Prior Restorative Procedures to Endodontic Treatment

Abstract

Tooth loss due to fracture and the failure of endodontic treatment (ET) are common situations in teeth with extensive tissue destruction. This is due to the fragility of the remaining dental structure and the difficulty in sealing cavities, which is sometimes associated with the violation of the supracrestal insertion tissue. The previous restoration of marginal ridges or cusps with composite resin (CR) restores their fracture resistance, due to the adhesive characteristics of the restorative material, while also protecting the quality of endodontic treatment through better sealing. However, the protocol adopted in teeth requiring endodontic treatment involves performing the restorative procedure only after the endodontic procedures. The objective of this study was to report a case in which restoration of marginal ridges and/or cusps was performed prior to endodontic treatment, focusing on maintaining the tooth in function without dental fracture. The restoration was performed with an inverted operative sequence before the endodontic treatment. There was a violation of the supracrestal insertion tissue, requiring crown lengthening surgery (CLS) prior to the restorative procedure. Clinical and radiographic evaluations were performed postoperatively at seven days, three, six, and nine months, and five years. Tooth function was maintained without dental fractures or restoration loss. Periradicular space healing occurred with the disappearance of the lesion. Performing the restorative procedure prior to endodontic treatment in teeth with extensive coronal destruction is an alternative technique that facilitates clinical procedures, reduces the likelihood of dental loss due to fracture, and promotes endodontic treatment success.

Keywords: chatgpt; clinical success; composite resin restorations; dental fracture; endodontics; periodontics.

Figure 1. (A) Extensive caries lesion in the upper left second premolar and (B) radiograph of the upper left second premolar showing involvement of the pulp chamber and periapical lesion.

Figure 2. Osteotomy was performed until a distance of 3 mm between the end of the preparation and the marginal bone crest was re-established.

Figure 3. Operative sequence, first session: (A) absolute isolation of the operative field, (B) pre-endodontic restoration of the dental element, reconstructing the marginal crests and cusps, (C) provisional coronal sealing after endodontic access, (D) after removal of the rubber dam, the detached flap was stabilized through vertical interrupted mattress suture and simple suture.

Figure 4. (A) Preparation of the root canals, (B) definitive post-endodontic restoration of the occlusal face, and (C) final radiography to verify the quality of the endodontic and restorative treatment.

Figure 5. Follow-up five years: (a) the restoration was in good adaptation and conservation, (b) the successful endodontic treatment and the healing of the periradicular tissues.

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