AL-AZHAR UNIVERSITY- GAZA

FACULTY OF DENTISTRY
PROSTHODONTIC DEPARTMENT

SHOULD CROWNS BE
PLACED ON
ENDODONTICALIY
TREATED TEETH?
PREPARED FOR :
DR. MOHAMMED MIQDAD

SUBMITTED BY :
TASNEEM SAFI

LAMEES BAROUD

HANEEN AL SMMAK

BASEL AL KRONZ

2016 - 2017

SHOULD CROWNS BE PLACED ON ENDODONTICALIY

TREATED TEETH?
A retrospective study of 1,273 teeth endodontically treated 1 to 25
years previously compared the clinical success of anterior and
posterior teeth.6 Endodontically treated teeth with restorations that
encompassed the tooth (onlays, partial- or complete-coverage metal
crowns,

and

metal

ceramic

crowns)

were

compared

with

endodontically treated teeth with no coronal coverage restorations.

It was determined that coronal coverage crowns did not significantly
improve the success of endodontically treated anterior teeth. This
finding supports the use of a conservative restoration such as an
etched resin in the access opening of other wise intact or minimally
restored anterior teeth. Crowns are indicated only on endodontically
treated anterior teeth when they are structurally weakened by the
presence of large and/or multiple coronal restorations or they require
significant form/color changes that cannot be effected by bleaching,
resin bonding, orporcelain laminate veneers. Scurria et al. collected
data from 30 insurance carriers in 45 states regarding the
procedures 654 general dentists performed on endodontically
treated teeth.7 The data indicated that 67% of endodontically
treated anterior teeth were restored without a crown, supporting the
concept that many anterior teeth are being satisfactorily restored
without the use of a crown.

When endodontically treated posterior teeth (with and without

coronal coverage restorations) were compared, a significant increase
in the clinical success was noted when cuspal coverage crowns were
placed on maxillary and mandibular molars and premolars.
Therefore, restorations that encompass the cusps should be used on
posterior teeth that have interdigitation with opposing teeth and
thereby receive occiusal forces that push the cusps apart. The
previously discussed insurance data indicated that 37 to 40% of
posterior pulpless teeth were restored by practitioners without a
crown,
a method of treatment not supported by the long-term clinical
prognosis of posterior endodontically treated teeth that do not have
cusp-encompassing crowns.7 There are, however, certain posterior
teeth (not as high as 40%) that do not have substantive occlusal
interdigitation or have an occlusal form that precludes interdigitation
of a nature that attempts to separate the cusps (such as mandibular
first premolars with small, poorly developed lingual cusps). When
these teeth are intact or minimally restored, they would be
reasonable candidates for restoration of only the access opening
without use of a coronal coverage crown.
Multiple clinical studies of fixed partial dentures,many with long
spans and cantilevers, have determined that endodontically treated
abutments failed more often than abutment teeth with vital pulps
owing

to

tooth

fracture,

supporting

the

greater

fragility

of

endodontically treated teeth and the need to design restorations

that reduce the potential for both crown and root fractures when
extensive fixed prosthodontics treatment is required. Gutmann

reviewed the literature and presented an overview of several articles

that identify what happens when teeth are endodontically treated
.These articles provide background information important to an
understanding of why coronal coverage crowns help prevent
fractures of posterior teeth. Endodontically treated dog teeth were
found to have 9% less moisture than vital teeth. Also, with aging,
greater amounts of peritubular dentin are formed, which decreases
the amount of organic materials that may contain moisture. It has
been shown that endodontic procedures reduce tooth stiffness by
5%, attributed primarily tothe access opening.
Tidmarsh described the structure of an intact tooth that permits
deformation when loaded occlusafly and elastic recovery after
removal of the load. The direct relationship between tooth structure
removed during tooth preparation and tooth deformation under load
of mastication has been described) Dentin from endodontically
treated teeth has been shown to exhibit significantly lower shear
strength and toughness than vital dentin. Rivera et al. stated that
the effort required to fracture dentin may be less when teeth are
endodontically treated because of potentially weaker collagen
intermolecular cross-links.
Conclusions
Restorations that encompass the cusps of endodontically treated
posterior teeth have been found to increase the clinical longevity of
these teeth. Therefore,crowns should be placed on endodontically
treated posterior teeth that have ocdusal interdigitation with
opposing teeth of the nature that places expansive forces on the
cusps. Since crowns do not enhance the clinical success of anterior

endodontically treated teeth, their use on relatively sound teeth

should be limited to situations in which esthetic and functional
requirements

cannot

be

adequately

achieved

by

other,more

conservative restorations (Figure 1).

Figure 1 incisal view of an intact central incisor that required endodontic

treatment owing to trauma. Placement of a bonded resin restoration in the
access opening is the only treatment required since crowns do not enhance the
longevity of anterior endodontically treated teeth. A crown would only be used
when esthetic and functional needs cannot be achieved through more
conservative treatments.