A New Treatment Approach Utilizing CAD/CAM Restorations for Endo-Treated Permanent Anterior and Posterior Teeth in Pediatric Patients. Dr. Ana Keohane, DDS, DMD, FICD; Dr. Gladys G. Carrasco Roman, DDS, CAGS
Abstract: Reconstruction of anterior young permanent teeth with severe coronal destruction after root canal therapy remains a challenge in dentistry. Post, cores, and total crowns present several contraindications for use in pediatric patients such as thinning of the root canal walls due to overpreparation, age of the tooth and the patient, cooperation for this treatment, growth of the patient, and aesthetics. Endocrown is a monolithic restoration made of ceramic material and composite resin such as lithium disilicate glassceramic -IPS e.max CAD and can be designed utilizing a digital workflow with an intraoral scanner (IOS) and computer-aided design/computer-assisted manufacturing (CAD/CAM). These devices are useful for taking impressions in children, are safe, accurate, and well-tolerated. Through this paper, we present a clinical case report of a 13-year-old female patient who received endocrowns for teeth #8 and #9 after endodontic retreatment and that were designed digitally. A oneyear follow-up demonstrated that CAD/CAM endocrowns should be considered as an alternative approach for the short-to-long-term treatment for endodontically treated permanent teeth with large coronal destruction in children. Keywords: Endocrown, Endodontic Therapy, Anterior Restorations, CAD/CAM, Intraoral Scanner (IOS), Children, IPS e.max CAD.
are the most popular technique for restoring young permanent anterior teeth after endodontic therapy. Still, these restorations are fragile and need to be replaced multiple times before the patient can receive a more definitive restoration.1 It is suggested that post, cores, and total crowns are the treatment of choice for largely damaged teeth after root canal therapy, however, thinning of the root canal walls due to overpreparation might happen when placing inter radicular posts1. Moreover, in the pediatric population, several factors must be considered such as the age of the tooth and the patient, the cooperation for this treatment, growth of the patient, and aesthetics.2 For these reasons we consider that post and cores have several contraindications for use in pediatric patients, consequently, we must be able to offer other alternatives in the choice of restorations. Endocrown is a crown made of ceramic material and composite resin that uses the pulp chamber to obtain macro mechanical retention, and micromechanical retention is achieved using adhesive cementation. This technique constitutes an alternative and reliable approach for restoring anterior and posterior permanent teeth with significant coronal destruction post-endodontic treatment in pediatric patients.2–4 These endocrowns are monolithic restorations and can be designed utilizing digital workflow with an intraoral scanner (IOS) and computer-aided design/ computer-assisted manufacturing (CAD/CAM) with a lithium disilicate glass-ceramic block. This material demonstrates highly esthetic qualities and long-term resistance. Furthermore, IOS are very useful digital devices for taking impressions in children, they are easy to use, accurate, and welltolerated.3 The purpose of this paper is to describe a clinical case, in which, we introduce an alternative treatment for severely damaged upper permanent central incisors with endodontic root-canal therapy in a pediatric patient and placement of IPS e.max CAD endocrowns utilizing digital workflow with an IOS and CAD/CAM.
2. Case Report 1. Introduction Dentists still face challenges regarding the rehabilitation of endodontically treated teeth with severe coronal destruction. Composite restorations
A 13-year-old female patient presented to the Boston University Henry M. Goldman School of Dental Medicine pre-doctoral treatment center during pediatric rotation with severe secondary caries on
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