Digital and Conventional Workflow for Endocrown Fabrication in Pulpotomy Permanent Tooth: Case Report

A higher chance of carrying out a successful full pulpotomy is dependent on the coronal restoration. Preservation of healthy dental structure is essential for providing mechanical stabilization of tooth-restoration integrity and increasing the number of suitable surfaces for adhesion. In this case, endocrown was a suitable restoration due to large coronal destruction. However, the preparation design and material selection affect the manufacturing technique. As shown in this case, the CAD/CAM technique demonstrated technical errors such as marginal chipping and overmilling, for these reasons changing to conventional technique for lithium disilicate endocrown fabrication was adopted. After one week of permanent cementation, the restoration was in good condition and abutment was normal with good gingival health.

1. Schwendicke F, Frencken JE, Bjørndal L, Maltz M, Manton DJ, Ricketts D, et al. Managing carious lesions: consensus recommendations on carious tissue removal. Adv Dent Res. 2016;28(2):58-67.

2. Wolters WJ, Duncan HF, Tomson PL, Karim IE, McKenna G, Dorri M, et al. Minimally invasive endodontics: a new diagnostic system for assessing pulpitis and subsequent treatment needs. Int Endod J. 2017;50(9):825-9.

3. Kunert GG, Kunert IR, da Costa Filho LC, de Figueiredo JAP. Permanent teeth pulpotomy survival analysis: retrospective follow-up. J Dent. 2015;43(9):1125-31.

4. Dalpino PH, Francischone CE, Ishikiriama A, Franco EB. Fracture resistance of teeth directly and indirectly restored with composite resin and indirectly restored with ceramic materials. Am J Dent. 2002;15(6):389-94.

5. Manhart J, Chen H, Hamm G, Hickel R. Buonocore memorial lecture. review of the clinical survival of direct and indirect restorations in posterior teeth of the permanent dentition. Oper Dent. 2004;29(5):481-508.

6. Biacchi GR, Basting RT. Comparison of fracture strength of endocrowns and glass fiber post-retained conventional crowns. Oper Dent. 2012;37(2):130-6.

7. Topkara C, Keleş A. Examining the adaptation of modified endocrowns prepared with CAD-CAM in maxillary and mandibular molars: a microcomputed tomography study. J Prosthet Dent. 2022;127(5):744-9.

8. Ghoul WE, Özcan M, Tribst JPM, Salameh Z. Fracture resistance, failure mode and stress concentration in a modified endocrown design. Biomater Investig Dent. 2020;7(1):110-9.

9. Abtahi S, Alikhasi M, Siadat H. Biomechanical behavior of endocrown restorations with different cavity design and CAD-CAM materials under a static and vertical load: a finite element analysis. J Prosthet Dent. 2022;127(4):600.e1-.e8.

10. Bjørndal L, Simon S, Tomson PL, Duncan HF. Management of deep caries and the exposed pulp. Int Endod J. 2019;52(7):949-73.

11. Carvalho MA, Lazari PC, Gresnigt M, Del Bel Cury AA, Magne P. Current options concerning the endodontically-treated teeth restoration with the adhesive approach. Braz Oral Res. 2018;32(1):147-58.

12. Dogui H, Abdelmalek F, Amor A, Douki N. Endocrown: An alternative approach for restoring endodontically treated molars with large coronal destruction. Case Rep Dent. 2018:1581952.

13. Altier M, Erol F, Yildirim G, Dalkilic EE. Fracture resistance and failure modes of lithium disilicate or composite endocrowns. Niger J Clin Pract. 2018;21(7):821-6.

14. Tribst JPM, Dal Piva AMO, Madruga CFL, Valera MC, Borges ALS, Bresciani E, et al. Endocrown restorations: Influence of dental remnant and restorative material on stress distribution. Dent Mater. 2018;34(10):1466-73.

15. Tribst JPM, Dal Piva AMO, Penteado MM, Borges ALS, Bottino MA. Influence of ceramic material, thickness of restoration and cement layer on stress distribution of occlusal veneers. Braz Oral Res. 2018;32:e118.

16. Ma L, Guess PC, Zhang Y. Load-bearing properties of minimal-invasive monolithic lithium disilicate and zirconia occlusal onlays: finite element and theoretical analyses. Dent Mater. 2013;29(7):742-51.

17. Arena A, Baldissara P, Ciocca L, Scotti R, Monaco C. Influence of preparation design and spacing parameters on the risk of chipping of crowns made with Cerec Bluecam before cementation. J Prosthodont Res. 2019;63(1):100-4.

18. Oğuz E, Kilicarslan M, Özgür M, Orhan K, Shujaat S. Comparison of marginal adaptation of different resin-ceramic CAD/CAM crowns: an in vitro study. J Adv Oral Res. 2021;12(1):112-8.

19. Goujat A, Abouelleil H, Colon P, Jeannin C, Pradelle N, Seux D, et al. Mechanical properties and internal fit of 4 CAD-CAM block materials. J Prosthet Dent. 2018;119(3):384-9.

20. Turkyilmaz I, Wilkins GN, Yun S. Moving from analogue to digital workflows in dentistry: Understanding undermilling and overmilling as detrimental factors in fabricating CAD/CAM crowns. Prim Dent J. 2022;11(2):59-61.

21. Thainimit I, Totiam P, Wayakanon K. The effect of preparation designs and location of margins on the marginal gap of CAD/CAM ceramic onlays. Songklanakarin Dent J. 2019;7(1):70-8.

22. Carvalho TF LJ, Matos JDM, Lopes GRS, Vasconcelos JEL, Zogheib LV, Castro DSM. Evaluation of the accuracy of conventional and digital methods of obtaining dental impressions. Int J Odontostomat. 2018;12(4):368-75.

23. Turkyilmaz I, Wilkins GN, Varvara G. Tooth preparation, digital design and milling process considerations for CAD/CAM crowns: Understanding the transition from analog to digital workflow. J Dent Sci. 2021;16(4):1312-4.

24. Todorović A, Lisjak D, Lazic V, Špadijer-Gostović A. Possible errors during the optical impression procedure. Serb Dent J. 2010;57(1):30-7.

Eungnapatanin M, Thong-ngarm W, Korjaroenrattanakul T. Digital and Conventional Workflow for Endocrown Fabrication in Pulpotomy Permanent Tooth: Case Report: A case reports/series. CM Dent J [Internet]. 2024 Apr 18 [cited 2024 Jul 15];45(1):13-19. Available from: https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=210

Eungnapatanin, M., Thong-ngarm, W. & Korjaroenrattanakul, T. (2024). Digital and Conventional Workflow for Endocrown Fabrication in Pulpotomy Permanent Tooth: Case Report. CM Dent J, 45(1), 13-19. Retrieved from: https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=210

Eungnapatanin, M., Thong-ngarm Weeranuch and Korjaroenrattanakul Tanida. 2024. "Digital and Conventional Workflow for Endocrown Fabrication in Pulpotomy Permanent Tooth: Case Report." CM Dent J, 45(1), 13-19. https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=210

Eungnapatanin, M. et al. 2024. 'Digital and Conventional Workflow for Endocrown Fabrication in Pulpotomy Permanent Tooth: Case Report', CM Dent J, 45(1), 13-19. Retrieved from https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=210

Eungnapatanin, M., Thong-ngarm, W. and Korjaroenrattanakul, T. "Digital and Conventional Workflow for Endocrown Fabrication in Pulpotomy Permanent Tooth: Case Report", CM Dent J, vol.45, no. 1, pp. 13-19, Apr. 2024.

Eungnapatanin Mookarin, Thong-ngarm Weeranuch, Korjaroenrattanakul Tanida "Digital and Conventional Workflow for Endocrown Fabrication in Pulpotomy Permanent Tooth: Case Report." CM Dent J, vol.45, no. 1, Apr. 2024, pp. 13-19, https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=210