Interim and Temporary Restorations Pre-endo Build Up PDF

# Interim and temporary restorations ## Pre-endo build up ### 14/11/2022 Giannis Plygkos DDS, MSc Scientific Collaborator EUC European University Cyprus School of Medicine ## Reasons for Pre-endo build up - Simplifies optimal rubber dam isolation for the subsequent endodontic visits - Creates...

# Interim and temporary restorations ## Pre-endo build up ### 14/11/2022 Giannis Plygkos DDS, MSc Scientific Collaborator EUC European University Cyprus School of Medicine ## Reasons for Pre-endo build up - Simplifies optimal rubber dam isolation for the subsequent endodontic visits - Creates space for prolonged function of irrigation solutions - Allows for effective inter-appointment temporisation to prevent bacterial microleakage, seepage of intracanal medicaments and gingival ingrowth into the cavity - Prevents fractures of the weakened tooth structure, thus maintaining repeatable reference points - Improves aesthetics during the endodontic treatment period, thus enhancing patients' acceptance - Facilitates post-endodontic restoration ## In which sequence? - HISTORY - CLINICAL AND RADIOGRAPHIC EXAMINATION - INFORMED CONSENT - LA - RUBBER DAM - RESTORABILITY ASSESSMENT - DECISION TO SAVE OR NOT - DECISION OF CLINICAL APPROACH UNTIL DEFINITIVE RESTORATION IS PLACED (SEQUENCE OF CLINICAL STEPS) ## Sequence of clinical steps? - INTERIM RESTORATION - FRACTURE PREVENTION? - TEMPORARY RESTORATION ## Interim restoration - a restoration that has been placed in a tooth after the previous restoration and/or caries have been removed at the commencement of endodontic treatment - provides structural integrity to the tooth while the tooth is undergoing endodontic treatment - is expected to remain in situ providing a good seal until the endodontic treatment is completed and a definitive restoration can be provided - provides support for weakened cusps preventing fracture between appointments as well as a good coronal seal ## Temporary restoration - a restoration placed within an endodontic access cavity (such a cavity is likely to have been cut through an interim restoration in most cases) - "temporary" suggests a shorter time than "interim" - desirable properties include ease of removal at the next appointment, inexpensive and having inferior aesthetic properties, thus making it more obvious at the time of removal so that additional tooth structure is not removed at the subsequent re-entry appointment ## The purpose of each is different to the other, and different materials and techniques are likely to be used and that is why different terms should be used. ## The cavity design and requirements will also be markedly different: - for interim restorations, they will be determined by the extent of the previous restorations, caries and cracks - for temporary restorations, the extent of the access cavity will be determined by the anatomy of the pulp chamber and root canals # Preventing Coronal Leakage Clinicians have six major opportunities to prevent coronal leakage in endodontically treated teeth: - Pre-endodontic tooth preparation - Thoroughness of the root canal obturation technique - Temporary seal of the root canal system, during and after treatment - Choice and integrity of the final tooth restoration - Timeliness in restoration and establishment of atraumatic occlusion - Long-term follow-up to evaluate the integrity of the definitive treatment # Pre-Endodontic Tooth Preparation Multiple issues regarding the potential for coronal leakage must be addressed in this phase of treatment because of the importance of asepsis in the prognosis of root canal treatment. Complete removal of caries and defective restorations, establishment of sound tooth margins above the gingival tissues for both rubber dam placement and ultimate tooth restoration, and examination of tooth structure for cracks or fractures using dyes or fiber optics are the major factors for prevention of coronal leakage during treatment planning and before root canal treatment. ## Abbott (Aus Dent J, 2004) - 245 teeth assessed before and after restoration removal - 95% of the teeth had one or more factors that could have led to pulpal and periapical disease ## Table 3 Detecting the quality of the coronal seal before and after dismantling restorations (Abbott 2004)²² | | Before restoration removal | After restoration removal | |------------|----------------------------------|-------------------------------| | Caries | 47 (19.2%) | 211 (86.1%) | | Cracks | 57 (23.3%) | 147 (60%) | | Marginal breakdown | 96 (39.2%) | 244 (99.6%) | # Preventing Coronal Leakage Clinicians have six major opportunities to prevent coronal leakage in endodontically treated teeth: - Pre-endodontic tooth preparation - Thoroughness of the root canal obturation technique - Temporary seal of the root canal system, during and after treatment - Choice and integrity of the final tooth restoration - Timeliness in restoration and establishment of atraumatic occlusion - Long-term follow-up to evaluate the integrity of the definitive treatment # Temporary Seal of the Root Canal System, During and After Treatment A faulty temporary filling during or following root canal treatment is one of the major causes for coronal leakage. Failure of the temporary restoration can be due to an inadequate thickness of material, improper placement of the material and failure to evaluate the occlusion after placement. Commonly ## Materials - Cavit, Cavit W and Cavit G are temporary filling materials self-curing under humidity for temporary filling of cavities. - The final hardness of the three variants decreases in the sequence of listing. - Cavit G can be removed in one piece without residue. - Not all products are available in all countries. - These Instructions for Use should be kept for the duration of product use. - Cavit for occlusal temporary fillings - Cavit W with increased bonding for endodontic treatments - Cavit G for temporary inlays - Intermediate Restorative Material - For intermediate restorations intended to remain in place for up to 1 year - Provides sedative like qualities on hypersensitive tooth pulp - Available in powder/liquid or capsule deliveries # Possible areas of bacterial penetration - THROUGH TEMPORARY BULK MATERIAL - INTERIM AND TEMPORARY INTERFACE - TEMPORARY AND TOOTH INTERFACE - PROXIMAL BOX (TOOTH INTERIM INTERFACE) # Examples of research experiments ## Coronal Bacterial Penetration after 7 days in class II endodontic access cavities restored with two temporary restorations: A Randomized Clinical Trial ### Conclusion The thickness of restorative material at the proximal tooth-restoration interface significantly influenced bacterial penetration. This study suggests that coronal restoration thickness of 4-5 mm and a proximal interface thickness of >2.15 mm for Cavit G and >2.35 mm for IRM in class II endodontic access cavities in molars are required to prevent bacterial penetration for a period of seven days. ## Marginal Leakage of Endodontic Temporary Restorative Materials around Access Cavities Prepared with Pre-Endodontic Composite Build-Up: An In Vitro Study ## Temporization for endodontics ### Table 1 Summary of in vitro studies on leakage of temporary endodontic materials in access cavities in tooth structure. | Author(s) | Year | Marker | Thickness (mm) | Thermal cycling | Best materials (in listed order) | |--------------|------|------------|-----------------|-----------------|-------------------------------| | Parris et al | 1964 | 2% aniline blue | 2 | - | Cavit - Kwikseal - No-Mix - ZOE - Dentin' - Temp-Pac - Kaisogen - zinc phosphate - gutta-percha | | Oppenheimer & Rosenberg | 1979 | methylene blue | 2 | - | Cavit - Cavit-G | | Tamse et al | 1982 | 0.5% eosin Y dye | 2 | - | Cavidentin - Cavit - G - Cavit - IRM - Katzinol | | Chohayeb e Bassiouny | 1985 | methylene blue | 2.5 | - | Cavit - Adaptic - Aurati - ZOE - zinc phosphate | | Tepätsky & Meimaris | 1988 | 10% methylene blue | 4 | - | Cavit - TERM | | Barkhordar & Stark | 1990 | 50% silver nitrate | 4 | + | Cavit - TERM - IRM | | Noguera & Mc Donald | 199 | 50% silver nitrate | 5 | + | TERM - Cavit - Cavit-G - Cavit-W - Dentemp - IRM | | Lee et al | 1993 | Basic fuchsin | 4 | + | Caviton - Cavit - IRM (6:1 and 2:1) | | Kazemi et al | 1994 | 2% methylene blue | 5 | + | Cavit - Tempit- IRM | | Mayer & Eickholz | 1997 | 1% methylene blue | 15 | + | Cavit - TERM - Kalsogen- IRM | | Cruz et al | 2002 | 1% fuchsin | 4 | - | Fermin - Caviton- Cavit - Canseal | | Radioactive isotopes | 1977 | Ca45 | 3 | - | Temp-Seal - Cavit - ZOE - zinc phosphate - IRM | | Marosky et al | 1996 | Na | 3 | - | IRM - ZOE - Cavidentin | | Friedman et al | 1996 | NaN | 3 | - | polycarboxylata - Cavit - G - Cavidentin | | Fluid filtration technique | 1988 | 0.2% fluorescein | - | - | Cavit - TERM | | Anderson et al | 1988 | Evans blue | - | - | Cavit - G - polycarboxylate (4:1 and 2:1) - ZOE (2:1) - IRM (6:1) | | Pashley et al | 1988 | Evans blue | 4 | + | ZOE (4:1) - IRM (4:1) - TERM (5:1) - IRM (7:1) - gutta-percha | | Bobotis et al | 1989 | 0.2% fluorescein | 4 | + | Cavit-G - GIC-TERM - Cavit - G - zinc phosphate - IRM - polycarboxylata | | Bacteria | 1964 | Sarcina lutea | - | - | Cavit - Kwikseal - ZDE - Kalsogen | | Paris et al | 1964 | Serratia marcesens | - | - | No-Mix - Dentin - zinc phosphate - gutta-percha | | Blaney et al | 1981 | P vulgaris | 3 | - | RM - Cavit | | Deveaux et al | 1992 | S. sanguis (Cavit) | 3.7 | - | TERM - Cavit - IRM | | Barthel et al | 1999| S. mutans | 5.4 | - | GIC - IRM - Cavit - Cavit - GIC | | Electrochemical technique | 1990 | 10 V potential difference | 3.5 | - | TERM - Cavit - IRM | | Lim | 1990 | 10 V potential difference | - | - | GIC (conditioned) - GIC (unconditioned) - Kalzinol - Cavit - W - RM - Cavit - Cavit-W - Cavit - G | | Jacquot et al | 1996 | 5 mV potential difference | 4 | - | | ### Table 2 Summary of in vivo studies on leakage of temporary endodontic restorative materials. | Author(s) | Year | Thickness (mm) | Best material (in listed order)* | |--------------|------|-----------------|-------------------------------| | Krakow et al | 1977 | - | (no leakage) ZOE > zinc phosphate (3 brands collectively) | | Lamers et al | 1980 | 2 | Cavit > Caviton > gutta-percha | | Beach et al | 1996 | 4 | Cavit > IRM > TERM | | *Rank order does not necessarily imply statistical significance in the publication.| ### Table 3 Summary of in vitro and in vivo studies on leakage of temporary endodontic materials in access cavities within coronal restorations. | Author(s) | Year | Marker | Thickness (mm) | Thermal cycling | Best material (in listed order)* | |--------------|------|------------|-----------------|-----------------|-------------------------------| | Melton et al | 1990 | India ink | 3.5 | + | Cavit > TERM | | Pai et al | 1999 | Basic fuchsin| 6 | + | Caviton > Caviton/IRM > IRM | | Radioactive isotopes | 1986 | Ca45 | 3.5 | + | ZOE > Cavit | | Fluid filtration technique | 1990 | 0.2% fluorescein dye | 4 | - | GIC > TERM > Cavit > Cavit-G > IRM > zinc phosphate > polycarboxylate | | Bacteria | 1996 | In vivo | 4 | - | Cavit > IRM > TERM | | *Rank order does not necessarily imply statistical significance in the publication.| # Preventing Coronal Leakage Clinicians have six major opportunities to prevent coronal leakage in endodontically treated teeth: - Pre-endodontic tooth preparation - Thoroughness of the root canal obturation technique - Temporary seal of the root canal system, during and after treatment - Choice and integrity of the final tooth restoration - Timeliness in restoration and establishment of atraumatic occlusion - Long-term follow-up to evaluate the integrity of the definitive treatment # Temporary Seal of the Root Canal System, During and After Treatment A minimum of four millimeters of material thickness provide an adequate seal. Based on current evidence, this seal can be expected to remain effective no longer than three weeks. Allowing a temporary material to remain longer than this period is an invitation to coronal leakage and future failure. voids. The cotton must be minimal and placed securely into the access cavity prior to placement of the filling to prevent a potential lifting or dislodgement of the temporary material. # Case Discussion ## Anterior Teeth - Multiple visits - One visit ## Endodontic Buildups - A Case Series - Caries excavation - Access sealed with GP point to maintain patency - Pre-endodontic build up with composite resin - Rubber dam application - initiation of root canal ## Posterior Teeth - multiple visits - one visit ## Interim and temporary restoration of teeth during endodontic treatment - **A-L Jensen, PV Abbott, J Castro Salgado** ## Orthodontic bands - pre-op xray - Bony exostoses and minimal tooth structure make it difficult case for rubber dam placement - Fitted orthodontic bands - Bands cemented with IRM - Effective isolation - Broken down molar after removal of restoration, post and caries - Fitted orthodontic band - Cotton in access to protect orifices - IRM loaded into band before cementation - Completed interim restoration before rubber dam placement - Eastman UCL ## Copper Bands - Use of a Copper Band to Make Resin Cores in Endodontically Treated Teeth Lacking Coronal Structure - V Alonso de la Peña - IL Darriba - M Caserio Valea - U Santana-Mora - Disadvantages - This technique depends on the clinician's skill. - It can be difficult to shape the matrix for teeth with irregular forms, such as the interproximal concavities of maxillary premolars, which would require the placement of interproximal wedges. - pre-op xray - Copper bands - Eastman UCL ## Table 5 Summary of restoration of the root filled tooth | Tooth type | No previous restorations (for premolars and molars where the marginal ridges are intact) | Previously heavily restored (for premolars and molars where one or more marginal ridges lost) | Previously crowned (for premolars and molars where both marginal ridges lost) | |---|---|---|---| | Anteriors: | | | | | Incisors | Interim: Sponge, 3 mm of Cavit and 3 mm IRM or GIC or composite in access cavity | Interim: Tooth built up in GIC or composite prior to access cavity preparation | Interim: Temp crown or leave as root stump with temp restoration & RPD overdenture for aesthetics (+/- temp post) | Interim: Sponge, 3 mm of Cavit and 3 mm IRM or GIC or composite in access cavity | Interim: Sponge, 3 mm of Cavit and 3 mm IRM or GIC or composite in access cavity | | Canines | Temp: 3 mm of GIC/RMGIC/Flowable composite orifice seal | Temp: Tooth built up in GIC or composite or amalgam prior to access cavity preparation | Temp: Sponge, 3 mm of Cavit and 3 mm IRM or GIC or composite in access cavity | Temp: 3 mm of GIC/RMGIC/Flowable composite orifice seal | Temp: Sponge, 3 mm of Cavit and 3 mm IRM or GIC in access cavity | | | | | | | | | | Definitive: 3 mm of GIC/RMGIC/Flowable composite orifice seal; Conventional composite in access cavity | Definitive: Composite build up (or crown for canines) | Definitive: Consider cuspal protection with onlay or crown (gold onlay where possible) | Definitive: 3 mm of GIC/RMGIC/Flowable composite orifice seal; Conventional composite in access cavity | Definitive: Replace crown +/- post | | | | | | | | | | OR Nayyar core amalgam restoration | OR Consider cuspal protection with plastic restoration or temporary crown/orthodontic band/copper ring | | | | | Posteriors: | | | | | | | Premolars | Initial: Sponge, 3 mm of Cavit and 3 mm IRM or GIC or composite in access cavity | Initial: Tooth built up in GIC or composite prior to access cavity preparation | Initial: Temp crown or leave as root stump with temp restoration (+/- temp post) | Initial: Sponge, 3 mm of Cavit and 3 mm IRM or GIC or composite in access cavity | Initial: Sponge, 3 mm of Cavit and 3 mm IRM or GIC or composite in access cavity | | Molars | Temp: 3 mm of GIC/RMGIC/Flowable composite orifice seal | Temp: Tooth built up in GIC or composite or amalgam prior to access cavity preparation | Temp: Sponge, 3 mm of Cavit and 3 mm IRM or GIC in access cavity | Temp: 3 mm of GIC/RMGIC/Flowable composite orifice seal & Conventional composite in access cavity | Temp: Sponge, 3 mm of Cavit and 3 mm IRM or GIC in access cavity | | | | | | | | | | Definitive: 3 mm of GIC/RMGIC/Flowable composite orifice seal & Conventional composite in access cavity | Definitive: Consider cuspal protection with onlay or crown (gold onlay where possible) | Definitive: Temp crown or leave as root stump with temp restoration (+/-temp post) | Definitive: 3 mm of GIC/RMGIC/Flowable composite orifice seal & Conventional composite in access cavity | Definitive: Replace crown & amalgam Nayyar core where possible | | | | | | | | | | OR Nayyar core amalgam restoration | OR Consider cuspal protection with plastic restoration or temporary crown/orthodontic band/copper ring | | | | # Restoration of the root canal treated tooth **S. Eliyas, J. Jalili and N. Martin³** **BRITISH DENTAL JOURNAL VOLUME 218 NO. 2 JAN.23 2015**