Opdam NJ, Roeters JJ, Loomans RA, Bronkhorst E. Seven year clinical evaluation of painful, cracked teeth restored with a direct composite restoration. J Endod. 2008; 34:808-811
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This is the second-part of this three-part series. The first paper discussed the occlusal and cracked tooth aetiological factors which may be responsible for restoration failure. This paper will outline the restorative options for cracked and root canal-treated teeth. It will also briefly give an overview of some of the potential endodontic complications commonly associated with failed restorations. The third, and final, part of the series will provide an overview of the previous papers and conclude with a case report.
CPD/Clinical Relevance: Failure of amalgam restorations is a commonly encountered clinical problem in general practice and no one case presents in the same way. Therefore, a competent endodontic diagnosis and implementation of the most appropriate, minimally invasive restorative option requires an adequate knowledge of the current literature.
Article
Direct intra-coronal restorations of bonded amalgam and resin-composite should be considered in cavities <1/2 the tooth width and without signs of bruxism. A direct restoration is less invasive and will reduce pulpal trauma. It has been demonstrated that >90% of teeth restored with resin-composite remained vital after 7 years.1 There are some reservations with regards to bonded amalgam owing to a difference in thermal expansion coefficient which may be ineffective at limiting crack propagation.2
Indirect inlays are available as gold (Figure 1), ceramic or resin-composite. However, this form of treatment is not advised owing to their limited role in the management of cracked teeth. Additionally, considering their wedge retention design, there is a high risk that inlays will exert pressure on the cavity walls thereby exacerbating the crack line(s).
Indirect onlays (Figure 2) may be used as a more conservative approach, with reduced trauma to the pulp. Indirect materials generally include gold (type III), cobalt chromium, lithium disilicate (pressed or milled) and composite (nanofill or nanohybrid). Indirect composite has demonstrated a six-year survival rate at 93%.3
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