Optimizing the restoration of posterior endodontically treated teeth: Adhesive restoration of endodontically treated posterior teeth

The implementation of new resin-based aesthetic adhesive restorative materials led to a paradigm shift in dentistry. Tooth cavity preparations are no longer dictated by the restorative material properties but are just “pathology driven”, as adhesion guarantees retention of the restorations without the need of friction and retentive designs. Therefore, many classical prosthetic principles seem today belong to the past, but are still applied. As an example, retention of restorations by long and invasive metallic posts in the root is no longer necessary. Even indications for standard full crowns have been widely reduced and onlays, overlays and endocrowns are considered today valid and more conservative alternatives. Also, the big breakthrough of digital technologies is driving dentistry to more standardized and affordable treatments, without compromises on final quality. As a matter of facts, dentistry today can be (and it should be) more conservative, cheaper and faster. The restoration of the endodontically treated tooth (ETT) is probably the field which represents these epochal changes best. The studies described in this thesis showed that in cases of small to medium intracoronal tooth cavities, resin-based restoratives applied directly by the operator are a valuable restorative option for ETT. In cases of extensive damage to tissues, bonded indirect restorations, such as endocrowns, that offer a full occlusal coverage are preferred to crowns. Laboratory performances of these endocrowns in terms of the mechanical failure loads/fatigue resistance and the adhesive retention are good and, in any case, comparable to those of conventional prosthodontic solutions. Results of recent in-vivo trials have also validated the clinical performances of this adhesive post-free restorative strategy.