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Endocrown Restoration on Postendodontics Treatment on Lower First Molar

Article · May 2019

DOI: 10.4103/jispcd.JISPCD_399_18

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Irmaleny Irmaleny

Universitas Padjadjaran

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Airlangga University

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303© 2019 Journal of International Society of Preventive and Community Dentistry | Published by Wolters Kluwer - Medknow

Restoration is one of the most important things in the field of dentistry, inrestoration, there are twomain things that must be considered, that was estheticfactors and functional factors. A tooth after endodontics treatment require morecomplexrestorationthannormaltooth,becauselotoffactorsneededtobeobservedfirst, one ofwhich is tissue residue, root canal anatomy, and even the economicscondition of the patient. Post, cores, and crowns themselves have several contraindications in theiruse, thereforeadentistmustbeable tohaveotheralternativesin the choice of restoration. Endocrown is an alternative that can be used by adentistinperformingpostendodonticsrestoration.

Keywords: Endocrown, endodontics, esthetic, postcore crown, restoration, vertucci type canal

Endocrown Restoration on Postendodontics Treatment on Lower First MolarIrmaleny1, Zuleika2, Sholeh Ardjanggi3, Andi Ainul Mardiyah3, Dian Agustin Wahjuningrum3

Access this article onlineQuick Response Code:

Website: www.jispcd.org

DOI: 10.4103/jispcd.JISPCD_399_18

Address for correspondence: Dr. Dian Agustin Wahjuningrum, Department of Conservative Dentistry, Faculty of Dental Medicine,

University of Airlangga, Jl. Prof. Moestopo 47, Surabaya 60132, Indonesia.

E‑mail: dian‑agustin‑[email protected]

variations, dilaceration or short roots, small diameterroot shapes,andhighcosts.Analternative to theuseofpostandcrownis theuseofadhesiveendodonticcrownoralsocalledendocrown.[5‑7]

Endocrown is a partial crown made from ceramicmaterial or composite resinwhich is appliedwith resincement to the postendodontic teeth. This restorationis full occlusal coverage and takes advantage of thepulp chamber to increase the adhesive surface area.Materials used for the manufacture of endocrownare feldsphatic and glass‑ceramic, hybrid compositeresins, and computer‑aided design and computer‑aidedmanufacturing (CAD/CAM) ceramics and compositeresins. [6,8] Endocrown indications include loss ofextensive tooth structure, small intermaxillary spaceswhere rehabilitation using pegs and crowns is notpossible because of insufficient thickness of ceramicmaterial, and cases where postuse is contraindicatedbecausethereareanatomicvariationsoftheroots.[7,9]

Case Report

IntroductIon

Endodontics is one of the most common treatmentsin the field of Dentistry. Endodontics is thetreatment of the pulp or root canal, where teeth thathave been treated with endodontic treatment havedifferent characteristics with teeth that are not treatedendodontic,oneofwhichisenduranceorfragilityofthetooth structure. Other factors that must be consideredare the position of the tooth, anatomy of the toothitself and the root canal, the remaining healthy tissuestructure, the functional activities in the area of dentalocclusion, theageof the toothand thepatient itself, thesupporting tissue of the tooth which is the periodontalincludesalveolarandgingiva,even thefinancialaspectsof the patient.Therefore, the choice of restorationmustbeexactlyasindicated.

The selected restoration in postendodontic treatmentmust pay attention to various aspects, as mentionedabove. Post, core, and crown are one of the mainchoices of various restoration options on tooth thathave been carried out by endodontics. Post, core, andcrown are the main choices because of the excellentesthetic,functionalfactors.[1‑4]Theuseofcompositepostand cores, when used appropriately and according toindications, results in long‑termsatisfaction.Limitationson the use of postcore, including root anatomical

1DepartmentofConservativeDentistry,FacultyofDentalMedicine,PadjadjaranUniversity,Bandung,2DentalDepartment,RegionalGeneralHospitalofSabang,Sabang,3DepartmentofConservativeDentistry,FacultyofDentalMedicine,UniversityofAirlangga,Surabaya,Indonesia

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Received : 11‑11‑18.Accepted : 22‑01‑19.Published : 07‑06‑19.

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For reprints contact: [email protected]

How to cite this article: Irmaleny, Zuleika, Ardjanggi S, Mardiyah AA, Wahjuningrum DA. Endocrown restoration on postendodontics treatment on lower first molar. J Int Soc Prevent Communit Dent 2019;9:303-10.

[Downloaded free from http://www.jispcd.org on Wednesday, November 6, 2019, IP: 112.215.244.58]

Irmaleny, et al.: Endocrown restoration on postendodontics treatment on lower first molar

304 Journal of International Society of Preventive and Community Dentistry ¦ Volume 9 ¦ Issue 3 ¦ May-June 2019

In this case, composite endocrownwas the treatmentofchoicebasedonthelossofextensivetoothstructureandorthodontictreatmenthasbeenplannedafter.

cAse rePortA 29‑year‑old female patient had reported to theDepartment of Conservative Dentistry and EndodonticsFKGUnpad,with chief complaint that shewants to geta restoration after treated by endodontist last week, shetoldthatsheisgoingtouseorthodontics[Figure1].

Patienthadnohistoryofhypertension,diabetesmellitus,allergicreaction,andbloodabnormalities.

extraoral examination1. Symmetricalface,lip,andnormaltemporomandibular

joint2. Normallymphnode.

intraoral examination1. Goodoralhygiene2. Temporary restoration was done on the occlusal

extensiontothebuccalpit,proximaldistal,andsomelingualingoodconditionwithoutanyleakageseen

3. Bitingtestandpercussiontestsshownnegativereaction,no sign of tooth movement, and normal periodontal[Figure2].

Radiological examination results showed that therewas a radiopaque appearance in enamel, dentin, up tothe dental pulp chamber of tooth 36. There were threestraight shape root canals, with distal roots branchingintotwo,andvisibleradiopaquefeaturesresemblingrootcanal fillers from orifice to apex. The alveolar crest isseen within normal height. The periodontal membraneis widened at the apical distal root. The lamina duraappears to disappear or seen diffuse at the apical distalroot. Periapical tissue around the distal root showsdiffuseradiopaquefeatures[Figure3].

treAtMent PlAn And ProcedureOn the first visit (July 28, 2016), clinical andradiographic examination was done, and diagnosis andprognosis of tooth 36 was made. Patient was informed

and inform consent was agreed about endocrownrestorationaccordingtoresistanceofthetoothstructure,VertucciTypeV root canal form, andminimal invasiveprincipal.

First, awax upwasmade and impression by puttywasdone to get elastomer matrix for temporary restoration.Endocrown preparation was done by wheel diamondbur, taking the coronal part of tooth structure until thesupragingivalmargin.Gutta‑perchawastakenbyflatendtapered diamond bur 1mm under orifice. Pulp chamberpreparation was also made by tapered diamond burshaping the pulp chamber divergent coronally 5°–10°of tooth axis [Figure 4]. Smart Dentin Replacement(SDR‑Dentsply) was applied on the pulp chamber as abase.

After preparation finished, impression was taken bydouble impression[Figure5],meanwhilemaxillary teethwere impressed by alginate and casted by dental stone.Temporary crown by Bis‑Acrilyc Composite (Protemp4 Temporization Material– 3M ESPE) was appliedto elastomer matrix and placed to tooth 36, the excessmaterials were taken using excavator. Temporary crowncanbeseeninFigure6.

Working model was prepared for indirect compositeendocrown making [Figure 7a‑h]. Application ofseparator was given to all surface of prepared tooth36, and proximal surface of tooth 37 and 35which hasa proximal contact to 36, so were antagonist teeth, forseveral seconds. Application of (SDR‑Dentsply) wasmade in tooth chamber until tooth preparation marginandlight‑cured.

Resin composite application by layering technique wasmade on working model. Resin composite that wasbeing used is Dual Shade resin composite (3M‑FIltekZ350XT Universal Composite). First A3 dentinshade resin composite is applied to all tooth surfaceremaining±0,5mmspaceforenamelshadecomposite.The remaining± 0, 5mm spacewasmeasured by handinstrument missura (LM Arte) and by occlusion withantagonistteeth,andlight‑curedafter.

Figure 1:Odontogram



305Journal of International Society of Preventive and Community Dentistry ¦ Volume 9 ¦ Issue 3 ¦ May-June 2019

Sectionalmatrixwasused for ideal proximal contouringto tooth 35 and 37 [Figure 7e‑f]. Application of A2enamelshadewasplacedonproximal,buccal,andlingualsurface by application of hand instrument (LM Arte)[Figure7e‑g].ApplicationofA2enamelshadecompositealsoplacedonocclusal,pitandfissure,andthencontouredby fissure hand instrument (LMArte) [Figure 7h]. Eachsteps of composite placement, continued by light curingprocess. Stain color (Coltene) was also used on pit andfissure by composite brush, after that a thin layer ofA2 enamel shade composite was placed on top andcontoured. Oxygen barrier is applied on all surfaces ofendocrownandlight‑cured[Figure8].

Clinical examination on the second visit (7 days later)showed asymptomatic, insensitivity to percussion,no tooth mobility nor periodontal abnormalities, andtemporaryrestorationwasinagoodcondition.

Temporary restoration was removed using crownremover,andafterthattryinendocrownontooth36wasdone.Restorationmargin and tooth shoulder preparationwaschecked.Occlusionwasalsocheckedbyarticulatingpaper on centric occlusionposition.Occlusal adjustmentwas done by flame fine finishing diamond bur, andpolished by rubber polishing enhance (Dentsply),

SofLex polishing disc (3M– ESPE), interdentalstrip (3M– ESPE), astro brush (Ivoclaire) and diamondpolishingpaste0.5µm(Ultradent).

Endocrown surface was etched on intaglio surface,rinsed, and silane was applied for several seconds,bonding,air‑driedwasusedsothatthebondingisonlyathinlayer,andthenlight‑cured[Figure9].

Adhesivestepisalsodoneontoothsurface,selectiveetchandbondingbythe5thgenerationbondingwasdoneonallprepared tooth 36 surface [Figure 10]. Etchedwas doneby37%phosphoricacidfor15s[Figure10a],rinsedanddried with three‑way syringe until moist [Figure 10b].Bondingwas applied on tooth surface after etchingwasdone by a microbrush [Figure 10c], after waiting forseveral seconds, bonding was thinned by air‑dried, andteflon tapewasplacedon tooth35 and37 [Figure10d],andthenlightcured.

Resin cement (Relyx– 3M ESPE) applied to surface ofprepared tooth 36 and to intaglio surface of restoration.

Figure 2:ClinicalAppearanceontooth36 Figure 3:PeriapicalRadiographontooth36

Figure 5:Doubleimpression

Figure 4:Beforeandaftercompositeendocrownpreparation




Restoration was applied to tooth 36, light‑cured for1 s, excess resin on buccal and lingual surface wasremoved by sickle scaler interdental, meanwhile excesson interdental surface was removed by dental floss.20 s light‑curingwas done on all surface of endocrownrestoration.

Oxygen barrier (OxyGel– Ultradent) was applied oncementing surface so that the polymerization is notinhibitedbyoxygen inhibited layer.After that, lightcurewasdone.CementationresultshowedinFigure11.

Patient was instructed to avoid hard textured food onregion 36 for 24 h, and to maintain good oral hygiene.Patientwasinformedaboutlongtermevaluation,1weekafterendocrowninsertionandafterorthodontictreatmentisfinished.

Follow‑up, 7 days after insertion showed that tooth 36wasasymptomatic, insensitive topercussion, andneithertoothmobilitynorperiodontalabnormalities.Restorationwasundergoodconditionandneithertransformationnordiscolorationofrestorationobserved[Figure12].

Radiographic examination showed radiopaque crownon enamel, dentin, through pulp chamber on tooth 36.Three root canals showed straight form,with distal roothas 2 branch, obturation was showed as radiopaque onorifice to apex.Alveolar crest showed normal condition.Periodontal membrane and lamina dura was also innormal condition. Periapical tissue surrounding distalroot showed slight radiopaque appearance [Figure 13].Polishingwasdoneonthisvisit.

dIscussIonRestorative design of teeth that have been treated withendodontics is a challenge for dentists and is still a

Figure 6:Waxupprocess(a)Lingualviewofwax‑up;(b)Buccalviewofwax‑up;(c)Oclusalviewafterinsertionoftemporarycrown

a b c

Figure 7:Indirectcompositeendocrownrestorationprocessontooth36(a)Separatorapplication;(b‑d)dentinshadeapplication,layerbylayerbuildthecore;(e)applicationofsectionalmatrixondistalareaofthetoothandapplicationofcompositeenamelshade;(f)applicationofsectionalmatrixonmesialareaofthetooth;(g)sculptingthebuccalandthelingualwall;(h)sculptingtheocclusalanatomyofthetooth

c

g

b

f

a

e

d

h

Figure 8: Result of composite endocrown restoration (a) occlusalview;(b)buccalview;(c)lingualview;(d)glycerineapplication(deox,Ultradent)asaoxygen‑barriergel;(e)relationshipofcrownheightinocclusionwithantagonisttooth(lingualview);(f)relationshipofcrownheightinocclusionwithantagonisttoot(buccalview);(g)endocrownfinalrestoration

a

b c d

e f g

Figure 9:Adhesive step on endocrown (a)Acid‑etching the intagliosurfaceofendocrownthenwashedoffwithwatersyringeanddriedoff;(b)Applicationofsilane;(c)Applicationofbondingagent;(d)Light‑curingofbondingagent

a b c

d




contentious issue. Conventional crownswithmetal pegsstillwidelyusedinthedentistry,buttheprincipleoftheirinvasive use has been widely criticized. New materialsfor restoration options using adhesive materials havebeen introduced at this time which can provide moreconservative dental results also faster, and cost‑effectivetreatment.[1‑4]

The choiceof postendodontic dental restoration is basedonseveralfactors.Thesefactorsincludethehealthytissuestructureof the remaining teeth, the teeth location in themouth,andtheestheticsthatareimportantasaselectionguide of adequate restorations. Other considerationfactors include the functionactivity in the toothocclusalarea, tooth age, endodontic/periodontal prognosis, andpatientfinancialaspects.

Assessmentofteethadhesionpropertiesafterendodontictreatmentof remaininghealthycoronal tissueof teeth isdone at thepreliminary stagewhen cavity removed andthepulptissueisremoved.Thisassessmentincludestheremainingwall tissue structure thatmust be healthy, nofissure,andaminimumthicknessof1mm.Thinphysicaland cavitywallsmust be detected before reconstructingthe preendodontic build‑up with composite resin,because part of the resin will be used as the basis fordefinitiverestoration.

The physiological and anatomical differences betweenanterior and posterior teeth are important whenselecting restorations.[5] Relationship of molar, caninelateral guidance, incisors anterior guidance to Class Iocclusion shows molar teeth receiving axial loads,anteriorteeth(incisorsandcanines)receiveshearload,while premolar teeth receive a more complex burdenofaxialandshearloads,andhencepremolarshavethepotential for fracture compared to other teeth.[5‑7] Thisindicates the use of postbased on the location of theteethinthemouthandtheloadreceivedbythetooth.

Classic treatments such as posts, cores, and crownsmust remain a primary consideration for severelydamaged premolars, until further clinical trials provethe possibility of restoring teeth adhesively withendocrown.[10] Several in vitro studies have proven thevalidity of molar endocrown and premolar, only a few in vivo studies havebeen conducted, and reportedgoodclinicalperformanceonmolar.[9,11‑13]

The use of post and composite cores, if usedappropriately and according to indications, results

Figure 13: Radiographic examination before and after compositeendocrownontooth36

Figure 10:Adhesivestepontooth36(a)acid‑etchingthetooth;(b)acid‑etchiswashedoffwithwatersyringeanddriedofftothemoiststate;(c)applicationofbondingagent;(d)light‑curingthebondingagent;(e)applicationofsealtapetotheproximalareaofadjacentteeth

d e

cba

Figure 12: Clinical assessment (a) preoperative occlusal view; (b)preoperativebuccalview; (c)occlusalviewof1week followupaftercompositeendocrowninsertionontooth36;(d)buccalviewof1weekfollowupaftercompositeendocrowninsertionontooth36

dc

ba

Figure 11:Clinicalexaminationaftercompositeendocrowncementation(a)Oclusalview;(b)Buccalview

a b




in long‑term satisfaction. Limitations on the use ofpost, including root anatomical variations, dilatedor short roots, small diameter root shapes, and highcosts. An alternative to the use of post and core isthe use of adhesive endodontic crown or also calledendocrown.[2,3]

Endocrown is a partial crown made from ceramicmaterial or composite resin which is cementedwith resin cement to the postendodontic teeth.This restoration is full occlusal coverage and takesadvantage of the pulp chamber to increase theadhesive surface area. Materials used for makingendocrown are feldsphatic and glass‑ceramic,composite hybrid resin, and CAD/CAM ceramic andcomposite resin.[6,8]

Endocrown indications include extensive loss oftooth structure, small intermaxillary spaces whererehabilitation using pegs and crowns is not possiblebecauseofinsufficientthicknessofceramicmaterial,andcaseswherepostuse is contraindicatedbecause there areanatomicvariationsoftheroots.[7,9]

In this study, the right maxillary first premolar hadV‑type root canalmorphology according to theVertucciclassification[Figure14].[8]

Endocrown has the advantage that its procedures areeasy and have better mechanical performance thanconventionalcrowns,lowercostsduetofewerprocedurestages,lesstime,andgoodesthetics.[9,12,14]

The endocrown preparation principle follows the samepattern as the preparation principle for indirect inlayand onlay restorations. This restoration uses all depth,extension, and inclination of the pulp chamber wall toimprove the stability and retention of the restoration,withoutremovingfillermaterialfrominsiderootcanal.[11]

The study states that composite resin overlays, relatedto their low modulus of elasticity, show better clinicalperformance than ceramics, including receiving and

minimizing internal loads.The difference inmodulus ofelasticity between ceramics and dentine causes the riskofrootfractureinteeth.[10,15]

The author chooses indirect nanocluster compositeresin, taking into account the stress‑absorbing propertiesand practical advantages including the possibility ofmodificationandeasilysurfacecorrection.[1]

Cavity preparation at the first visit and adhesiveapplicationwhen cementing has the same procedure forendocrown ceramic and composite resin restorations.Thedifferenceisonlyintagliosurfaceadhesiveactionofbothmaterialswhencemented.Occlusalportioncutbackat least 2–3 mm with a butt‑margin is recommendedfor ceramics and composite resin restorations. Buccalmargins are placed on the ⅓ supragingival cervix or0.5–1mmsubgingivalforestheticpurposes.[16,17]

The use of dual shade composite nanocluster, FiltekZ350XT (3M– Espe) for endocrown restorations waschosen based on functional and esthetic considerations,and long‑term temporary restoration because patientswoulduseorthodonticbracesafterward.

Filtek Z350XT (3M– Espe) contains nanocluster filler,which is a combination of 20 nm silica filler, 4–11 nmzirconia filler, and zirconia/silica filler cluster. Theliteraturestatesthatthissystemshowsgoodresultsbasedon compressive and diametric tensile strength, flexuralstrengthandmodulus,fracturetoughness,wearresistance,lowvolumetricshrinkage,andgoodesthetics.[18]

The superiority of the Z350XT compared to othercomposites are easily polished, colors that blend withthe surrounding teeth, good handling, and good clinicalperformance [Table 1]. This system has four completecolor opacity, including dentin, body, enamel, andtranslucent. The Filtek Z350XT Restoration is indicatedfor use as an anterior and posterior direct restoration,core build‑up, splinting, and indirect restorations (inlay,onlay,andveneer).[18]

The endocrown restoration clinical success dependslargelyontheexactmeasurementofthematerialuseattherestorative stage. Selection of temporary crownmaterialwithProtemp4(3M‑ESPE) isanadequate techniqueforgumhealth preservation and preventing teethmovementduring endocrown restorations procedure.[6] Protemp4 (3M‑ESPE) was chosen because its advantages thanothermaterial, such as fracture resistance for short‑termor long‑term use, good mechanical strength, decentappearancewithout polishing, easy to use, and availableinsixcolors.[19]

Temporarycrownmakingtechniqueswerecarriedoutusingmodified direct technique with elastomeric matrix whichFigure 14:Vertucciclassification7




chosenbecauseitseasymanipulation,goodanatomicalandmorphological shape, well convection for periodontiumtissue protection, andgreatfinishing andpolishing results.

This technique is recommended for one or more teethbecauseitprovidesaclinicaladvantageofthematerialandworkingtimeandcanberelinedseveraltimes.

Dualcureresincement(RelyXU200SelfAdhesiveResinCement‑3MESPE)wasused in thiscasebyconsideringthe need for light‑cured light to penetrate the thicknessof the composite endocrown. Relyx U200 is permanentself‑adhesiveresincementwithdualcure,radiopaqueandbroad‑spectrum polymerization for indirect restorationapplications. Its clinical material performance comparedto other ingredients shows high adhesion strength, lowpostoperative sensitivity, good mechanical properties,decentcolorstability,andlong‑termstability.[20]

Table 1: Comparison of physical and mechanical properties of Z350XT composite resin with other composite resinLevel Filtek™

Z350 XT Universal

Restorative (DEB

shades)

Filtek™ Z350 XT Universal

Restorative (T shades)

Filtek™ Supreme XT

Universal Restorative

(DEB shades)

CeramX™ Mono

Durafill® VS

Estelite® Sigma Quick

EsthetX® HD

Gradia® Direct

Grandio®Herculite ® XRV Ultra™

Premise™

CompressiveStrength

Mpa 370.56 394.01 361.37 346.8 349.86 364.19 376.83 323.4 341.84 349.1 370.81StDev 15.13 25.05 23.78 22.96 10.4 14.03 35.41 7.92 16.04 23.51 18.83

DiametralTensileStrength

Mpa 86.12 90.64 85.53 63.31 55.89 77.56 73.64 52.82 81.28 80.65 65.89StDev 3.91 1.4 5.47 6.49 2.87 2.98 2.38 5.89 5.63 5.76 8.18

FlexuralStrength

Mpa 165.14 157.98 165.9 113.68 64.5 111.08 132.9 106.07 144.03 106.48 108.64StDev 13.59 8.16 5.4 11.52 3.62 3.94 8.65 6.77 17.54 14.34 9.64

FlexuralModulus

Mpa 11348.00 9180.00 11436.00 8830.00 2613.00 7552.00 10128.00 6299.00 19437.00 7679.00 7839.00StDev 271.00 431.00 442.00 379.00 66.00 202.00 146.00 185.00 299.00 541.00 183.00

FractureToughness

K1c 1.84 1.51 1.92 1.69 1.01 ‑ 1.70 1.05 1.68 ‑ 1.81StDev 0.19 0.02 0.21 0.05 0.09 ‑ 0.12 0.06 0.07 ‑ 0.03

Shrinkage % 1.97 2.48 2.06 1.97 2.00 1.80 2.58 1.92 1.69 2.70 1.66StDev 0.03 0.06 0.06 0.05 0.08 0.05 0.05 0.04 0.04 0.07 0.06

PolishRetentionInitial Mean 94.83 93.83 92.81 72.9 86.33 93.93 92.45 76.17 67.27 89.67 91.6

StDev 1.03 1.39 2.35 ‑ 0.15 0.68 2.33 0.32 1.71 2.17 0.96500cycles Mean 86.82 88.04 83.09 36.03 74.82 67.62 54.75 37.98 43.47 69.63 70.36

StDev 5.77 6.01 6.08 7.27 4.85 7.45 3.86 10.27 4.82 9.21 5.971000cycles Mean 83.32 85.72 78.73 25.5 68.08 64.14 27.65 21.58 35.31 60.83 63.11


StDev 6.43 5.12 8.57 2.74 6.15 3.88 2.64 5 3.29 6.85 8.483000cycles Mean 73.19 82.01 62.89 10.45 58.7 64.29 29.28 13 17.26 52.57 44.12



StDev 5.36 6.05 8.19 1 3.57 9.53 0.65 1.16 0.96 11.58 3.126000cycles Mean 68.62 79.72 54.73 7.98 53.21 65.01 27.65 10.55 11.48 54.88 37.18

StDev 4.77 4.42 7.75 0.71 6.32 3.33 1.01 1.22 0.98 4.57 53‑BodyWearRate

umlost

5.61 6.54 5.07 32.04 15.22 7.5 7.38 15.17 8.49 15.78 16.27

StDev 0.63 0.5 0.8 0.68 0.55 0.46 0.31 1.43 0.64 2.13 0.55

Table 2: Composition of RelyX self‑adhesive cementBase paste Catalyst pasteMethacrylatemonomerscontainingphosphoricacidgroup

Methacrylatemonomers

Methacrylatemonomers Alkaline(basic)fillersSilanatedfillers SilanatedfillersInitiatorcomponents InitiatorcomponentsStabilizers StabilizerRheologicaladditives Pigment

Rheologicaladditives




The combination of two polymerization mechanisms,light and chemical, guarantees polymerization under nolight conditions [Table 2]. This material has adequatemechanicalandsufficeadhesionproperties,and iseasilyapplied with double‑bodied syringes with providedmixingtips,whichpreventairbubblesformation.[20]

Prepolymerization of the cement may result in easyremoval of excess material from the edges of therestoration and teeth. Mechanical reduction of excesscement can cause trauma to themarginal gingival tissueandcausegingivalrecession.

conclusIonRestoration after endodontic treatment in 36 usingendocrowncomposite in this casegavegood results andcould be considered as an option in restoring posteriorteeth after endodontic treatment with consideration oflong‑termtemporaryrestoration.

declaration of patient conSentTheauthorscertifythattheyhaveobtainedallappropriatepatientconsentforms.Intheformthepatient(s)has/havegiven his/her/their consent for his/her/their images andother clinical information to be reported in the journal.Thepatientsunderstandthat theirnamesandinitialswillnotbepublishedanddueeffortswillbemadetoconcealtheiridentity,butanonymitycannotbeguaranteed.

suggestIonLong‑term evaluation of composite endocrownrestorationsisneededaslong‑termtemporaryrestoration

financial Support and SponSorShipNil.

conflictS of intereStTherearenoconflictsofinterest.

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20. Posts F, Pack A. The Strong Bond you Can Rely on elyxU200–StrengthwePutTrust;2012.


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