Restoration of an Endodontically Treated Tooth
The process of root canal treatment and the subsequent choice of restorative technique undoubtedly require careful consideration so as to prevent possible failure of the treatment process due to extraradicular and intraradicular infections.1, 2 Root canal treatment is itself indicated in the treatment of carries with pulpal infection caused by tooth decay. While endodontic treatment deals with periodontal damage to the pulp, restorative dentistry repairs exposed and damaged dentine and enamel. This process aims at reinforcing an otherwise fragile root filled tooth and the assurance of high quality dental therapy. Professionals in collaboration who concur with this, recognize the fact that the complete filling process revolves around establishing a “bacteria tight seal of the root canal”.3(218) This is attributed to the claims that root filling processes reduce a tooth’s rigidity making it vulnerable to fracture damage and even discolouration in comparison to a vital tooth. 1, 4 Recent contradictory evidence however, shows a very slight difference in the dentin of endodontically treated teeth and the corresponding vital tooth. Attention is instead directed towards access preparation, amount of missing tooth structure and reduced inherent protective feedback as the factors that necessitate restoration.21 The restoration process thus aims at maintaining a tooth’s structural potency and aesthetic value by restoring its original structure.1, 3, 5 The lack of conclusive literature and the upsurge of literary evidence in dentistry, has made the restoration process a controversial topic of debate, necessitating the use of evidence based data to facilitate the process. For instance, professional studies show a reduction in the success rate of the procedure to 71% when restoration is not carried out.3 The issue of whether or not a cuspal coverage is significant for the tooth’s retention and the type of crown material is dependent on the type of tooth and remaining structure.15,22 Evidence however, implies greater chances of tooth survival in crowned teeth with statistics showing survival rates of teeth without crowns at 1, 2 and 5 years being recorded as 96%, 88% and 36% respectively.23 The placement of posts is another controversial issue with some practitioners arguing that dentistry should be minimally invasive and that it does not possess restoration qualities.5, 6, 19, 22 With regards to this, Naumann, Kiessling and Seemann6 recognize that the choice of restoration technique is governed by a number of factors that revolve around the condition of the tooth/teeth and the wide array of restoration material. Evidence from a one year analysis of a military clinic provided by McComb23 showed that 60% of endodontically treated teeth failures were caused by post restoration fractures, while periodontal problems constituted 32% making the restoration process a prime issue. As a result of these considerations among others, the following research focuses on restoration techniques and the factors that influence the treatment process selected.