Contemporary Restoration of Endodontically Treated Teeth. Nadim Z. Baba
an external approach, but replacement with an implant is probably a more predictable approach to management.
Treatment for cervical invasive resorption is quite successful if the lesion can be restored before too much tooth structure is lost. It is often necessary to perform the restorative procedure in conjunction with a periodontal tissue flap, raised for more convenient access. Because the pulp is not usually affected by the resorptive lesion, it is not necessary to do RCT as part of the treatment. RCT is often included, though, if the lesion is close to the pulp or if pulpal symptoms are part of the clinical findings. The material of choice for restoring the lost tooth structure is glass-ionomer cement.
The last type of resorption to be discussed is referred to as idiopathic resorption54 (Fig 2-18) because the etiology is obscure. It can involve a single tooth or several teeth; in the latter case, it is referred to as multiple idiopathic tooth resorption. As with resorptions in general, symptoms are mild or nonexistent. Mild soreness when the soft tissues surrounding the resorbing tooth are touched may be the only signal that something is happening to the tooth. This type of resorption can be quite aggressive, and a great amount of tooth structure can be lost. As with resorption other than infection-related resorption, the pulp plays no role, and much tooth structure can be lost before the resorptive lesions come close to the pulp cavities. The resorptive process does not seem to penetrate the predentin layer at the periphery of the pulp tissue.
Fig 2-18 Idiopathic resorption. This type of resorption, which often includes several teeth and then is termed multiple idiopathic resorption (arrows), has no known etiology. Management of such situations is very difficult. Restoration of resorbed areas, if accessible, can provide some con tinued function for the affected teeth, but eventual loss of such teeth is most likely to occur.
Treatment for idiopathic resorption has a very disappointing history. Frequently, so much tooth structure is lost that restoration of such teeth is very difficult. In addition, continued resorption may take place, further frustrating the management of these situations. If identified early, the affected tooth or teeth may be maintained for some time, making it worth the effort to treat. The practical option in many of these situations, however, is likely the replacement with dental implants. In any case, performance of RCT on a tooth with idiopathic resorption is not recommended unless the pulp is diseased.
Summary
Restoration of endodontically treated teeth requires careful planning. This involves evaluation of the endodontic treatment (preferably both before and after the treatment), an understanding of the complexities involved in RCT, and a recognition that many factors affect the outcome of the combined endodontic-prosthodontic management of patients. As in so many areas of medicine and dentistry, teamwork is often the key to success.
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