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Successful root canal treatment requires management of the bacterial infection within the root canal space and protection of residual tooth structure with direct/indirect restorations. Long-term success depends upon prevention of re-infection of the root canal space as well as ensuring favourable distribution of the occlusal forces throughout the residual tooth structure. Appropriate planning and design of the final restoration prior to initiating root canal treatment is paramount in achieving this objective. This article describes simultaneous restorability assessment and access cavity preparation to optimize outcome of both endodontic and prosthodontic treatment of the endodontically involved tooth.
CPD/Clinical Relevance: This paper proposes a method to improve visibility and reduce iatrogenic errors whilst simultaneously facilitating effective design of the definitive restoration based on the quantity and distribution of residual tooth structure.
Article
The purpose of providing root canal treatment is to retain teeth as functional and/or aesthetic units of the dentition. To achieve this objective, the following criteria must be fulfilled:
Successful decontamination of the root canal system alone is not sufficient to ensure long-term survival of the tooth as a functional unit. Effective pre-operative assessment of the strategic importance of the tooth in the context of the overall dentition, its periodontal support, the opposing dentition, static and dynamic occlusal forces on the tooth in question and the amount and distribution of residual tooth structure allow for careful case selection of teeth that are worth retaining with a favourable medium- to long-term prognosis.
The definitive restoration must seal the root canal space from the oral cavity as well as preserve and protect the residual tooth structure by ensuring even distribution of the occlusal forces. Endodontically treated teeth may be restored either directly, with plastic filling materials (amalgam, composite resin), or indirectly with cast partial, cast full or all-ceramic restorations. Aesthetics, functional requirements, financial considerations and the patient expectations are all to be considered when selecting the definitive restoration.
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