Belleflamme
- severely damaged non vital posterior teeth
- endo crown rather than post and core
- survival of 98.8% after 10 years
- fewer catastrophic failures
- Use of IDS and lithium disilicate
- another advantage – quicker
- IDS strengthens the restoration (need article)
- “the more you bond the less you need to be concerned with mechanical retention”
- enamel by itself is actually weaker than feldspathic porcelain, but its strengthened by the DEJ (nature’s bond) – likewise
- It cannot be emphasized enough that bonding is everything
- Belleflamme MM, Geerts SO, Louwette MM, Grenade CF, Vanheusden AJ, Mainjot AK. No post-no core approach to restore severely damaged posterior teeth: An up to 10-year retrospective study of documented endocrown cases. J Dent. 2017 Aug;63:1-7. doi: 10.1016/j.jdent.2017.04.009. Epub 2017 Apr 27. PMID: 28456557.
- These ferrule-less restorations should never be done without a sound bonding-strategy. If we are not relying on mechanical retention, we must be absolutely certain that we have an exceptional bond.
- Immediate dentin sealing must be completed.
- Next, create a composite build-up. Composite is placed in the chamber and (if space permits) used to create a slight buildup. You’ll notice this approach is different compared to other endocrowns in which the entire chamber is filled with the ceramic restorative material.
- After the build-up is completed, a glycerine gel is applied to the composite and cured to minimize the oxygen inhibited layer (OIL).
- Finally, the enamel margins are refined with a fine diamond and the surface is cleaned with pumice to remove any excess of the OIL.
- A preheated resin composite is used for bonding of the indirect restoration (also known as the thermo-modified luting technique). This approach is used rather than traditional dual-cure resin cement. Pre-warmed packable composite offers several advantages over traditional dual-cure resin cements. 1. Easier clean up 2. no limit on working time 3. Increased polymer conversion 4. Better color stability Personally, for this task I use Clearfil AP-X that is warmed to 155 F for 5 min. Careful consideration must be made to ensure AP-X is not over-warmed. A peroxide within the AP-X will cause it to set if it is heated for too long). Again, please note that I have absolutely no conflicts of interest.
- Güth JF, Edelhoff D, Goldberg J, Magne P. CAD/CAM Polymer vs Direct Composite Resin Core Buildups for Endodontically Treated Molars Without Ferrule. Oper Dent. 2016 Jan-Feb;41(1):53-63. doi: 10.2341/14-256-L. Epub 2015 Aug 12. PMID: 26266648.
- Magne P, Carvalho AO, Bruzi G, Anderson RE, Maia HP, Giannini M. Influence of no-ferrule and no-post buildup design on the fatigue resistance of endodontically treated molars restored with resin nanoceramic CAD/CAM crowns. Oper Dent. 2014 Nov-Dec;39(6):595-602. doi: 10.2341/13-004-L. Epub 2014 Aug 1. PMID: 25084102.
- Gregor L, Bouillaguet S, Onisor I, Ardu S, Krejci I, Rocca GT. Microhardness of light- and dual-polymerizable luting resins polymerized through 7.5-mm-thick endocrowns. J Prosthet Dent. 2014 Oct;112(4):942-8. doi: 10.1016/j.prosdent.2014.02.008. Epub 2014 Apr 22. PMID: 24767899.
- Goulart M, Borges Veleda B, Damin D, Bovi Ambrosano GM, Coelho de Souza FH, Erhardt MCG. Preheated composite resin used as a luting agent for indirect restorations: effects on bond strength and resin-dentin interfaces. Int J Esthet Dent. 2018;13(1):86-97. PMID: 29379905.
- Uctasli, Mine Betül et al. “Effect of preheating on the mechanical properties of resin composites.” European journal of dentistry vol. 2,4 (2008): 263-8.