Crack the Code: Preventing Fractures in Endodontics - 第6回国際歯科シンポジウム

Preserving natural teeth is crucial for maintaining overall health. However, root fracture is one of the causes of tooth extraction, and its incidence is increasing, with a large proportion of cases occurring in teeth that have undergone root canal treatment. In Japan, root canal treatment is more common in people in their 70s compared to other age groups. In the elderly, pulp chamber constricting, decreased tooth strength, and reduced nerve transmission are observed, so root canal treatment must be performed carefully. Therefore, elucidating the mechanisms of tooth aging is essential for the long-term preservation of natural teeth.

After root canal treatment, dentists are still frequently confronted in daily practice with a challenging decision: how to properly restore endodontically treated teeth (ETT). Several restorative options are available, ranging from direct composite restorations to indirect solutions such as inlays, onlays, overlays, and full-coverage crowns. In addition, the indication for intra-radicular posts remains a topic of debate―specifically, whether fiber posts are still recommended or not.
More recently, the concept of the endocrown has been introduced as a conservative and reliable alternative to full-coverage crowns, particularly when combined with CAD/CAM technology. This approach aims to preserve tooth structure while providing adequate mechanical performance and esthetic outcomes.
The restoration of endodontically treated teeth must fulfill multiple objectives, including mechanical resistance, esthetics, function, and biological preservation. The selection of the restorative approach and materials depends on several criteria, such as the amount of remaining tooth structure, occlusal load, tooth position, esthetic demands, and adhesive possibilities.
Through a series of clinical cases supported by a review of the most recent literature, this presentation will address the key questions related to the restoration of endodontically treated teeth. A clear, step-by-step clinical decision-making protocol will be presented to guide clinicians toward predictable, long-term restorative success.