References

Jensen A, Abbott P V, Salgado JC Interim and temporary restoration of teeth during endodontic treatment. Aust Dent J. 2007; 52:S83-99
Mannocci F, Cowie J Restoration of endodontically treated teeth. Br Dent J. 2014; 216:341-346 https://doi.org/10.1038/sj.bdj.2014.198
Kielbassa AM, Frank W, Madaus T Radiologic assessment of quality of root canal fillings and peri-apical status in an Austrian subpopulation. An observational study. PLoS One. 2017; 12
Faria ACL, Rodrigues RCS, de Almeida Antunes RP Endodontically treated teeth: characteristics and considerations to restore them. J Prosthodont Res. 2011; 55:69-74
Nagasiri R, Chitmongkolsuk S Long-term survival of endodontically treated molars without crown coverage: a retrospective cohort study. J Prosthet Dent. 2005; 93:164-170
Awawdeh L, Hemaidat K, Al-Omari W Higher maximal occlusal bite force in endodontically treated teeth versus vital contralateral counterparts. J Endod. 2017; 43:871-8875
Schneider BJ, Freitag-Wolf S, Kern M Tactile sensitivity of vital and endodontically treated teeth. J Dent. 2014; 42:1422-1477
Ferrari M, Pontoriero DIK, Ferrari Cagidiaco E, Carboncini F Restorative difficulty evaluation system of endodontically treated teeth. J Esth Rest Dent. 2022; 34:65-80
Sabeti M, Kazem M, Dianat O Impact of access cavity design and root canal taper on fracture resistance of endodontically treated teeth: an ex vivo investigation. J Endod. 2018; 44:1402-1406
Juloski J, Radovic I, Goracci C Ferrule effect: a literature review. J Endod. 2012; 38:11-19
Clark D, Khademi J Modern molar endodontic access and directed dentine conservation. Dent Clin. 2010; 54:249-273
Naumann M, Schmitter M, Frankenberger R, Krastl G ‘Ferrule comes first. Post is second!’ Fake news and alternative facts? A systematic review. J Endod. 2018; 44:212-219
Al-Sanabani FA, Al-Makramani BM, Alaajam WH Effect of partial ferrule on fracture resistance of endodontically treated teeth: a meta-analysis of in vitro studies. J Prosthodont Res. 2023; 67:348-359
Jurado CA, Amarillas-Gastelum C, Tonin BSH Traditional versus conservative endodontic access impact on fracture resistance of chairside CAD-CAM lithium disilicate anterior crowns: an in vitro study. J Prosthodont. 2023; 32:728-734 https://doi.org/10.1111/jopr.13625
Abou-Elnaga MY, Alkhawas MBAM, Kim HC, Refai AS Effect of truss access and artificial truss restoration on the fracture resistance of endodontically treated mandibular first molars. J Endod. 2019; 45:813-817
Magne P, Spreafico RC Deep margin elevation: a paradigm shift. Am J Esthet Dent. 2012; 2:86-96
Samartzi TK, Papalexopoulos D, Ntovas P Deep margin elevation: a literature review. Dent J (Basel). 2022; 10
Frankenberger R, Hehn J, Hajtó J Effect of proximal box elevation with resin composite on marginal quality of ceramic inlays in vitro. Clin Oral Investig. 2013; 17:177-183
Cavalheiro CP, Scherer H, Imparato JCP Use of flowable resin composite as an intermediate layer in class II restorations: a systematic review and meta-analysis. Clin Oral Investig. 2021; 25:5629-5639
Yuan Y, Intajak P, Islam R Effect of sodium hypochlorite on bonding performance of universal adhesives to pulp chamber dentin. J Dent Sci. 2023; 18:1116-1124
Gavriil D, Kakka A, Myers P, O'Connor CJ Pre-endodontic restoration of structurally compromised teeth: current concepts. Br Dent J. 2021; 231:343-349
Rao S, Ballal N V Endodontic buildups: a case series. J Dent. 2017; 5:6-12
Kimble P, Corso AM, Beattie M Biomimetics and the restoration of the endodontically treated tooth. Braz Dent Sci. 2023;
Kimble P, Stuhr S, McDonald N, Venugopalan A Decision making in the restoration of endodontically treated teeth: effect of biomimetic dentistry training. Dent J (Basel). 2023; 11
Spagnuolo G, Pires PM, Calarco A An in-vitro study investigating the effect of air-abrasion bioactive glasses on dental adhesion, cytotoxicity and odontogenic gene expression. Dent Mater. 2021; 37:1734-1750
Magne P IDS: immediate dentin sealing (IDS) for tooth preparations. J Adhes Dent. 2014; 16
Deliperi S, Bardwell DN Reconstruction of nonvital teeth using direct fiber-reinforced composite resin: a pilot clinical study. J Adhes Dent. 2009; 11:71-78
Alleman DS, Alleman DS, Deliperi S Decoupling with time: a solution to the problem of the hierarchy of bondability. Inside Dentistry. 2021; 17:35-40
Valizadeh S, Ranjbar Omrani L, Deliperi S, Sadeghi Mahounak F Restoration of a nonvital tooth with fiber reinforce composite (wallpapering technique). Case Rep Dent. 2020; 2020 https://doi.org/10.1155/2020/9619787
Deliperi S, Alleman D, Rudo D Stress-reduced direct composites for the restoration of structurally compromised teeth: fiber design according to the ‘wallpapering’ technique. Oper Dent. 2017; 42:233-243

Current concepts in restoring endodontically treated teeth

From Volume 52, Issue 1, January 2025 | Pages 26-34

Authors

Lora Mishra

BDS, MDS (Endodontics), Professor, Department of Conservative Dentistry and Endodontics, Siksha ‘O’ Anusandhan, Institute of Dental Sciences, Bhubaneswar, Odisha, India

Articles by Lora Mishra

Tony Francis

BDS, MDS

BDS, MDS (Endodontics), Associate Professor, Department of Conservative Dentistry and Endodontics, Manipal University College Malaysia, Melaka, Malaysia

Articles by Tony Francis

Deviprasad Nooji

BDS, MDS (Prosthodontics), Professor, Department of Prosthodontics, KVG Dental College and Hospital, Sullia, Karnataka, India

Articles by Deviprasad Nooji

Himanshi Aggarwal

BDS, MDS (Prosthodontics), Maxillofacial Prosthetics Fellow, Department of Restorative Sciences, School of Dentistry, University of Alabama at Birmingham, USA

Articles by Himanshi Aggarwal

Ewen McColl

BSc(Hons), BDS, MFDS, FDS RCPS, MCGDent, MRD RCS Ed, MClinDent, FDS RCS(Rest Dent), FHEA, FDTF(Ed), , BSc (Hons), FCGDent, FDTFEd, FFD RCSI

BSc (Hons), BDS, FDS RCPS, FCGDent, MRD RCS Ed, MClinDent, FDS RCS(Rest Dent), FDTFEd, FFD RCSI, FHEA, Head of School, Director of Clinical Dentistry, Peninsula Dental School, University of Plymouth

Articles by Ewen McColl

Email Ewen McColl

Prashanti Eachempati

BDS, MDS (Prosthodontics), MSc, MPhil, DICOI, FADI, FICCDE, FAIMER, FAoME,

BDS, MDS (Prosthodontics), MSc, MPhil, DICOI, FADI, FICCDE, FAIMER, FAoME, Peninsula Dental School, University of Plymouth

Articles by Prashanti Eachempati

Abstract

Restoration of endodontically treated teeth (ETT) is crucial for long-term success. This article reviews current concepts in restoring ETT, which focuses on structural integrity and functional performance. Key factors, including residual tooth structure, ferrule effect and peri-cervical dentine preservation, are discussed alongside advances in conservative access designs, biomimetic protocols and innovative materials, such as ultra-high molecular weight polyethylene fibres. Decision-making frameworks, including the Restorative Difficulty Evaluation System (RDES), are highlighted to support clinicians in achieving predictable outcomes, ensuring tooth survival and patient satisfaction.

CPD/Clinical Relevance: The long-term success of endodontically treated teeth depends on selecting appropriate restorative strategies that ensure structural integrity, functional performance and aesthetic outcomes, informed by current evidence and tailored clinical decision-making.

Article

Prevailing evidence identifies bacterial infiltration through the coronal structure of the tooth as the primary cause of endodontic and pulpal diseases.1 The restorative phase of endodontic treatment is thus critical, not only forming the culmination of the procedure with a focus on preventing recontamination, but also preserving long-term functionality and aesthetic aspects of the tooth.2 The success of endodontic procedures is more influenced by microbial eradication and the establishment of an effective coronal seal and is a decisive factor in the long-term success of treatment.3 Additionally, the restoration process reinforces the structural integrity of the tooth and contributes to the maintenance of periodontal health. This article provides a concise overview of the current concepts in restoring endodontically treated teeth (ETT), underscoring their importance in preserving tooth viability and performance.

The challenges in treating ETT are multifaceted, often arising from structural compromises owing to extensive caries, previous restorations, and necessary removal of tooth structure during treatment. While there was a belief that root canal therapy could cause teeth to become more brittle by reducing moisture content, research has shown that there is no significant difference in moisture between vital and endodontically treated human teeth.4 Present understanding indicates that it is not the endodontic treatment, but rather the loss of coronal and peri-cervical hard tissues that mostly contributes to an increased susceptibility to fractures.5 The resulting reduction in dentine volume and sound tooth structure inevitably impacts the mechanical resilience of the tooth. Additionally, the absence of pulp tissue affects mechanoreceptive feedback, potentially making ETT more prone to fracture under adverse loading conditions.6,7

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