Endodontic Management with Posterior Indirect Adhesive Restoration by CAD-CAM Procedure - Case Report

Abstract

Successful endodontic management depends on knowledge of the anatomy, appropriate modification in the treatment protocol and utilization of a computer-aided design system for final restoration. The residual structure of teeth with endodontic treatment must be preserved and is crucial to long-term survival. The objective of this case report is to describe the clinical treatment steps for endodontic management with PIAR (Posterior Indirect Adhesive Restoration) as the final restoration treatment on the first right mandibular molar using CAD-CAM procedures.

PIAR is very common nowadays in definitive restoration after root canal treatment procedure.^[1] Modern tooth restoration techniques that rely on adhesion are replacing traditional techniques that depend on mechanical retention.^[2] The use of indirect bonded restoration is very frequent in case of extended coronal destruction of a posterior tooth. The primary objective of treating compromised posterior teeth is minimal invasiveness by adhesion, which has led to a total shift in operator strategies toward minimally invasive bonded restorations. Preservation of healthy tissue, which is the main benefit of their restorations, since adhesive restorations do not need extra tooth preparation to achieve resistance and retention form.^[2,3]

The tooth structures to be evaluated include dentin, marginal ridge, pulp chamber and remaining cusp. To improve the strength, the cusp should be covered when required. The main causes of technical failure include leakage margins, excessive wear, and loss of retention.^[4] Modern restorative dentistry is showing a lot of interest in minimally invasive dentistry due to the advancement and development of adhesive bonding procedures. Maintaining the integrity of tooth structure is essential to the durability of teeth and restorations.^[5,6]

Following endodontic therapy, restorative procedures are performed while considering biomechanical and functional aspects such as canine guidance, group function, occlusion type, overjet, overbite, parafunction presence or absence, cavity dimension, occlusal surface, and remaining wall thickness.^[7] The following goals are needed when choosing the best restoration: preventing the infiltration of microorganisms into the root canal system; restoring the tooth's form, stability, and appropriate points of contact with adjacent teeth; restoring function; shielding the remaining tooth structure from additional (carious and non carious) hard tissue loss and fracture; maintaining the health of the marginal periodontal tissues; and maintaining optimal aesthetics.^[8]

Adhesion of the restorative material to the tooth is facilitated by appropriate bonding methods, which also improve marginal adaptation, prevent microleakage, and make the prepared tooth and the replacement itself more fracture resistant.^[9,10] The interface to the tooth and the interface to the restorative material are two quite different interfaces to take into account. A dual bond-a micromechanical interlocking and a real chemical bond-should be provided by the optimal bonding process to different kinds of indirect restoration.^[9]