Papalexopoulos Dimokritos, Samartzi Theodora-Kalliopi, Sarafianou Aspasia
Department of Prosthodontics, National and Kapodistrian University of Athens, Athens, Greece, Phone: +6988600246, e-mail:
DDS, Private Practice, Athens, Greece.
J Contemp Dent Pract. 2021 Apr 1;22(4):422-426.
The aim of this literature review is to determine whether endocrowns are a reliable alternative for endodontically treated teeth with extensive loss of tooth structure, the indications and contraindications of this restorative choice, the principles that should be followed for tooth preparation and which material is most appropriate for endocrown fabrication.
Rehabilitation of endodontically treated teeth with severe coronal destruction has always been a challenge for the dental clinician. Until recently, the fabrication of a metal-ceramic or all-ceramic full-coverage crown along with a metal or glass fiber post has been the "gold standard" proving its efficacy via numerous clinical studies. With the development of CAD/CAM technology and the evolution of dental materials, new minimally invasive techniques have been introduced with less need for adjustments and less incorporation of structural defects. One of them, the "monoblock technique," proposed by Pissis in 1995, was the forerunner of endocrown restoration, a term used by Bindl and Mörmann to describe an all-ceramic crown anchored to the internal portion of the pulp chamber and on the cavity margins, thus obtaining macromechanical retention provided by the axial opposing pulpal walls and microretention attained with the use of adhesive cementation.
Endocrowns require a decay-oriented preparation taking advantage of both the adhesion and the retention from the pulp-chamber walls, they are strongly indicated in endodontically treated molars in cases where minimal interocclusal space and curved or narrow root canals are present and they should be manufactured from materials that can be bonded to the tooth structure.
Endocrowns are a reliable alternative to traditional restorative choices, given that the clinicians respect the requirements and indications describing this technique.
Traditional restorative techniques demanding tooth substance removal and minimizing the opportunity for reinterventions should be reconsidered.
本综述的目的是确定内冠对于牙体组织大量丧失的根管治疗牙是否是一种可靠的替代修复方式，这种修复选择的适应证和禁忌证，牙体预备应遵循的原则以及哪种材料最适合制作内冠。
对根管治疗后冠部严重破坏的牙齿进行修复，一直是牙科临床医生面临的挑战。直到最近，制作金属烤瓷或全瓷全冠以及金属或玻璃纤维桩一直是“金标准”，众多临床研究已证明其有效性。随着CAD/CAM技术的发展和牙科材料的演变，引入了新的微创技术，所需调整更少，结构缺陷纳入也更少。其中之一，1995年皮西斯提出的“整体技术”，是内冠修复的先驱，宾德尔和默尔曼用这个术语来描述一种全瓷冠，它锚固在髓腔内部和洞缘，从而获得轴向相对的髓壁提供的宏观机械固位以及使用粘结性粘结剂实现的微固位。
内冠需要进行以龋坏为导向的预备，利用髓腔壁的粘结力和固位力，在根管治疗后的磨牙存在最小咬合间隙以及根管弯曲或狭窄的情况下强烈推荐使用，并且应由能够粘结到牙体结构的材料制成。
如果临床医生遵循描述该技术的要求和适应证，内冠是传统修复选择的可靠替代方式。
需要去除牙体组织并尽量减少再次干预机会的传统修复技术应重新考虑。
