Direct composite versus glassceramic endocrowns for mechanically compromised molar teeth

For the success after the root canal treatment, an adequate restoration is important to restore the function. This can be done using a filling or a crown. To date, clinical guidelines concerning the choice between a filling or a crown on molar teeth with a root canal are lacking. Within this thesis, the prognosis and restoration of such molar teeth was evaluated using a systematic review, a survey and in vitro and in vivo studies. Main focus was molar teeth with severe coronal destruction and the choice between a filling or a glass-ceramic endocrown. An endocrown is a crown with an extension in the pulp chamber, that is adhesively luted to the tooth. Both filling and endocrown require minimum amount of tooth preparation. From the systematic review, low quality evidence suggest that there was no difference between a filling or a crown after 2.5-3 years. For Dutch general dentists, the indication for the type or restoration was mainly determined by the amount of tooth tissue left. Dentists graduated between 2010-2020 opted significantly more often for a less invasive preparation than dentists graduated before 2010. The prognosis on the medium-term (up to 7 years) of molar teeth after a complex root canal (re)treatment was good, with a survival estimate of 91,7% [95%CI: 86,8%-94,9%]. Molar teeth with adjacent teeth and an adequate root canal treatment had a higher chance of survival. Fracture strength of molar teeth restored in vitro with a filling or an endocrown was not significantly different after aging in a chewing simulator. Preliminary results of a randomized clinical trial suggested no difference in clinical performance after 12 months for molar teeth with extensive tissue loss restored with either a filling or an endocrown.

Dissertation: http://hdl.handle.net/11370/688b6abb-932a-4edc-b9c1-6aad23fa7443