J
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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.
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.