Biomimetic Rehabilitation of a Structurally Compromised Endodontically Treated Mandibular First Molar Using a CAD/CAM Endocrown: A Case Report
Endocrown; Biomimetic dentistry; CAD/CAM; Endodontically treated tooth; Lithium disilicate; Adhesive restoration
AuthorsAbstractPurpose: To present the biomimetic rehabilitation of a structurally compromised endodontically treated mandibular first molar using a CAD/CAM-fabricated endocrown as a conservative alternative to conventional post-core restorations. Case report: A 21-year-old male patient presented with deep carious destruction of tooth 46, associated with extensive loss of coronal tooth structure and periapical pathology. Clinical and radiographic evaluation led to a diagnosis of pulp necrosis with asymptomatic apical periodontitis. Nonsurgical root canal treatment was performed under magnification using a multivisit protocol, incorporating calcium hydroxide intracanal medication and obturation with a bioceramic sealer. A one-month followup demonstrated a reduction in periapical radiolucency, indicating initiation of healing. Given the limited residual tooth structure and absence of a favorable ferrule, a biomimetic approach was adopted. Following deep margin elevation, an endocrown preparation was performed to utilize the pulp chamber for added macromechanical retention while preserving radicular dentin. A fully digital workflow using the CEREC system enabled fabrication of a monolithic lithium disilicate-based endocrown (Dentsply Tessera). Adhesive cementation was carried out using a dual-cure resin cement following appropriate surface treatment and bonding protocols. The restoration exhibited satisfactory marginal adaptation, occlusal harmony, and functional stability. Post-cementation radiographic evaluation confirmed proper seating of the restoration along with continued periapical healing. Conclusion: Endocrowns fabricated using CAD/CAM technology represent a predictable and minimally invasive biomimetic alternative for the rehabilitation of structurally compromised endodontically treated teeth. Appropriate case selection, adhesive protocols, and digital workflows contribute to favorable clinical and biological outcomes. 1. Introduction Extensive coronal destruction in endodontically treated teeth (ETT) poses a serious restorative challenge, especially when the remaining tooth structure is not sufficient to support sufficient retention and resistance form to permit conventional full-coverage restorations 1-4. Such teeth have traditionally been restored using post-core systems to retain a coronal restoration, although such an approach often necessitates further removal of radicular dentin, which may compromise the structural integrity of the root and increase the risk of catastrophic failure 5-8. The concept of biomimetic restorative dentistry has become prominent in recent years, focusing on the preservation of the remaining toothrestoration complex and the use of adhesive techniques to strengthen the residual tooth-restoration complex 9-12. In this paradigm, endocrowns have •••••••••••••••••••••••••••••••• ejprd.org- Published by Riset Publishing Services LLC.
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