What is Restorability Assessment?
= assessment of all factors related to remaining tooth structure and supporting structures, which will permit predictable placement and retention
of a functional and if necessary aesthetic restoration, without causing damage to
the surrounding tissues
Which factors affect Restorability Assessment?
- remaining tooth structure
- periodontal status
- endodontic status
- patient status
- dentition
- ferrule effect
How to regain ferrule effect with teeth broken down at or below the gingival margin?
- Surgical crown lengthening
- Orthodontic extrusion
- Surgical extrusion
Function of cracked tooth:
= incomplete fracture initiated from crown and extends subgingivally, directed MD
Function of splint tooth:
= complete fracture initiated from the crown and extending subgingivally, usually directed MD through both of the marginal ridges and the proximal surfaces
How is surgical crown lengthening performed?
=> by gingivectomy and/or bone removal
What is orthodontic extrusion (forced eruption)?
Movement of a tooth by applying
extrusion forces in all regions of the periodontal ligament
What is surgical extrusion?
The remaining tooth structure is repositioned at a more coronal / supra-gingival position in the same socket in which the tooth was
located originally
How to restore posterior teeth?
- posts don’t increase R so we dont need them -> premolars require post more often than M
- coronal coverage improves clinical success
- crown placement (NO cuspal coverage)
- both M and D contacts
- tooth not serving as a RPD or fixed bridge abutment (no RCT)
- RCT
- premolars are more likely than molars to be subjected to lateral forces
- try to conserve dentine
- direct or indirect onlays
- premolars have longer survival rate than molars
How to restore anterior teeth?
- coronal coverage doesn’t improve clinical success
- must resist lateral forces
- post indicated when crown is planned
- crowns don’t improve the success of endo treated teeth
- bleaching of discoloured teeth instead of crowning
Why root filled teeth have a higher risk of fracture?
- Dehydration of dentine and transformation of collagen fibre structure
- Reduction of the flexural strength and modulus of elasticity of dentine by NaOCl irrigation and Ca(OH)2 medication during RCT
- Loss of proprioception (protective feedback mechanism) after pulp removal
- Missing tooth structure caused by caries and previous extensive restorations
- Loss of structural integrity associated with access preparation during endodontic treatment
Contra-indication for treatment?
vertical root fracture and
split tooth
