Endodontic Treatment, Retreatment, and Surgery by Bobby Patel

Author:Bobby Patel
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

The decision to gain direct access through an existing restoration or dismantle first must be based on the vulnerability of recontamination during root canal retreatment. It is crucial that the coronal seal be maintained both during and after endodontic treatment to prevent reinfection of the canal space. It is well documented that if coronal leakage occurs (especially when a poor coronal restoration is combined with a poor root filling), then failure is likely to occur [18–20]. If the crown is judged to be of good quality (both clinically and radiographically) with no obvious marginal discrepancies macroscopically, then retreatment can be carried out with a conservative access preparation which can be sealed using either adhesive or amalgam Nayyar core restorations upon completion [21]. In a laboratory study using incisor teeth, cutting an access cavity resulted in a 15 % reduction in relative strength, and subsequent amalgam restoration resulted in a 5 % reduction in relative strength [22]. Restoration of a crowned tooth with a plastic restoration following completion of endodontic treatment ensures that coronal seal is maintained not requiring replacement of the crown.

Dismantling of the coronal restoration is necessary if crown margins are defective or undermined by caries. Retaining such a restoration risks jeopardising further success in the future due to reinfection. For temporary crown and bridge, the restorations can be removed easily using either a scaler or large spoon excavator. Various methods used for permanent crown removal include sectioning, using lifting devices and ultrasonics and can be classified according to whether the method is deemed conservative (prosthesis remains intact), semi-conservative (minor damage to the prosthesis but can potentially be reused) and destructive (prosthesis is damaged and not reusable) [23, 24] (see Table 10.2).Table 10.2Classification for crown and bridge disassembly

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