Restorative options for root filled teeth Flashcards
what is the root filled tooth at risk of
what other 2 things is the root filled tooth risk of
what is the risk of patient not having pulp
Without pulp, patients don’t know what they’re doing so much- overload, biting
How do we preserve dentin,enamel yet still achieve root canal
what are the 4 principles of restoring root filled teeth
what is restoration
describe the coronal tissue assessment before RCT
what other factors would you consider in coronal tissue assessment
what is the ferrule effect
Post is going to fill the canal
Crown isn’t going to overload
Needs to be the right occlsuions
Prepare post
Instead of using tooth tissue, the crown is overlapped
Occlusal forces supported by crown are transferred around the root
Encircling of natural tooth is achieving the ferrule effect
1.5-2 mm of overlap of crown beyond that natural tooth tissue
what is the Nayyar type core
Molar
Place composite in
And place large composite into coronal aspect of root canal
Crown on the top achieving ferrule
Core - enough tooth tissue to bond too
Why do we use posts
Describe different types of post
what are the lab stages involved in cast post and core
Rarely done due to better alternatives
- a post is cast along with the core in the lab and this single unit is then cemented into the tooth at a further visit
- a temporary post and core is needed between appointments
the first stage of post involves
Lab casts up the dental impression
Pour it , they have a model
sLab can construct a post
what is an endo crown
what is failure of restored root filled teeth
Drill into root canal
Angulations wrong
Rubber dam
- root fracture
- fractured post
- poor coronal seal
- Why are root-filled teeth structurally weaker?
➡️ Once the pulp is gone:
❌ No proprioception ➝ can’t sense biting forces properly
🔨 Weakened structure ➝ due to access cavity + caries
🦷 Increased fracture risk from normal chewing forces
🔐 2. What are the main goals of restoring a root-filled tooth?
✅ Protect tooth structure
✅ Prevent reinfection
✅ Restore function & aesthetics
✅ Maintain periodontal health
✅ Provide a coronal seal to block bacteria
✅ Prevent over-eruption & drifting by maintaining contact points
💫 3. What is the Ferrule Effect?
🦷 A 360° band of 1.5–2 mm sound tooth structure that:
Reinforces the tooth
Helps resist fracture
Distributes occlusal forces
Is vital for post/core success
📍 Think of it like a metal ring around a barrel – it holds everything together! 💍
🔍 4. Why is a ferrule so important?
🛡️ Boosts fracture resistance
📉 Reduces stress on post/core
🔁 Prevents failure from torque or lateral forces
🌟 Increases longevity of restoration
✅ More important than post type!
📏 5. What are the ideal ferrule dimensions?
📏 Height: 1.5–2 mm
🌍 Ideally 360° around tooth
✅ On natural dentine
🚫 Shouldn’t invade biological width
🛠️ 6. What if there’s no ferrule available?
🔧 Try to create one using:
🦷 Crown lengthening
🦷 Orthodontic extrusion
❌ Extract if not restorable
🧪 7. What are the treatment options for root-filled teeth?
🔹 Extract ❌
🔹 Retain and restore:
Direct restoration (composite/amalgam) 💎
Indirect restoration (onlay/crown) 👑
Post + Core when needed 🪛
🧠 8. What assessments must be done before restoring?
📋 Endodontic – success of RCT, canal shape
📋 Periodontal – probing depths, mobility
📋 Coronal Tissue – height (ferrule?), thickness, cracks
🪞 9. What aesthetic & occlusal factors should be considered?
🎨 Tooth colour, shape, visibility
🦷 In occlusion?
🔄 Contributes to lateral/protrusive guidance?
📌 Post-crowned canines should NOT guide – switch to group function
📌 Posterior = ICP contact only
📌 Anterior = incisal guidance shared
🎯 10. When is a direct restoration enough?
✔️ Sufficient coronal tissue
✔️ Minimal wall loss
✔️ Low occlusal load
🦷 Composite or amalgam may work just fine
🔄 GP reduced to CEJ + RM-GIC over it
🧱 11. What is a Nayyar Core?
A “core-within-the-canal” design 🧩:
Uses coronal part of canal
Composite or amalgam placed
No post needed
Crown sits on top to create ferrule 👑
🪛 12. When do you need a post?
⚙️ If there’s insufficient coronal structure to hold the core
⚠️ Posts do NOT strengthen the tooth
😬 Over-prepping for a post may cause more harm
📏 13. What are the ideal post dimensions?
🔹 Length ≥ crown height
🔹 4–5 mm of GP left apically
🔹 Diameter < 1/3 root width
🔹 Respect the canal anatomy
🧵 15. How is a prefabricated post placed?
Remove GP with GG burs
Shape canal with parapost drills
Try-in fibre post
Cement in canal
Place composite core
🧩 14. What types of posts are available?
✨Prefabricated (chairside):
🔸 Stainless steel
🔸 Titanium
🔸 Fibre-reinforced composite 💖
✨Cast post and core (lab-made):
Custom-fit
Post & core are one unit
Requires impression + lab stage 🧪
🔧 16. How is a cast post & core placed?
Prepare canal
Take impression using plastic post & silicone
Send to lab 🧑🔬
Fit custom metal post & core
Cement + restore with crown 👑
👉 Use temp core between visits
🧠 17. What is an Endo Crown?
A monolithic crown that:
Extends into pulp chamber (no separate post)
No ferrule needed
Ideal for molars with wide pulp chambers
Still under research 🧬
⚠️ 18. What are the common failures of restored root-filled teeth?
💔 Coronal leakage ➝ reinfection
💔 Root fracture
💔 Post fracture
💔 Poor angulation (rubber dam issues)
💔 No ferrule ➝ restoration fails
👑 19. When do you use cuspal coverage (onlays/crowns)?
🦷 Posterior teeth: more fracture risk
🧱 If:
1 wall missing ➝ consider it
2+ walls missing ➝ must do it
✅ Class I with all thick walls = may not need
🔁 Design to conserve as much natural tooth as possible
