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      Endocrowns: review

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          Abstract

          The ideal restoration of endodontically treated teeth (ETT) has been widely and controversially discussed in the literature. Prevention of healthy dental structure is essential to help mechanical stabilization of tooth-restoration integrity, increase the amount of suitable surfaces for adhesion and thus positively affect the long-term success. ETT are affected by a higher risk of biomechanical failure than vital teeth. With the development of adhesive systems, the need for post-core restorations is also reduced. Especially for restoration of excessively damaged ETT, endocrowns have been used as an alternative to the conventional post-core and fixed partial dentures. Compared to conventional methods, good aesthetics, better mechanical performance, and less cost and clinic time are the advantages of endocrowns.

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          Reduction in tooth stiffness as a result of endodontic and restorative procedures.

          Endodontically treated teeth are thought to be more susceptible to fracture as a result of the loss of tooth vitality and tooth structure. This study was designed to compare the contributions of endodontic and restorative procedures to the loss of strength by using nondestructive occlusal loading on extracted intact, maxillary, second bicuspids. An encapsulated strain gauge was bonded on enamel just above the cementoenamel junction on both the buccal and lingual surfaces, and the teeth were mounted in nylon rings leaving 2 mm of root surface exposed. Under load control, each tooth was loaded at a rate of 37 N per s for 3 s and unloaded at the same rate in a closed loop servo-hydraulic system to measure stiffness. A stress-strain curve was generated from each gauge prior to alteration of the tooth and after each procedure performed on the tooth. Cuspal stiffness, as a measure of tooth strength, was evaluated on one of two series of sequentially performed procedures: 1. (a) unaltered tooth, (b) access preparation, (c) instrumentation, (d) obturation, and (e) MOD cavity preparation; or 2. (a) unaltered tooth, (b) occlusal cavity preparation, (c) two-surface cavity preparation, (d) MOD cavity preparation, (e) access, (f) instrumentation, and (g) obturation. Results on 42 teeth indicate that endodontic procedures have only a small effect on the tooth, reducing the relative stiffness by 5%. This was less than that of an occlusal cavity preparation (20%). The largest losses in stiffness were related to the loss of marginal ridge integrity. MOD cavity preparation resulted in an average of a 63% loss in relative cuspal stiffness.(ABSTRACT TRUNCATED AT 250 WORDS)
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            Evaluation of the biomechanical behavior of maxillary central incisors restored by means of endocrowns compared to a natural tooth: a 3D static linear finite elements analysis.

            The present study aimed at evaluating different restoring configurations of a crownless maxillary central incisor, in order to compare the biomechanical behavior of the restored tooth with that of a sound tooth. A 3D FE model of a maxillary central incisor is presented. An arbitrary static force of 10 N was applied with an angulation of 125 degrees to the tooth longitudinal axis at level of the palatal surface of the crown. Different material configurations were tested: composite, syntered alumina, feldspathic ceramic endocrowns and glass post resorations with syntered alumina and feldspathic ceramic crown. High modulus materials used for the restoration strongly alter the natural biomechanical behavior of the tooth. Critical areas of high stress concentration are the restoration-cement-dentin interface both in the root canal and on the buccal and lingual aspects of the tooth-restoration interface. Materials with mechanical properties underposable to that of dentin or enamel improve the biomechanical behavior of the restored tooth reducing the areas of high stress concentration. The use of endocrown restorations present the advantage of reducing the interfaces of the restorative system. The choice of the restorative materials should be carefully evaluated. Materials with mechanical properties similar to those of sound teeth improve the reliability of the restoartive system.
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              Biomechanical considerations for the restoration of endodontically treated teeth: a systematic review of the literature, Part II (Evaluation of fatigue behavior, interfaces, and in vivo studies).

              The restoration of endodontically treated teeth has long been guided by empirical rather than biomechanical concepts. Part I of this literature review presented up-to-date knowledge about changes in tissue structure and properties following endodontic therapy, as well as the behavior of restored teeth in monotonic mechanical tests or finite element analysis. The aim of the second part is to review current knowledge about the various interfaces of restored, nonvital teeth and their behavior in fatigue and clinical studies. The basic search process included a systematic review of articles contained in the PubMed/Medline database, dating between 1990 and 2005, using single or combined key words to obtain the most comprehensive list of references; a perusal of the references of the references completed the review. Nonvital teeth restored with composite resin or composite resin combined with fiber posts resisted fatigue tests and currently represent the best treatment option. In comparison to rigid metal and/or ceramic posts, when composite resin or composite resin/fiber posts fail, the occurrence of interfacial defects or severe tooth breakdown is less likely. Adhesion into the root, however, remains a challenge because of the unfavorable ovoid canal configuration, as well as critical dentin microstructure in the deepest parts of the canal. Thus, specific combinations of adhesives and cements are recommended. The clinical performance of post-and-core restorations proved satisfactory overall, in particular with a contemporary restorative approach using composite resin and fiber posts. However, the clinical literature does not clearly isolate or identify exact parameters critical to success. This, in turn, emphasizes the importance and relevance of in vitro studies to further improve the quality and long-term stability of prosthetic foundations.
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                Author and article information

                Journal
                J Istanb Univ Fac Dent
                J Istanb Univ Fac Dent
                J. Istanbul Univ. Fac. Dent.
                jiufd
                jiufd
                IUFD
                Journal of Istanbul University Faculty of Dentistry
                Istanbul University Faculty of Dentisty (Istanbul, Turkey )
                2149-2352
                2149-4592
                2015
                29 April 2015
                : 49
                : 2
                : 57-63
                Affiliations
                [ ]Department of Prosthodontics, Faculty of Dentistry, Bulent Ecevit University, Turkey
                Author notes
                [* ]To whom correspondence should be addressed: Dr. Seda Cengizedu Department of Prosthodontics Faculty of Dentistry Bulent Ecevit University Zonguldak Turkey Phone: 0372 2613600 sedabc@ 123456hotmail.com
                Article
                jiufd-49-2-355
                10.17096/jiufd.71363
                5573486
                28955538
                2e3a976e-2bc0-4933-ba8f-eaba8c769afc
                Copyright © 2015 Journal of Istanbul University Faculty of Dentistry

                This article is licensed under Creative Commons License Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) license ( https://creativecommons.org/licenses/by-nc-nd/4.0/). Users must give appropriate credit, provide a link to the license, and indicate if changes were made. Users may do so in any reasonable manner, but not in any way that suggests the journal endorses its use. The material cannot be used for commercial purposes. If the user remixes, transforms, or builds upon the material, he/she may not distribute the modified material. No warranties are given. The license may not give the user all of the permissions necessary for his/her intended use. For example, other rights such as publicity, privacy, or moral rights may limit how the material can be used.

                History
                : 09 October 2013
                : 02 December 2014
                Categories
                Articles
                Biological Sciences
                Dentistry

                endocrown,adhesive restoration,endodontically treated teeth

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