Restoring endodontically treated teeth
One of the big questions that constantly gets asked in our courses is, “How do you restore endodontically treated teeth?” Especially if there is a small access opening on a large molar. Suffice it to say, I’ve heard some speakers espouse the merits of simply doing an occlusal inlay for a molar that has been endodontically treated. If you have heard the same, my advice to you is don’t listen to this and do your patient a disservice.
This one paper summarizes it nicely:
Are full cast crowns mandatory after endodontic treatment in posterior teeth?
Tikku AP, Chandra A, Bharti R.
J Conserv Dent. 2010 Oct;13(4):246-8.
The main take-away from the article is summarized below:
"Root canal treated posterior teeth without crowns are lost at a much higher rate than teeth supported with full cast crowns. The risk involved in losing the endodontically treated posterior teeth to fracture if not supported by full cast crown is too high to take."
The standard has been full coverage for all molars in this category for over 40 years. When measuring the occlusal load on second molars compared with second bicuspids, the difference in force between these teeth is greater than 30%. To use any intracoronal approach would be foolhardy and illadvised. I agree with that standard.
Problem is to this day there are still speakers who recommend an occlusal inlay for molars with rct instead of full coverage. Makes me want to bang my head in a wall when I hear t.
