The restorative aspect of endodontics: Part I: Pre-Endo build-up
04/04/2024
Fellow
Warning: Undefined variable $post in /var/www/vhosts/styleitaliano-endodontics.org/endodontics.styleitaliano.org/wp-content/plugins/oxygen/component-framework/components/classes/code-block.class.php(133) : eval()'d code on line 2
Warning: Attempt to read property "ID" on null in /var/www/vhosts/styleitaliano-endodontics.org/endodontics.styleitaliano.org/wp-content/plugins/oxygen/component-framework/components/classes/code-block.class.php(133) : eval()'d code on line 2
Pre-endo build-up is an essential part of the endodontic procedure. It has 4 main purposes. First of all, it confirms that the tooth is restorable by means of isolating the healthy dental tissue. It ensures that there is no microbial leakage in the endodontic space. It allows the correct use of electronic apex locator, preventing fluids from interacting with it. It creates a reservoir for the irrigants to act effectively. That is the why.
Now, we need a feasible, teachable, repeatable protocol to implement it. The how to.
Fig. 1
-Patient with clear medical history
-Reports pain on chewing and
food impaction in the area
CLINICAL EXAMINATION:
- -Tooth #25 with multiple cracks,
a failing restoration and a fracture
in the distal ridge. Food impaction
is observed. Percussion test positive
Radiographic examination:
-Incomplete RCT
Treatment plan:
-Remove caries, cracks and assess
tooth restorability and prognosis
-If restorable, it requires retreatment
And indirect restoration with cuspal
coverage
Fig. 2
STEP 1
- -Remove proximal caries in width of 1-1,5mm without entering yet the pulp chamber
- -This facilitates the rd application and avoids tearing during margin preparation
Fig. 3
STEP 2
Matrix, wedge and ring in place.
We observe that the buccal canal is untreated and deroofing is incomplete.
Fig. 4
STEP 3
- -Restore proximal wall
- -Remove all decay and cracks
- -Start retreatment by deroofing
Fig. 5
Post – operative situation.
We can observe the tight adaptation of the restorative material on the margins.
Fig. 6
Patient with clear medical history reports:
Pain on chewing and sensitivity to cold stimuli in the area of premolars
-Xray and clinical examination reveal a failing restoration, multiple cracks and pain in percussion on tooth #25.
-Diagnosis: Irreversible pulpitis
-Treatment plan : Endo, reconstruction and cusp coverage
Fig. 7
Upon removal of restoration and decay.
-Cone-fit and post-operative radiograph with complete sealing of the isthmus area with the restorative materials.
Fig. 8
Gerasimos Giannakis received the Doctor of Dental Surgery degree from the University of Athens in 2018.
He has special interest in the field of endodontics, restorative dentistry and microsurgical techniques.
Since then has completed
STYLE ITALIANO Daily menu 40th edition , Milan 2020
TOOTH WEAR MASTER COURSE, by Didier Dietschi 2021
EXPERT COURSE IN MASTERING SOFT TISSUE SURGERY,
In cooperation with the University of Cologne 2022
MICROSCOPE SIMULATION COURSE ON CANAL BLOCKAGE MANAGEMENT by Chaniotis, Sousa Dias, 2020
He is working as an endodontics associate in a clinic, responsible also for the restoration of endodontically treated teeth.
Working exclusively under the microscope and rubber dam, has the opportunity to document the cases.
In the Style Italiano Congress in Greece 2023, was part of the bootcamp and became fellow of the Style Italiano Endodontics community.
Conclusions
We have showcased the significance of pre-endo build-up for a successive outcome. It offers us a clean field of work, assessment of restorability and ensures the correct workflow of endo treatment. In the next series of articles, we will talk about deep margin elevation, post-endo reconstruction and surgical crown lengthening.
Bibliography
Dimitrios Gavriil , Angeliki Kakka , Paul Myers , Christopher J O Connor Pre-endodontic restoration of structurally compromised teeth: current concepts Br Dent J. 2021; 231(6): 343–349.
Atsushi Kameyama, Aoi Saito, Akiko Haruyama, Tomoaki Komada, Setsuko Sugiyama, Toshiyuki Takahashi, and Takashi Muramatsu Marginal Leakage of Endodontic Temporary Restorative Materials around Access Cavities Prepared with Pre-Endodontic Composite Build-Up: An In Vitro Study Materials s(Basel) 2020 Apr 5;13(7):1700.
