Restoring+Endodontically+Treated+Teeth

=Guidelines For Restoring RCT Teeth=
 * 1) Ensure the RCT was successfully completed
 * 2) Minimal amount of tooth loss during endo and restoring
 * As the diameter of the RC increases the integrity of the tooth decreases
 * 1) The longer the post the lower chance of root fracture
 * Be sure to leave ~ 4 mm of gutta percha
 * Use the most conservative post design
 * Your goal is to avoid using post if at all possible
 * 1) Anterior teeth with in tact marginal ridges will not require post or full coverage crown
 * They have the same fracture resistance as a untreated tooth
 * 1) Anterior teeth(w/ RCT) that require a crown will commonly need a post and/or core
 * This will increase fracture resistance of the coronal 1/3
 * The post should be about the same diameter as the canal
 * Exception to the rule is occasionally mand. 1st premolar
 * Bonded restoration probably strengthen teeth but is not proven
 * Ensure an adequate ferrule of at least 1mm to 2mm (2 being ideal)[[image:Messages Image(206549540).jpg width="330" height="392" align="right"]]
 * Risk of Posts:
 * Perforation
 * Root Fracture
 * Retreatment Concerns
 * Be aware of root fluting (concavities of the root)
 * For best prognosis use a long post that will not increase the diameter of the prepared canal
 * Don't cut off the remaining crown so you can have a flat plane
 * Use adequate ferrule on root surface (approximately 2mm)
 * 1) Use 2 mm ferrule that doesn't violate biologic width
 * Biologic extends approximately 2 mm from the crest of the alveolar bone
 * 1) How and when to remove gutta percha for the post
 * Use a warmed instrument to remove GP
 * Can remove GP for the post whenever a post is needed (Leave at least 4 mm of GP)
 * Sealer seals the apical foramen and doesn't cement the GP in place
 * 1) The Design of post/restoration is more important than the cement used
 * The ideal cement is the cement that would more easily allow for retreatment
 * 1) In essence you want to make everything about your restoration rigid. This will decrease flexing and thus decrease the risk of micro leakage.

Compiled From James Robbins. Guidelines for the restoration of endodontically treated teeth. JADA 120:558-566,1990