Extreme bruxism Zirc endo-crowns great, but what if increasing VDO

J

jcbdmd

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I have done many, many, many "endo-crowns" on badly broken-down flat top teeth due to extreme grinding, and knock on wood have usually had great success. Usually we are doing singles or sometime all 4 lower anteriors this way, and we try to copy the existing occlusion first and enhance the esthetics as a distant second.

We usually have a decent sized endo access, and on occasion I have had to rely on only the access for retention as the top of the crown has to be flat-topped.

We typically still cement these with a GIC, but occasionally I have to bond.

All of this has worked for me, even on the worst case bruxism my dad had seen in 43 years...

However, what about the fractured tooth due to trauma? One that has to be restored up to ideal proportions. For these cases we were taught to place a post in an attempt to gain ferrule, convert the broken tooth into a ideal prepped tooth with the post retaining the core.

I have had success with that too, but strangely the success seems to be slightly less than the extreme meat grinder cases.

Tangential to my earlier discussion of full mouth rehab, if you have the badly worn dentition and are increasing the vertical, are zirconia endo access "pegs" with a small conservative chamfer enough to retain multiple endo treated crowns in the arch?

Bond or cement?

Obviously a lingualized/denture occlusal scheme with flatter teeth on the lowers and more esthetic uppers would minimize forces.

I hate splinting teeth, but I would guess that it would work pretty well with zircona IF you could get multiple endo crowns to draw.

How do lab scanners do on endo retention? I am sure IOS would struggle.
 
CoolHandLuke

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are zirconia endo access "pegs" with a small conservative chamfer enough to retain multiple endo treated crowns in the arch?

Bond or cement?
these sound like questions you should ask an endo specialist, not lab monkeys.

How do lab scanners do on endo retention? I am sure IOS would struggle.
this is more like it. lab scanners and IOS can capture most prepped teeth without much issue.

if however your prep looks like this:

you will have problems with everything and maybe you should get checked for parkinsons
 
J

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are zirconia endo access "pegs" with a small conservative chamfer enough to retain multiple endo treated crowns in the arch?

Bond or cement?
these sound like questions you should ask an endo specialist, not lab monkeys.
There are probably some lab monkeys on here who mill a lot of these endo peg retained crowns... a lot of bondodontists swear by the little flat top "occlusal veneers."

Question is how many require re-makes or are not successful.

I would guess you guys are painfully aware of re-makes just like we are painfully aware of the 7th time we have had to re-do "this damned maryland bridge I talked myself into".

Anyone seeing failures on endo crowns due to the material?

Then part B is: are these failures cuspy or monoplane.

EDIT: I would think monoplane failure would be the "peg," but Cuspy failures might be de-bond/cement failure, or tooth splitting (no remake, just an implant crown, er, win-win?)
 
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I've only done a few of these, all zr, both IOS and impression- they haven't come back, nor have I heard complaints of de-cementation... I will say the Dr quality is different from those who do a separate P&C and the like... and I wouldn't be surprised if they do need to be recemented bc of lack of tooth retention.

Are they perio compromised? Heavy grinders? How many are lacking natural tooth structure? Bridge span? etc etc one shoe doesn't fit all with these cases

I personally would rather a P&C and crown, for fear of fracturing/ losing more tooth structure.. but I'm just a lab monkey who likes saving natural teeth.. ironically lol

Haven't seen teeth fail due to a certain material, only poor hygiene/ occlusion/ rehabilitation etc

In my cases, Zr is also never bonded, except for Zr veneer cases.. always cemented.
 
TheLabGuy

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I've had my fair share of these come across my desk, they seem to work out great, even when we are increasing the vertical. Granted, the endo access hole isn't > 3mm. Very similar to folks putting retention boxes on second molars where the coronal height of the prep is shorter than my brother in law. As for cement, I always suggest a RMGI cement...seems to be working fine. P.S. My brother in law is short ;)
 
J

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I've had my fair share of these come across my desk, they seem to work out great, even when we are increasing the vertical.

Trying to think of the last time I did one of these on a canine, which IMO would be the test on if they work with increased VDO, and I got nothing. Don't know if I have ever done one on a cuspid... You?

Typically even in badly broken down canines, I have enough ferrule to do a conventional prep, but that would be an interesting proof of concept.
 
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