Kishen, A. (2015) Biomechanics of fractures in endodontically
bution of stress within a root. International Endodontic Journal, treated teeth. Endodontic Topics, 33, 3–13.
39, 443–452. Kishen, A. & Asundi, A. (2005) Experimental investigation on the
Ikram, O.H., Patel, S., Sauro, S. & Mannocci, F. (2009) Micro- role of water in the mechanical behavior of structural den-
computed tomography of tooth tissue volume changes fol- tine. Journal of Biomedical Materials Research Part A, 73,
lowing endodontic procedures and post space preparation. 192–200.
International Endodontic Journal, 42, 1071–1076. Kishen, A. & Vedantam, S. (2007) Hydromechanics in dentine: role
Ilie, N., Bucuta, S. & Draenert, M. (2013) Bulk-fill resin-based com- of dentinal tubules and hydrostatic pressure on mechanical
posites: an in vitro assessment of their mechanical perfor- stress-strain distribution. Dental Materials, 23, 1296–1306.
mance. Operative Dentistry, 38, 618–625. Kishen, A., Shi, Z., Shrestha, A. & Neoh, K.G. (2008) An investi-
Imazato, S., Kuramoto, A., Takahashi, Y., Ebisu, S. & Peters, M.C. gation on the antibacterial and antibiofilm efficacy of cat-
(2006) In vitro antibacterial effects of dentin primer of Clearfil ionic nanoparticulates for root canal disinfection. Journal of
protect bond. Dental Materials, 22, 527–532. Endodontics, 34, 1515–1520.
Irie, M., Suzuki, K. & Watts, D.C. (2002) Marginal gap formation of Kishen, A., Shrestha, S., Shrestha, A., Cheng, C. & Goh, C. (2016)
light-activated restorative materials: effects of immediate setting Characterizing the collagen stabilizing effect of crosslinked
shrinkage and bond strength. Dental Materials, 18, 203–210. chitosan nanoparticles against collagenase degradation. Dental
Irie, M., Suzuki, K. & Watts, D.C. (2004) Immediate performance Materials, 32, 968–977.
of self-etching versus system adhesives with multiple light- Krastl, G., Weiger, R., Filippi, A., Van Waes, H., Ebeleseder, K., Ree,
activated restoratives. Dental Materials, 20, 873–880. M. et al. (2021) Endodontic management of traumatized perma-
Isufi, A., Plotino, G., Grande, N.M., Ioppolo, P., Testarelli, L., Bedini, nent teeth: a comprehensive review. International Endodontic
R. et al. (2016) Fracture resistance of endodontically treated Journal, 54, 1221–1245.
teeth restored with a bulkfill flowable material and a resin com- Kul, E., Yanikoglu, N., Yesildal Yeter, K., Bayindir, F. & Sakarya,
posite. Annali di Stomatologia, 7, 4. R.E. (2020) A comparison of the fracture resistance of premo-
Jameson, M.W., Hood, J.A. & Tidmarsh, B.G. (1993) The effects of lars without a ferrule with different post systems. Journal of
dehydration and rehydration on some mechanical properties of Prosthetic Dentistry, 123, 523.e1–523.e5.
human dentine. Journal of Biomechanics, 26, 1055–1065. Kwak, Y., Choi, J., Kim, K., Shin, S.J., Kim, S. & Kim, E. (2019)
Juloski, J., Radovic, I., Goracci, C., Vulicevic, Z.R. & Ferrari, M. The 5- year survival rate of nonsurgical endodontic treat-
(2012) Ferrule effect: a literature review. Journal of Endodontics, ment: a population-based cohort study in Korea. Journal of
38, 11–19. Endodontics, 45, 1192–1199.
|
Lang, H., Korkmaz, Y., Schneider, K. & Raab, W.H. (2006) Impact root dentine–mechanical, chemical and structural evaluation.
of endodontic treatments on the rigidity of the root. Journal of International Endodontic Journal, 40, 786–793.
Dental Research, 85, 364–368. Marinescu, A.G., Cîrligeriu, L.E., Boscornea-pușcu, A.S., Horhat,
Laumbacher, H., Strasser, T., Knüttel, H. & Rosentritt, M. (2021) R.M., Sgîia, S.T., Stoia, D.I. et al. (2020) Fracture strength eval-
Long-term clinical performance and complications of zirconia- uation of teeth with different designs of endodontic access
based tooth-and implant-supported fixed prosthodontic resto- cavities. Romanian Journal of Oral Rehabilitation, 12, 76–84.
rations: a summary of systematic reviews. Journal of Dentistry, Martins, M.D., Junqueira, R.B., de Carvalho, R.F., Lacerda, M., Fae,
111, 103723. D.S. & Lemos, C.A.A. (2021) Is a fiber post better than a metal
Leong, D.J., de Souza, N.N., Sultana, R. & Yap, A.U. (2020) Outcomes post for the restoration of endodontically treated teeth? A sys-
of endodontically treated cracked teeth: a systematic review tematic review and meta-analysis. Journal of Dentistry, 112,
and meta-analysis. Clinical Oral Investigations, 24, 465–473. 103750.
Li, F. & Kishen, A. (2018) Deciphering dentin tissue biomechanics Menezes, M.S., Queiroz, E.C., Campos, R.E., Martins, L.R.M. &
using digital moire interferometry: a narrative review. Optics Soares, C.J. (2008) Influence of endodontic sealer cement on
and Lasers in Engineering, 107, 273–280. fibreglass post bond strength to root dentine. International
Li, F.C., Nicholson, E., Singh, C.V. & Kishen, A. (2020) Microtissue Endodontic Journal, 41, 476–484.
engineering root dentin with photodynamically cross-linked Morimoto, S., Rebello de Sampaio, F.B., Braga, M.M., Sesma, N. &
nanoparticles improves fatigue resistance of endodontically Özcan, M. (2016) Survival rate of resin and ceramic inlays,
treated teeth. Journal of Endodontics, 46, 668–674. onlays, and overlays: a systematic review and meta-analysis.
Loewenstein, W.R. & Rathkamp, R. (1955) A study on the pressore- Journal of Dental Research, 95, 985–994.
ceptive sensibility of the tooth. Journal of Dental Research, 34, Moszner, N., Fischer, U.K., Ganster, B., Liska, R. & Rheinberger, V.
287–294. (2008) Benzoyl germanium derivatives as novel visible light
Lu, T., Peng, L., Xiong, F., Lin, X.Y., Zhang, P., Lin, Z.T. et al. (2018) photoinitiators for dental materials. Dental Materials, 24,
A 3-year clinical evaluation of endodontically treated posterior 901–907.
teeth restored with two different materials using the CEREC AC Nadeau, B., Chen, Z. & Kishen, A. (2019) Free water loss-induced
chair-side system. Journal of Prosthetic Dentistry, 119, 363–368. heterogeneous residual strain and reduced fatigue resistance in
Ma, P.S., Nicholls, J.I., Junge, T. & Phillips, K.M. (2009) Load fatigue root dentine: a 3-dimensional digital image correlation analy-
of teeth with different ferrule lengths, restored with fibre posts, sis. Journal of Endodontics, 45, 742–749.
composite resin cores, and all-ceramic crowns. The Journal of Nagasiri, R. & Chitmongkolsuk, S. (2005) Long-term survival of end-
Prosthetic Dentistry, 102, 229–234. odontically treated molars without crown coverage: a retrospec-
Macedo, V.C., Faria e Silva, A.L. & Martins, L.R. (2010) Effect of ce- tive cohort study. Journal of Prosthetic Dentistry, 93, 164–170.
ment type, relining procedure, and length of cementation on Naumann, M., Sterzenbach, G., Dietrich, T., Bitter, K., Frankenberger,
pull-out bond strength of fiber posts. Journal of Endodontics, R. & von Stein-Lausnitz, M. (2017) Dentin-like versus rigid end-
36, 1543–1546. odontic post: 11-year randomized controlled pilot trial on no-
Madhavan, K., Belchenko, D., Motta, A. & Tan, W. (2010) Evaluation wall to 2-wall defects. Journal of Endodontics, 43, 1770–1775.
of composition and crosslinking effects on collagen-based com- Naumann, M., Schmitter, M., Frankenberger, R. & Krastl, G. (2018)
posite constructs. Acta Biomaterialia, 6, 1413–1422. “Ferrule comes first. Post is second!” fake news and alternative
Magne, P. (2021) MiM for DME: matrix-in-a-matrix technique for facts? A systematic review. Journal of Endodontics, 44, 212–219.
deep margin elevation. The Journal of Prosthetic Dentistry. Nikolaenko, S.A., Lohbauer, U., Roggendorf, M., Petschelt, A.,
https://doi.org/10.1016/j.prosdent.2021.11.021 Dasch, W. & Frankenberger, R. (2004) Influence of c-factor and
Magne, P., Lazari, P.C., Carvalho, M.A., Johnson, T. & Del Bel Cury, layering technique on microtensile bond strength to dentin.
A.A. (2017) Ferrule-effect dominates over use of a fiber post Dental Materials, 20, 579–585.
when restoring endodontically treated incisors: an in vitro Oglakci, B., Kazak, M., Donmez, N., Dalkilic, E.E. & Koymen, S.S.
study. Operative Dentistry, 42(4), 396–406. (2019) The use of a liner under different bulk-fill resin com-
Malament, K.A., Margvelashvili- Malament, M., Natto, Z.S., posites: 3D GAP formation analysis by x-ray microcomputed
Thompson, V., Rekow, D. & Att, W. (2021) Comparison of 16.9- tomography. Journal of Applied Oral Science, 28, e2019004.
year survival of pressed acid etched e. max lithium disilicate Öztürk, E., Bolay, Ş., Hickel, R. & Ilie, N. (2013) Shear bond strength
glass-ceramic complete and partial coverage restorations in of porcelain laminate veneers to enamel, dentine and enamel-
posterior teeth: performance and outcomes as a function of dentine complex bonded with different adhesive luting sys-
tooth position, age, sex, and thickness of ceramic material. The tems. Journal of Dentistry, 41, 97–105.
Journal of Prosthetic Dentistry, 126, 533–545. Pantvisai, P. & Messer, H.H. (1995) Cuspal deflection in molars in
Mannocci, F., Bertelli, E., Sherriff, M., Watson, T.F. & Pitt Ford, T.R. relation to endodontic and restorative procedures. Journal of
(2002) Three-year clinical comparison of survival of endodon- Endodontics, 21, 57–61.
tically treated teeth restored with either full cast coverage or Papa, J., Cain, C. & Messer, H.H. (1994) Moisture content of vital vs
with direct composite restoration. The Journal of Prosthetic endodontically treated teeth. Dental Traumatology, 10, 91–93.
Dentistry, 88, 297–301. Pashley, D.H. (1990) Dentin permeability. In: LSW, S. (Ed.)
Mannocci, F., Bhuva, B. & Stern, S. (2008) Restoring teeth following Experimental endodontics. CRC Press, pp. 20–46.
root canal re-treatment. Endodontic Topics, 19, 125–152. Pashley, D.H. (1991) Dentin bonding: overview of the substrate with
Marending, M., Luder, H.U., Brunner, T.J., Knecht, S., Stark, W.J. & respect to adhesive material. Journal of Esthetic and Restorative
Zehnder, M. (2007) Effect of sodium hypochlorite on human Dentistry, 3, 46–50.
|
Pashley, D.H., Tay, F.R., Breschi, L., Tjäderhane, L., Carvalho, R.M., Sabatini, C. & Patel, S.K. (2013) Matrix metalloproteinase inhibitory
Carrilho, M. et al. (2011) State of the art etch-and-rinse adhe- properties of benzalkonium chloride stabilizes adhesive inter-
sives. Dental Materials, 27, 1–16. faces. European Journal of Oral Sciences, 121, 610–616.
Patel, S., Bhuva, B. & Bose, R. (2022) Vertical root fractures in root Saberi, E.A., Pirhaji, A. & Zabetiyan, F. (2020) Effects of end-
treated teeth-current status and future trends. International odontic access cavity design and thermocycling on fracture
Endodontic Journal, 55, 804–826. strength of endodontically treated teeth. Clinical, Cosmetic and
Perdigão, J., Reis, A. & Loguercio, A.D. (2013) Dentin adhesion Investigational Dentistry, 12, 149–156.
and MMPs: a comprehensive review. Journal of Esthetic and Sailer, I., Makarov, N.A., Thoma, D.S., Zwahlen, M. & Pjetursson,
Restorative Dentistry, 25, 219–241. B.E. (2015) All-ceramic or metal-ceramic tooth-supported fixed
Pereira, R.D., Leoni, G.B., Silva-Sousa, Y.T., Gomes, E.A., Dias, T.R., dental prostheses (FDPs)? A systematic review of the survival
Brito-Júnior, M. et al. (2021) Impact of conservative endodontic and complication rates. Part I: single crowns (SCs). Dental
cavities on root canal preparation and biomechanical behavior Materials, 31, 603–623.
of upper premolars restored with different materials. Journal of Salehrabi, R. & Rotstein, I. (2004) Endodontic treatment outcomes
Endodontics, 47, 989–999. in a large patient population in the USA: an epidemiological
Plotino, G., Grande, N.M., Isufi, A., Ioppolo, P., Pedullà, E., Bedini, study. Journal of Endodontics, 30, 846–850.
R. et al. (2017) Fracture strength of endodontically treated teeth Sampaio, P.C., de Almeida Junior, A.A., Francisconi, L.F., Casas-
with different access cavity designs. Journal of Endodontics, 43, Apayco, L.C., Pereira, J.C., Wang, L. et al. (2011) Effect of con-
995–1000. ventional and resin-modified glass-ionomer liner on dentin
Prati, C., Chersoni, S., Montebugnoli, L. & Montanari, G. (1999) Effect adhesive interface of class I cavity walls after thermocycling.
of air, dentin and resin-based composite thickness on light in- Operative Dentistry, 36, 403–412.
tensity reduction. American Journal of Dentistry, 12, 231–234. Santos, G.C., Jr., Santos, M.J. & Rizkalla, A.S. (2009) Adhesive ce-
Pratt, I., Aminoshariae, A., Montagnese, T.A., Williams, K.A., mentation of etchable ceramic esthetic restorations. Journal of
Khalighinejad, N. & Mickel, A. (2016) Eight-year retrospective the Canadian Dental Association, 75, 379–384.
study of the critical time lapse between root canal completion Santos, T., Abu Hasna, A., Abreu, R.T., Tribst, J.P.M., de Andrade, G.S.,
and crown placement: its influence on the survival of endodon- Borges, A.L.S. et al. (2022) Fracture resistance and stress distri-
tically treated teeth. Journal of Endodontics, 42, 1598–1603. bution of weakened teeth reinforced with a bundled glass fiber-
Pupo, Y.M., Farago, P.V., Nadal, J.M., Simão, L.C., Esmerino, L.A., reinforced resin post. Clinical Oral Investigations, 26, 1725–1735.
Gomes, O.M.M. et al. (2014) Effect of a novel quaternary am- Santosh, S.S., Ballal, S. & Natanasabapathy, V. (2021) Influence of
monium methacrylate polymer (QAMP) on adhesion and an- minimally invasive access cavity designs on the fracture resis-
tibacterial properties of dental adhesives. International Journal tance of endodontically treated mandibular molars subjected
of Molecular Sciences, 15, 8998–9015. to thermocycling and dynamic loading. Journal of Endodontics,
Randow, K. & Glantz, P.O. (1986) On cantilever loading of vital 47, 1496–1500.
and nonvital teeth an experimental clinical study. Acta Saratti, C.M., Rocca, G.T., Durual, S., Lohbauer, U., Ferracane, J.L. &
Odontologica Scandinavica, 44, 271–277. Scherrer, S.S. (2021) Fractography of clinical failures of indirect
Rashidi, H., Yang, J. & Shakesheff, K.M. (2014) Surface engineering of resin composite endocrown and overlay restorations. Dental
synthetic polymer materials for tissue engineering and regener- Materials, 37, e341–e359.
ative medicine applications. Biomaterials Science, 2, 1318–1331. Sarfati, A. & Tirlet, G. (2018) Deep margin elevation versus crown
Reddington, L., Knowles, J., Nazhat, S., Young, A., Gulabivala, K. & lengthening: biologic width revisited. International Journal of
Ng, Y.L. (2003) An in vitro evaluation of the visco-elastic be- Esthetic Dentistry, 13, 334–356.
haviour and composition of dentine matrix soaked in EDTA Sauro, S. & Pashley, D.H. (2016) Strategies to stabilise dentine-bonded
and NaOCl independently and in combination. International interfaces through remineralising operative approaches –state
Endodontic Journal, 36, 939. of the art. International Journal of Adhesion and Adhesives, 69,
Ree, M.H. & Schwartz, R.S. (2017) Long-term success of nonvital, 39–57.
immature permanent incisors treated with a mineral trioxide Sauro, S., Watson, T.F., Thompson, I., Toledano, M., Nucci, C. &
aggregate plug and adhesive restorations: a case series from Banerjee, A. (2012a) Influence of air-abrasion executed with
a private endodontic practice. Journal of Endodontics, 43, polyacrylic acid-bioglass 45S5 on the bonding performance of a
1370–1377. resin-modified glass ionomer cement. European Journal of Oral
Reeh, E.S., Messer, H.H. & Douglas, W.H. (1989) Reduction in tooth Sciences, 20, 168–177.
stiffness as a result of endodontic and restorative procedures. Sauro, S., Watson, T.F., Thompson, I. & Banerjee, A. (2012b) One-
Journal of Endodontics, 15, 512–516. bottle self-etching adhesives applied to dentine air- abraded
Rocca, G.T., Sedlakova, P., Saratti, C.M., Sedlacek, R., Gregor, L., using bioactive glasses containing polyacrylic acid: an in vitro
Rizcalla, N. et al. (2016) Fatigue behavior of resin-modified microtensile bond strength and confocal microscopy study.
monolithic CAD-CAM RNC crowns and endocrowns. Dental Journal of Dentistry, 40, 896–905.
Materials, 32, e338–e350. Sauro, S., Faus-Matoses, V., Makeeva, I., Nuñez Martí, J.M., Gonzalez
Rosa, W.L., Piva, E. & Silva, A.F. (2015) Bond strength of universal Martínez, R., García Bautista, J.A. et al. (2018) Effects of poly-
adhesives: a systematic review and meta-analysis. Journal of acrylic acid pre-treatment on bonded-dentine interfaces created
Dentistry, 43, 765–776. with a modern bioactive resin-modified glass ionomer cement and
Rueggeberg, F.A., Caughman, W.F., Curtis, J.W., Jr. & Davis, H.C. subjected to cycling mechanical stress. Materials (Basel), 11, 1884.
(1993) Factors affecting cure at depths within light-activated Sauro, S., Makeeva, I., Faus-Matoses, V., Foschi, F., Giovarruscio, M.,
resin composites. American Journal of Dentistry, 6, 91–95. Maciel Pires, P. et al. (2019) Effects of ions-releasing restorative
|
materials on the dentine bonding longevity of modern univer- Slimani, A., Sauro, S., Gatón Hernández, P., Gurgan, S., Turkun, L.S.,
sal adhesives after load-cycle and prolonged artificial saliva Miletic, I. et al. (2021) Commercially available ion-releasing
aging. Materials (Basel), 12, 722. dental materials and cavitated carious lesions: clinical treat-
Scaffa, P.M., Vidal, C.M., Barros, N., Gesteira, T.F., Carmona, A.K., ment options. Materials (Basel), 14, 6272.
Breschi, L. et al. (2012) Chlorhexidine inhibits the activity of Söderholm KJ. Dental adhesives … how it all started and later evolved.
dental cysteine cathepsins. Journal of Dental Research, 91, The Journal of Adhesive Dentistry. 2007;(9 Suppl):227- 230.
420–425. Erratum in: J Adhes Dent. 2007 Dec;9(6):546.
Schmitter, M., Doz, P., Rammelsberg, P., Gabbert, O. & Ohlmann, Sorensen, J.A. & Engelman, M.J. (1990) Ferrule design and fracture
B. (2007) Influence of clinical baseline findings on the survival resistance of endodontically treated teeth. Journal of Prosthetic
of 2 post systems: a randomized clinical trial. International Dentistry, 63, 529–536.
Journal of Prosthodontics, 20, 173–178. Spagnuolo, G., Pires, P.M., Calarco, A., Peluso, G., Banerjee, A.,
Schmitter, M., Hamadi, K. & Rammelsberg, P. (2011) Survival of two Rengo, S. et al. (2021) An in-vitro study investigating the effect
post systems--five-year results of a randomized clinical trial. of air-abrasion bioactive glasses on dental adhesion, cytotox-
Quintessence International, 42, 843–850. icity and odontogenic gene expression. Dental Materials, 37,
Schwartz, R.S., Murchison, D.F. & Walker, W.A. (1998) Effects of 1734–1750.
eugenol and noneugenol endodontic sealer cements on post Spitznagel, F.A., Scholz, K.J., Strub, J.R., Vach, K. & Gierthmuehlen,
retention. Journal of Endodontics, 24, 564–567. P.C. (2018) Polymer- infiltrated ceramic CAD/CAM inlays
Sedgley, C.M. & Messer, H.H. (1992) Are endodontically treated and partial coverage restorations: 3-year results of a prospec-
teeth more brittle? Journal of Endodontics, 18, 332–335. tive clinical study over 5 years. Clinical Oral Investigations, 22,
Sequeira-Byron, P., Fedorowicz, Z., Carter, B., Nasser, M. & Alrowaili, 1973–1983.
E.F. (2015) Single crowns versus conventional fillings for the Sturm, R., Prates Soares, A., Sterzenbach, G. & Bitter, K. (2021)
restoration of root- filled teeth. The Cochrane Database of Interface analysis after fatigue loading of adhesively luted
Systematic Reviews, 9, CD009109. bundled fiber posts to human root canal dentin. Journal of the
Setzer, F.C., Boyer, K.R., Jeppson, J.R., Karabucak, B. & Kim, S. Mechanical Behavior of Biomedical Materials, 119, 104385.
(2011) Long-term prognosis of endodontically treated teeth: a Sung, H.W., Chang, Y., Chiu, C.T., Chen, C.N. & Liang, H.C. (1999)
retrospective analysis of preoperative factors in molars. Journal Crosslinking characteristics and mechanical properties of a bo-
of Endodontics, 37, 21–25. vine pericardium fixed with a naturally occurring crosslinking
Shrestha, A., Friedman, S. & Kishen, A. (2011) Photodynamically agent. Journal of Biomedical Materials Research, 47, 116–126.
crosslinked and chitosan-incorporated dentin collagen. Journal Tada, S., Allen, P.F., Ikebe, K., Zheng, H., Shintani, A. & Maeda,
of Dental Research, 90, 1346–1351. Y. (2015) The impact of the crown-root ratio on survival of
Signore, A., Benedicenti, S., Kaitsas, V., Barone, M., Angiero, F. & abutment teeth for dentures. Journal of Dental Research, 94,
Ravera, G. (2009) Long-term survival of endodontically treated, 220S–225S.
maxillary anterior teeth restored with either tapered or parallel- Tan, L., Chen, N.N., Poon, C.Y. & Wong, H.B. (2006) Survival of
sided glass-fibre posts and full-ceramic crown coverage. Journal root filled cracked teeth in a tertiary institution. International
of Dentistry, 37, 115–121. Endodontic Journal, 39, 886–889.
Silva, E.J.N.L., Pinto, K.P., Ferreira, C.M., Belladonna, F.G., De-Deus, Teichmann, M., Göckler, F., Weber, V., Yildirim, M., Wolfart, S. &
G., Dummer, P.M. et al. (2020) Current status on minimal ac- Edelhoff, D. (2017) Ten-year survival and complication rates
cess cavity preparations: a critical analysis and a proposal for a of lithium- disilicate (empress 2) tooth- supported crowns,
universal nomenclature. International Endodontic Journal, 53, implant-supported crowns, and fixed dental prostheses. Journal
1618–1635. of Dentistry, 56, 65–77.
Silva, C.F., Cabral, L.C., Navarro de Oliveira, M., da Mota, M.V., Tekçe, N., Pala, K., Demirci, M. et al. (2016) Influence of different
Machado, A.C., Blumenberg, C. et al. (2021a) The influence composite materials and cavity preparation designs on the frac-
of customization of glass fiber posts on fracture strength and ture resistance of mesio-occluso-distal inlay restoration. Dental
failure pattern: a systematic review and meta-analysis of pre- Materials, 35, 523–531.
clinical ex-vivo studies. Journal of the Mechanical Behavior of Thomas RM, Kelly A, Tagiyeva N, Kanagasingam S (2020).
Biomedical Materials, 118, 104433. Comparing endocrown restorations on permanent molars
Silva, E.J.N.L., Versiani, M.A., Souza, E.M. & De-Deus, G. (2021b) and premolars: a systematic review and meta-analysis. British
Minimally invasive access cavities: does size really matter? Dental Journal. https://doi.org/10.1038/s41415-020-2279-y.
International Endodontic Journal, 54, 153–155. Epub ahead of print
Silva, E.J.N.L., De- Deus, G., Souza, E.M., Belladonna, F.G., Tian, F., Jett, K., Flaugher, R., Arora, S., Bergeron, B., Shen, Y.
Cavalcante, D.M., Simões-Carvalho, M. et al. (2022) Present sta- et al. (2021) Effects of dentine surface cleaning on bonding of
tus and future directions –minimal endodontic access cavities. a self-etch adhesive to root canal sealer-contaminated dentine.
International Endodontic Journal, 55, 531–587. Journal of Dentistry, 112, 103766.
Sim, I.G., Lim, T.S., Krishnaswamy, G. & Chen, N.N. (2016) Decision Toledano, M., Cabello, I., Aguilera, F.S., Osorio, E. & Osorio, R. (2015)
making for retention of endodontically treated posterior Effect of in vitro chewing and bruxism events on remineraliza-
cracked teeth: a 5-year follow-up study. Journal of Endodontics, tion, at the resin-dentin interface. Journal of Biomechanics, 48,
42, 225–229. 14–21.
Skupien, J.A., Luz, M.S. & Pereira-Cenci, T. (2016) Ferrule effect: Torbjörner, A. & Fransson, B. (2004) A literature review on the
a meta-analysis. JDR Clinical and Translational Research, 1, prosthetic treatment of structurally compromised teeth.
31–39. International Journal of Prosthodontics, 17, 369–376.
|
Tribst, J.P.M., Lo Giudice, R., Dos Santos, A.F.C., Borges, A.L.S., Yanik, D. & Turker, N. (2022) Stress distribution of a novel bundle
Silva-Concilio, L.R., Amaral, M. et al. (2021) Lithium disili- fiber post with curved roots and oval canals. Journal of Esthetic
cate ceramic Endocrown biomechanical response according to and Restorative Dentistry, 34, 550–556.
different pulp chamber extension angles and filling materials. Yildirim, G., Demir, C., Güven, M.Ç., Koç, O. & Dalkiliç, E.E. (2021)
Materials (Basel), 14, 1307. Influence of fiber insertion and different material type on
Vallittu, P.K. (2009) Interpenetrating polymer networks (IPNs) in stress distribution in endocrown restorations: a 3D-FEA study.
dental polymers and composites. Journal of Adhesion Science Computer Methods in Biomechanics and Biomedical Engineering,
and Technology, 23, 961–972. 1–11. https://doi.org/10.1080/10255842.2021.2019228
Van Meerbeek, B., De Munck, J., Yoshida, Y., Inoue, S., Vargas, M., Yiu, C.K., Hiraishi, N., Tay, F.R. & King, N.M. (2012) Effect of
Vijay, P. et al. (2003) Buonocore memorial lecture. Adhesion chlorhexidine into dental adhesive resin on durability of
to enamel and dentin: current status and future challenges. resin-dentin bond. The Journal of Adhesive Dentistry, 14,
Operative Dentistry, 28, 215–235. 355–362.
Van Meerbeek, B., Van Landuyt, K., De Munck, J., Hashimoto, M., Zheng, Z., Sun, J., Jiang, L., Wu, Y., He, J., Ruan, W. et al. (2022)
Peumans, M., Lambrechts, P. et al. (2005) Technique-sensitivity Influence of margin design and restorative material on the
of contemporary adhesives. Dental Materials Journal, 24, 1–3. stress distribution of endocrowns: a 3D finite element analysis.
Wang, X., Shu, X., Zhang, Y., Yang, B., Jian, Y. & Zhao, K. (2019) BMC Oral Health, 22, 30.
Evaluation of fiber posts vs metal posts for restoring severely
damaged endodontically treated teeth: a systematic review and
meta-analysis. Quintessence International, 50, 8–20.
Wollensak, G. & Iomdina, E. (2009) Long-term biomechanical prop- How to cite this article: Mannocci, F., Bitter, K.,
erties of rabbit sclera after collagen crosslinking using ribofla- Sauro, S., Ferrari, P., Austin, R. & Bhuva, B. (2022)
vin and ultraviolet a (UVA). Acta Ophthalmologica, 87, 193–198. Present status and future directions: The
Xiong, J., Shen, L., Jiang, Q. & Kishen, A. (2020) Effect of crosslinked
restoration of root filled teeth. International
chitosan nanoparticles on the bonding quality of fiber posts in
root canals. Journal of Adhesive Dentistry, 22, 321–330.
Endodontic Journal, 55(Suppl. 4), 1059–1084.
Yan, W., Montoya, C., Oilo, M. et al. (2017) Reduction in fracture resis- Available from: https://doi.org/10.1111/iej.13796
tance of the root with aging. Journal of Endodontics, 43, 1494–1498.

Int Endodontic J - 2022 - Mannocci - Present Status and Future Directions The Restoration of Root Filled Teeth

Uploaded by

Copyright:

Available Formats

Int Endodontic J - 2022 - Mannocci - Present Status and Future Directions The Restoration of Root Filled Teeth

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Int Endodontic J - 2022 - Mannocci - Present Status and Future Directions The Restoration of Root Filled Teeth

Uploaded by

Copyright:

Available Formats

Received: 8 June 2022

| Accepted: 5 July 2022

Present status and future directions: The restoration of root

Francesco Mannocci1 | Kerstin Bitter2 | Salvatore Sauro3 | Paolo Ferrari4 |

Bhavin Bhuva is the main author.

Int Endod J. 2022;55(Suppl. 4):1059–1084. ﻿ wileyonlinelibrary.com/journal/iej | 1059

I N T RO DU CT ION quality, it seems logical that these should be considered

a greater unity between the endodontic and restorative

Randow & Glantz, 1986)

filling materials and

(Reeh et al., 1989)

Effect of root canal

For this narrative review, an unrestricted literature search

Root canal preparation (Hansen &

et al., 2001; Marending

Effect of irrigants and

full text was retrieved.

Collagen alteration (Driscoll

The structural and biomechanical considerations which

(Helfer et al., 1972; Sedgley &

(Bhuva et al., 2021; Table 1).

These factors, in combination, affect restoration and

contributory factor. Evidence also exists for the impact of

properties of dentine that result from loss of vitality, and

the effects of endodontic and restorative procedures,

Residual tooth volume DENTINE SUBSTRATE

(a) (b) (c) (d)

(a) (b) (c)

(d) (e) (f)

(a) (b) (c) (d)

(e) (f) (g)

(h) (i) (j)

(a) (b) (c)

(d) (e) (f) (g)

(h) (i) (j)

(a) (b) (c) (d) (e)

(f) (g) (h) (i)

(j) (k) (l)

(a) (b) (c)

(d) (e) (f)

literature, lithium-­disilicate ceramics appear to be the ma- AUTHOR CONTRIBUTIONS

CON C LUS I ON S ETHICS STATEMENT

You might also like

Int Endod J. 2022;55(Suppl. 4):1059–1084. wileyonlinelibrary.com/journal/iej | 1059

literature, lithium-disilicate ceramics appear to be the ma- AUTHOR CONTRIBUTIONS