The conservative restoration of single posterior endodontically treated teeth

Aim: To analyse, through a literature review, the factors leading the clinician in the choice of the bonded composite restoration in the posterior endodontic treated tooth. Summary: The long-term success of endodontic therapy is the result of cleaning, shaping and three-dimensional root canal obturation, respecting original anatomy, and using a minimally invasive instrumentation technique; a coronal seal, preferably made in the same single visit, protects the root canal system from oral contamination by microrganisms found in saliva. Endodontic treated teeth show irreversible anatomical, biochemical, and biomechanical changes; their propension to fracture conditions the restoration options for the clinician. Bonded composite resins are the materials of choice for single treated teeth restoration, in presence of a sufficient quantity of cervical enamel. Composite materials allow conservative preparations, reduce the removal of healthy tooth substance, reinforce the residual tooth tissues, have an elasticity modulus closer to dentin, can be repaired, and guarantee aesthetics. After the review of recent international literature, a clinical rationale has been discussed in order to choose either a direct technique (more conservative, but less practicable) or an indirect one (inlay, but mostly onlay and overlay). Respecting bioeconomy principles, endodontic posts are used only in presence of serious loss of coronal substance to provide adequate retention for a core buildup. Full crowns are indicated in heavily compromised teeth with extensive involvement of the cervical enamel; in such cases, a traditional cementation is preferred. Optimal isolation of the operating field with rubber dam and periodontal surgery, restoring the proper biological width, are two requirements for the long-term success of adhesive restorations. Learning key points: 1) Characteristics of the endodontic treated teeth. 2) Endodontic treatment and restoration with a minimally invasive approach. 3) Direct and indirect adhesive composite restorations (inlay, onlay, overlay). (C) 2011 Societa Italiana di Endodonzia. Published by Elsevier Srl. All rights reserved.