Endocrown - a Novel Approach in Rehabilitation: A Report of Two Cases

INTRODUCTION

The term “Endocrown” was coined by Bindl and Mormann in 1999. These restorations are anchored to the internal portion of the pulp chamber thus obtaining macromechanical retention provided by the pulpal walls and micro mechanical retention provided by adhesive cements.²

Restoration of teeth with extensive coronal destruction remains a clinical challenge. When a tooth is endodontically treated, a considerable amount of tooth structure is already lost due to trauma or caries in addition to the central destruction created for the endodontic access. This usually leaves the tooth with insufficient sound tooth structure to support a casted restoration. Also, there are increased chances of tooth fracture under masticatory forces. To this condition Endocrown is a novel approach, it fulfill the goal to have minimally invasive preparations with maximal tissue conservation for the favourable long term prognosis.³

Endocrown is a good alternative in cases with endodontically treated teeth with short clinical height but sufficient tissue available for adhesion and stability when compared to post and core followed by full coverage restorations. So the present article discusses endodontically treated lower molar which is restored by endocrown preparation.⁴

CASE REPORT-1

A 29 year old male patient reported to Department Of Conservative dentistry And Endodontics with a chief complaint of decayed tooth in the lower left back region of the jaw since 2 months .On the basis of clinical and radiographic examination root canal treatment was advised which was followed by endocrown placement.

CASE REPORT-2

A 37 year old male patient reported to Department of Conservative dentistry And Endodontics with a chief complaint of decayed tooth in the lower right back region of the jaw since 3 months .On the basis of clinical and radiographic examination root canal treatment was advised which was followed by endocrown placement

DISCUSSION

Minimally invasive preparations, with maximal tissue conservation, are now considered the gold standard for restoring endodontically treated teeth. The endocrowns are based on the same rationale: the preparation consists of circular supragingival/equigingival butt-joint margin and central retention cavity. The internal portion of the cavity provides macromechanical retention while micromechanical retention is achieved by adhesive cementation. The cervical sidewalk is the foundation of this restoration, the objective of which is to accomplish a wide, uniform, steady surface resistant to compressive stress. The saddle form of the pulpal floor warrants stability and retention.⁵

They possess several advantages over conventional posts and cores and crowns they are easier to prepare and require less clinical time and appointments. Esthetic properties are equally good. Also, adhesive restorations can decrease the infiltration of microorganisms from the coronal to the apical part thus improving the clinical success of the endodontic treatment. Moreover, they show a great advantage in cases where posts are contraindicated due to short or narrow canals.⁶

CONCLUSION

Endocrowns are a feasible alternative to conventional post core and fixed partial dentures in restoration of endodontically treated teeth with extensive coronal tissue loss. It’s indicated in posterior teeth and have shown better performance in molars than premolars. Compared to traditional methods, better esthetics and mechanical performance, conservation of remaining tooth structure, low cost and short clinical time are the advantages of endocrowns and they can be successfully used for restoration of teeth with short clinical crowns.¹

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