Two Appointments Endo Resto: a simplified workflow to make prosthodontics helpful to endodontics

The high predictability of our treatments allows us to organize endodontics appointments so that in just two sessions the patient can get a definitive restoration. In fact, the old concept envisaged several operational sessions, in some cases leading to the finalization of the work no sooner than 45 days.

This new concept provides for the delivery of the final restoration within 14 days, guaranteeing our patient significant biological, economic and time savings. The professional, on the other hand, saves in terms of hourly cost of the chair (number of appointments) and material used, also making endodontic treatment more comfortable and simple thanks to the preventive occlusal reduction. 

Once the need for root canal therapy has been established, we begin with an accurate occlusal reduction, checking the maintenance of the correct interarch prosthodontic spaces (depending on the type of material chosen for the restoration) even before the start of endodontic therapy.

Afterwards, the previous restorations are removed, if present, and we start with the first phase of marginal decayed tissue removal, taking care not to enter the chamber, while initially leaving contaminated tissue in its proximity: the selective removal of infected marginal tissue allows us to isolate correctly at a later time without damaging the integrity of the dam, allowing us to save time and material; the deferred removal of caries allows us to isolate the operating field in a dry environment free from any bleeding, making the subsequent endodontic marginal seal easier thanks to the use of the liquid dam.

This protocol requires absolute isolation from "conservative" imprinting, therefore several teeth will be isolated at a time and the element to be treated will be "sealed" thanks to the use of a liquid dam, in order to avoid the possibility of passage of sodium hypochlorite to the oral cavity (1-2).

Once the dam has been positioned, we remove the decayed tissue entirely and proceed with the chamber opening and the localization of the canal orifices. Once the endodontic phase has been completed and the access cavity has been adequately cleansed, the liquid dam is removed and, if necessary, we proceed with the relocation of the margins and with the build-up of the tooth (3-4-5-6). Having already reduced the occlusal table, the preparation of the tooth is very rapid, limiting itself to the creation of the interproximal boxes and its finishing and polishing (6-7). After that we remove the isolation, check the prosthodontic space again, take a precision impression (analog or digital) and finally, after spot etching and adhesion, we place the temporary filling with polymerizable pmma (e.g. Telio - Ivoclar) in order to avoid mesiodistal movements of adjacent teeth as well as extrusion of the treated element.

The following week, once the prosthodontic overlay has been made (composite, lithium disilicate or hybrid, depending on the therapeutic indication), we easily remove the temporary filling and proceed again with the isolation of the operating field and finally bond the definitive restoration, as per protocol, with adhesive technique (6). Now all we have to do is refine and polish the prosthodontic margins, if necessary touch up the occlusion and dismiss the patient.