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Additive bonding approaches to managing root-filled, cracked or weak teeth Martin Kelleher Will Donovan Nagina Safi Dental Update 2025 52:1, 707-709.
Authors
MartinKelleher
MSc, FDSRCS, FDSRCPS, FCGDent
MSc, FDSRCS, FDSRCPS, FDSRCS, FCGDent, Specialist in Restorative Dentistry and Prosthodontics, Consultant in Restorative Dentistry, King's College Dental Hospital, London
Root-filled, cracked or very weak back teeth pose perennial problems for patients and dentists alike. A biologically sensible and perhaps unorthodox approach to create occlusal clearance is by adding direct resin composite pragmatically to the biting surfaces of various other much sounder teeth. Doing additive bonding first loads those sounder teeth preferentially, without damaging them, while creating ‘adequate’ clearance space between the occlusal surface of the structurally compromised back tooth and its opponents during all jaw movements. Once the space is gained over the occlusal aspects of that root-filled tooth (or other cracked or weak teeth), it is kept by immediately bonding some strikingly different-coloured restorative material onto the strongest part of its occlusal surface at that same visit. The empirical composite devices that are bonded on to the chosen stronger teeth are maintained in position during the adaptation period by the patient to their pragmatic new occlusion, but they are modifiable, if that is ever required. Their adaptation to this new occlusion can be verified easily with the patient prior to making them a cuspal-coverage protective restoration for their weak tooth. At any mutually convenient time afterwards, simply grinding off the obviously contrasting-coloured composite off the weak tooth provides most of the occlusal space required for that cuspal-coverage restoration, but without having to remove significantly more sound tooth tissue to achieve that outcome.
CPD/Clinical Relevance: A pragmatic approach to create occlusal clearance for structurally compromised premolars and molars is described.
Article
Despite decades of dogma, disagreements and debate, the supposedly ‘ideal restoration’ for root-filled premolar and molar teeth remains controversial.1 Most ‘authorities’ advocate cuspal coverage of some sort to ‘protect and restore the root-filled tooth to its full form and function’, while usually conforming to the patient's existing intercuspal position (ICP), meaning without altering their existing anterior occlusal vertical dimension.1 Leaving aside the dubious wisdom of subjecting an already compromised root-filled back tooth to all of those ongoing occlusal, as well as potentially damaging clenching/bruxism forces, some of which might well have been involved in the tooth requiring that root filling in the first place, that traditional dogma nearly always involves the loss of more valuable sound tooth structure in order to create enough space for whatever ‘restorative’ material is deemed to be appropriate for that situation.1
The proposition offered in this article is that additive direct composite bonding of many other strong teeth is a non-destructive way of getting space over the occlusal aspect of a weak root-filled tooth rather than taking more off its occlusal (and possibly other surfaces) to provide a cuspal coverage restoration with the aim of reducing the risks of a later catastrophic vertical fracture.
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