Postendodontic Tooth Restoration - Part I: The Aim and the Plan of the Procedure

Endodontskim zahvatom uklanjamo pulpu, nekrotičan dentin i dio zdrava tvrdoga zubnog tkiva. Time smanjujemo otpornost preostala zubnoga tkiva na sile vlaka i tlaka koje nastaju pri okluzijskim dodirima zuba. Zato restaurativna opskrba endodontski liječena zuba mora zadovoljiti zahtjeve retencije restorativnoga nadomjestka, otpornosti nadomjestka i zubnoga tkiva na sile unutar žvačnoga sustava, dobra koronarnog i intraradikularnoga brtvljenja te estetske zahtjeve. Poslijeendodontska opskrba uključuje sljedeće postupke: nadoknadu izgubljena zubnoga tkiva aloplastičnim materijalima u izravnoj ili neizravnoj izvedbi (ispunom amalgamom, kompozitom, stakleno ionomernim cementom, ili izradbom inleja, onleja ili overleja); uporabom intrakanalnih i parapulpnih kolčića uz nadoknadu zubne krune aloplastičnim materijalom; izradbu batrljka zuba aloplastičnim materijalom s uporabom intrakanalnih i parapulpnih kolčića ili bez njih uz nadoknadu zubne krune protetskim nadomjestkom; laboratorijski izrađenom nadogradnjom uz nadoknadu zubne krune protetskim nadomjestkom. U nekim slučajevima bit će dovoljno samo zabrtviti pristupni kavitet nekim od aloplastičnih materijala, a u drugim bit će potrebno osigurati okomitu stabilizaciju preostaloj kruni u obliku intraradikularne nadogradnje i izraditi protetski nadomjestak. Izbor postupka ovisit će o stupnju razorenosti zubne krune, smještaju zuba u zubnome luku, okluzijskim dodirima zuba, morfologiji korijenskih kanala, funkcijskim i estetskim zahtjevima, materijalnim mogućnostima te o vremenu koje imamo na raspolaganju. Pravilno prepoznata indikacija uz poštivanje svih faza izabranog postupka poslijeendodontske opskrbe osigurat će opskrbljenom zubu punopravnu ulogu u stomatognatom sustavu.Endodontic procedure requires removal of the pulp tissue and necrotic dentine, as well as a significant amount of healthy hard dental tissue, which results in reducing the resistance of the tooth to the occlusal loading forces. Restoration of such a tooth needs to satisfy requirements for retention of the restorative material, its resistance, as well as the resistance of the remaining dental tissue to occlusal forces, good coronal and intraradicular obturation and also aesthetic requirements. Postendodontic treatment includes the following procedures: replacement of lost tissues using alloplastic materials directly or indirectly (amalgam, composite resin and glass-ionomer cement fillings or inlay, onlay or overlay restorations); the alloplastic material crown restorations using intracanal posts and parapulpal pins; the alloplastic material core buildup with or without intracanal posts and parapulpal pins covered with prosthetic crown; restoration of lost tooth structure using laboratory made post and core covered with prosthetic crown. Sealing of endodontic cavity using one of the alloplastic materials would be the treatment of choice in uncomplicated cases, whereas in severely damaged teeth ensuring remaining tooth structure by vertical stabilization and the prosthetic crown would be necessary. The choice of procedure depends on the severity of crown damage, the tooth position in the arch, occlusal contacts, morphology of root canal spaces, functional and aesthetic aspects, financial ability and available time for performing the procedure. The correct indication evaluation respecting all steps of the chosen procedure will provide long term survival of the postendodontically treated tooth in the stomatognathic system