International Journal of Applied Dental Sciences 2019; 5(1): 253-256

ISSN Print: 2394-7489

ISSN Online: 2394-7497
IJADS 2019; 5(1): 253-256 Endocrown preparation: Review
© 2019 IJADS
www.oraljournal.com
Received: 24-11-2018 Dr. Marwa EI Elagra
Accepted: 28-12-2018
Dr. Marwa EI Elagra Abstract
MSc, Lecturer in Prosthodontic Endodontically treated teeth usually need special techniques to be restored and regain function.
Department, Riyadh Elm Endocrown can be an excellent option for restoring severely damaged teeth, which showed better
University, Prince Abdulaziz bin performance in molars than premolars. It is an adhesive restoration with minimally invasive preparation.
Musaed bin Jalawy, Riyadh, The preparation design should provide sufficient retention, stability and structural durability to the
KSA, Saudi Arabia restoration. Several studies described Endocrown preparation following Bindl and Mormann technique.
However, few studies described some modifications to the original preparation.

Keywords: Endocrown, ferrule, crown preparation

Introduction
Endodontically treated teeth usually need special techniques to restore them. When a tooth is
Endodontically treated, a considerable amount of tooth structure usually was lost due to
trauma or caries in addition to the central destruction created by the endodontic access
preparation. This usually makes the tooth left with insufficient sound tooth structure to support
a casted restoration unaided. In addition to the complication in the subsequent restorations,
there will be an increased chance of tooth fracture during mastication [1].
The choice of restoration will be thus influenced by the type of tooth; posterior or anterior, and
the amount of the remaining tooth structure [1, 2].
To solve these problems a couple of clinical techniques were suggested. Anterior teeth with a
limited access opening and sufficient tooth structure can be just restored by a direct restoration
with no need for the placement of a crown. However, posterior endodontically treated teeth
will always need cuspal coverage due to their morphological characteristics and the increased
loads they are subjected to.
A tooth with substantial coronal structure loss will need core buildup and a crown. However, if
the tooth structure remaining is not sufficient to retain the core an extra retentive mechanism
have to be introduced [2].
Traditionally to retain the core structure in such cases a post or dowel is placed. These posts
can be prefabricated posts with a direct core or a one-piece custom-made post and core. Only
historically a single piece post-core and a crown are placed [1].
In the beginning, it was thought that the post and core supported the remaining tooth structure,
but later studies proved that post only aid in the retention of the restoration [3]. On the contrary,
actually removing from the radicular structure to place the post might weaken the root and
make it more susceptible to fracture. Moreover, the presence of a post might preclude future
endodontic re-treatment if necessary [1, 3].
In 1980 Nayyar et al. defined amalcore or coronal- radicular restorations. The procedure
implied the placement of amalgam into the pulp chamber, which will enter 2-4 mm inside the
canal. The pulp chamber must have enough width and depth to contribute to restoration
retention [4].
The introduction of adhesives and the development of effective dentine adhesives was a
Correspondence changing point in the restoration of Endodontically treated teeth, which made the insertion of a
Dr. Marwa EI Elagra radicular post a less favored option as long as there is sufficient surface area for adhesion [3].
MSc, Lecturer in Prosthodontic In 1995 Pissis presented a novel technique that utilized porcelain core/crown unit a single unit.
Department, Riyadh Elm
The technique was called the monobloc technique it was suggested by the author to replace the
University, Prince Abdulaziz bin
Musaed bin Jalawy, Riyadh, traditional metal post and core [5].
KSA, Saudi Arabia

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Soon enough in 1999, based on Pissis concept, Bindle and Axial Preparation
Mörmann introduced the Endocrown technique. It was At this step, undercuts in the access cavity should be
described as an adhesive crown characterized as full porcelain eliminated. A cylindrical-conical course grit diamond with an
crowns fixed to posterior Endodontically treated teeth [6] occlusal taper of 7 degrees is utilized to make the pulp
Several studies showed high success rates of Endocrowns in chamber and endodontic access cavity continuous. Diamond
molars and showed higher fracture resistance when compared should be held parallel to the long access of the tooth,
to posts [7-11]. excessive pressure is avoided and the pulpal floor is kept
Endo crowns presented several advantages over posts and untouched. Reducing a lot from the walls of the pulp chamber
cores and crowns, they are easier to prepare and apply and will result in the reduction of their thickness and the enamel
requires lesser clinical time and visits. Esthetic properties are strip width. The cavity depth must be at minimum 3 mm. [13,
also superb [3]. Also, adhesive restorations can decrease the 16, 17]
The greater the extent of the pulp chamber the better the
infiltration of microorganisms from the coronal to the apical mechanical properties [19]. The recommended endocrown
part thus improve the clinical success of endodontic treatment measurements are a 3 mm diameter cylindrical pivot and a 5
[6]
. Moreover, they show a great advantage in cases where mm depth for the first upper premolars and a 5 mm diameter
posts are contraindicated due to short or narrow canals. and a 5 mm depth for molars [13].
Endo crowns are indicated in Endo treated teeth with suitable Bindl and Mörmann evaluated the performance of premolars
pulp chamber depth. Nevertheless, Endocrown is and molars Endocrowns and perceived that the premolars
contraindicated in cases with a short and narrow pulp showed more failures than the molars, that was due to the
chamber, if adhesion is not certain and if there is a very little adhesion failure on them [9]. Adhesion failure in premolar
tooth structure remaining [12]. endocrowns might be because of the diminished surface of
adhesive bonding in comparison to molars, and the increased
Preparation proportion of the prepared tooth structure to the overall crown
The main purpose for the use of Endocrowns is to attain an causing higher leverage for premolars than molars [3].
all-ceramic bonded restoration that is minimally invasive of Premolars having deep occlusal fissures have higher
root canals. Therefore, the Endocrown preparation is different flexibility than ones that are shallow or fissuerless. Thus,
from the conventional full coverage crowns [13]. Several premolars endocrowns must have a flatter occlusal table to
studies described the endocrown preparation following Bindl minimize the crown height and the cuspal slopes resulting in
and Mormann technique. While few studies described some shallower fissures to decrease cuspal bend and the threat of
modifications to the original preparation. fracture during grinding [20].
In an attempt to improve the success of premolars
Rational endocrowns, the need for further intraradicular extensions
Endocrown is a monolithic ceramic bonded restoration with a might be a prerequisite [21]. Gulec and Ulusoy compared two
supragingival butt joint keeping as much as possible enamel designs with and without intraradicular extension; they found
for improved adhesion. The endocrown will invade the pulp that the modified endocrown design with intraradicular
chamber only. The pulpal chamber shape and cavity warrants extensions protected the remaining tooth structures better than
stability and retention. No need for further preparation. the unmodified endocrown design. Regarding the stresses that
Furthermore, the pulpal floor saddle form enhances stability. occurred in enamel, modified endocrown restoration design
[13]
. transmitted less stress highlighting that it is a more tooth-
friendly design. However, the stresses that occurred in
Occlusal preparation restorative materials, maximum principle stress values were
A minimum of 2 mm occlusal height reduction in the axial higher for the modified endocrown restoration design. They
direction should be attained. The ceramic occlusal thickness is concluded that when the material volume used for the
usually 3-7 mm. Studies indicated that the fracture resistance restoration increases, the material itself is adversely affected
of all-ceramic restorations rises with the increase of occlusal but the stress transmitted to the dental tissues is reduced [22].
thickness, and that endocrowns with 5.5 mm thickness
fracture resistance is twice as much as ceramic crowns with Ferrule
1.5 mm occlusal thickness [14, 15] The presence of ferrule in full coverages crowns supported by
The reduction can be done by making 2mm depth orientation post and core was thoroughly investigated and well
grooves, then with a coarse grit wheel diamond occlusal acknowledged to increase fractures resistance and fatigue
surface reduction is done. The diamond is directed along the cycles to failure [23-26].
long axis of the tooth, parallel to the occlusal plane. The Einhorn et al. [27] investigated the consequence of the ferrule
diamond shape ensures the proper reduction alignment and features incorporation, on molar endocrown failure resistance.
the desired flat surface, wherein the cervical margin or Their results showed that adding ferrule to preparations
cervical sidewalk is determined. Ideally, the margins should increased the dentin surface available for bonding. However,
there were milling limitations in reproducing the endocrowns
be kept supragingival allover In areas where the esthetic
inner surface. Hence, it was reported that the more complex
requirements or clinical factors requires a difference in level,
the preparation design became because of the addition of
a slope of no more than 60° should be between the different ferrule, the resultant endocrown inner surface adaptation to
cervical levels. Any undermined enamel with less than 2 mm the preparation seemed to reduce. (Figure 1)
thickness should be eliminated [13, 16, 17]. They concluded that ferrule-containing endocrown
The cervical sidewalk is the foundation of the restoration, the preparations revealed significantly superior failure loads than
objective is to accomplish a wide, uniform, steady surface regular endocrown restorations; yet, there was no difference
resistant to compressive stress [18]. The prepararation should among the groups in the calculated failure stress based on
be parallel to the occlusal surface to confirm stress resistance existing surface area for adhesive bonding. Moreover, less
along the long axis of the tooth [13, 16, 17]. occurrences of disastrous failure were detected with the

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Endocrown preparations containing 1 mm of preparation al. [28] described the use of metal-ceramic endocrown. To
ferrule design. improve the retention and stability of this restoration
additional feature was proposed to the endocrown preparation.
Additional features Retentive grooves (1 mm deep) were placed on the buccal and
Endocrowns are made usually from bonded ceramic lingual axial surfaces of the external aspect of the tooth. The
restorations, taking into consideration the benefit of adhesion metal-ceramic endocrown restoration was also sandblasted as
in the retention of the restoration. In a case report, Vinola et an additional mean to enhance restoration retention.

Fig 1: Three preparation design with no ferrule, 1 mm ferrule, 2 mm ferrule. Reproduced with permission from Einhorn M, DuVall N,
Wajdowicz M, Brewster J, Roberts H. Preparation Ferrule Design Effect on Endocrown Failure Resistance. Journal of Prosthodontics. 2019;
28(1):e237-42. (John Wiley and Sons Publication)

Conclusion 281.
Endocrown is now considered to be a highly recommended 2. Shillingburg H, Sather D. Fundamentals of fixed
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sufficient retention and stability and structural durability to coronal-radicular dowel and core technique for
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Financial support and sponsorship: Nil. adhesively placed Cerec Endo-crowns after 2 years--
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