Restoring extensively damaged endodontically treated posterior teeth is always a challenge in dentistry. The use of endocrowns has gained popularity in restoring severely damaged endodontically treated teeth (ETT) in recent years. In this clinical report, a structurally compromised mandibular second molar with symptomatic irreversible pulpitis and normal apical tissue was endodontically treated. Surgical crown lengthening was attempted thereafter to increase the crown height. However, marginal periodontal tissue re-growth occurred after surgical crown lengthening. The tooth was subsequently restored with endocrown which was fabricated using computer-aided design and computer-aided manufacturing-based hybrid-ceramic. In conclusion, endocrown can be a viable restorative modality for ETT with compromised clinical crown height.
The management of patients with severely worn dentition is challenging due to the loss of occlusal vertical dimension and tooth structure creating an uneven plane of occlusion. This case report describes the importance of every step of the conventional and improvised methods in treating tooth wear patients. Stages from the initial work-up of tooth wear assessment, substantial surgical crown lengthening, the controlled method of increasing vertical dimension, the precise method of crown preparations, advanced impression techniques till the cementation procedure of final restorations.
The whole treatment was in a reorganized approach such that the new inter-cuspal position (ICP) coincided with the retruded axial position (RAP). When restoring worn dentition, cl inician should always have a proper planning, decent implementation for each stages thus guarantee excellent performances. However maintenance and recall visits are the main keys to long term success.
This case report demonstrates sequential periodontic, orthodontic and prosthodontic treatment modalities to save and restore deep horizontally fractured maxillary central incisor. The location of fracture was deep in the mucosa which reveals less than 2 mm of tooth structure to receive the crown. The procedures like surgical crown lengthening, endodontic post placement, orthodontic forced eruption, core build-up and metal-ceramic crown restoration were sequentially performed to conserve the fractured tooth. Forced eruption is preferred to surgical removal of supporting alveolar bone, since forced eruption preserves the biologic width, maintains esthetics, and at the same time exposes sound tooth structure for the placement of restorative margins.