Probably because in most cases an onlay (without post) provides excellent results, simply filling the pulpal chamber with a composite resin.

As far as I know, the reason is secondary decay. In such a case the caries will progress rapidly into the root, while it usually does not when there are separate post&core and a crown.

Are there any supportive study for this observation Dr.Samet ?

I'd agree partly with Dr Attal on this, people are less knowledgeable about endo crowns and thus less likely to try them over conventional methods.

I know several veteran (restorative/prosthetic specialist) clinicians who do endo crowns after RCTs and have even shown me excellent 10 year results to date (but this is just observational evidence).

I fail to see how caries risk could be increased if the inside of the tooth is formed of a ceramic instead of a glass fiber post/composite (or an antique-style metal post even). Is this because the marginal integrity is better on post/core restored crowns than in endocrowns?

I would really like to see the literature backing the secondary decay claim.

Best regards, AT

are there any clinical trials published on endocrowns compared to posts+crowns available in the literature? are there prospective clinical trials or at least retrospective studies? how endocrowns can held lateral and protrusive forces when placed on anterior maxillary teeth?what about ferrule?

if we can answer to these questions positively, probably endocrowns will be more popular and used by practitioners.

A quick PubMed search came up with these four preclinical studies which may be of interest:

http://www.ncbi.nlm.nih.gov/pubmed/21942234

http://www.ncbi.nlm.nih.gov/pubmed/25084102

http://www.ncbi.nlm.nih.gov/pubmed/24309044

http://www.ncbi.nlm.nih.gov/pubmed/23604697

The list of 4 lab papers does't mean too much and does't answer to my questions; evidence based dentistry, under many limitations, needs randomized clinical trials.

if then somebody want to make a quick pubmed search on posts, fiber posts etc ....around thousands of papers were published.  May be that can be one of the possible answer to the original question of this research gate.

It may be a matter of keeping treatment options open.  Providing separate crown and endodontic therapy permits removal of the crown in (as noted above) recurrent caries.  There is also the possibility of (suspected)  root fracture that can, in some cases be treated with a cast crown separate from the endodontic component of treatment.

An endocrown would not have that same versatility.

This is not an official FDA opinion.  It is my personal opinion.

It's hard to find clinical trail while there are few dentists believe on this preparation design without a convincing reason!  

I have recently tried Endocrowns on 3 patients in my Institute. Probably will have to wait for few years to confirm its longevity as an alternative. But as the indications given it may be tried in badly broken down teeth. 

This approach was used in the Northeast in the 60's and perhaps before that. It fell out of favor because it lacked one major requirement - "make it repairable".  There are many reasons crowns need to be replaced and if you needed to remove the endo-crown you had a major problem.   

Dental implant is relatively getting cheaper and predictable.

World of Dentistry is changing very fast with modern concepts and innovative designs. So, Endocrowns concept is losing its popularity. Dental implants are definitely getting cheaper but from the point of saving a natural tooth we can try other options if not Endocrowns rather than opting for extraction followed by implants.

About the cost:  when we compare the endo crown with cast post and core then crown >> the endo crown will be cheaper. 

And I think it will be easy to repair while it filled only the chamber of the pulp cavity comparing to post, isn't it ?

Dear all, reading your comments made me quite sad... Not sure I can appreciate the implant comment 

I can only say from what others tell me is that when endo molar crowns fail and they always do the occurrence is always catastrophic. Zero retrievability. If you can place a core buildup and a separate crown with a ferrule then you have a better chance of a long term outcome. If you cannot do those three things then remove the tooth and place an implant.

I am in total agreement with Dr. Kessler.

Dear collegue

Endocrowns are cheaper and faster and in many cases more conservative. Plus, they fit well with CADCAM technology. In Geneva we are doing that on all molars from approximately one decade and with good results, at least comparable with classical post-core-PFM treatment (some minor problems such as chipping, secondary caries..like ALL treatments in dentistry). Never debonding. The only real problem is that vertical fracture when it comes (few cases fortunately) it extends to the root in a cathastrophic way. No matter the material, Lava, Empress, Tetric or E-Max. That is because this kind of monolithic restoration does not have a metallic / high-strength ceramic framework or , as in case of post-core-crown, cement interfaces, where fracture can be stopped or deviated. For the moment we cannot give a proportion to this phenomenon, but it is rare. Fibers nets lying on the cavity seem to be a solution. (i am working on it). For severly destroyed premolars and anteriors as Dr Ferrari said I will stay on classical treatments untill further in-vitro and in-vivo findings. But sure it is a promising option for a simpler and more sustainable dentistry.

Hope it could be helpful ;)

Using deductive reasoning one has to conclude from Dr Kessler s statement that dental implants are to be valued similar to natural teeth..... Well evidence does not support this statement for multiple reasons which to name would absolutley break the format.

There are indeed very few papers to support the indication of endo crowns. Coronal rehab of an endo treated tooth can today be performed in  various ways. 

Sorry but i can't figure out the link between dental implant and the endocrown concept. If the latter is indicated it means that the tooth must not be extracted...hope ethical consideration will progressively overcome business aspects...Sorry to be naïve.

Frederic and Liviu, I felt this thread was for discussion for indications and successes for an endocrown. If the tooth is not restorable then extract it and place an implant. If the tooth can be restored, can an endocrown which is a single unit be successfully delivered. Yes.  But I feel if you get recurrent decay you cannot retrieve it easily and rerestore it. If you separate the two you will have a better long term success.  That being said please direct me to literature that will build my confidence for long term success of the endocrown and not just the fact that it can be done. I want to learn more to pass it along for our new dentists.

Thanks Aaro, I will look through those articles.

Hello,

Marco, I only listed the literature which I felt answers the questions about ferrule and the concept that bonding a glass ceramic restoration being suitable for these procedures. However, no RCTs are published to my knowledge on this matter (searched OVID, Pubmed and Scholar on this). Still, the preclinical work seems promising.

Professor Goldstein and Dr Kessler: I totally agree, repairability is what I, for one, hadn't thought of thoroughly. However, I feel that the experiences from the '60s may theoretically not be comparable to outcomes achieved with modern-day ceramic bonding systems? À propos, why is there a distinct lack of literature if the concept has been around for this a long time if I may ask those with long experience?

To Dr Giovanni, I happen to work in the Turku institute of dentistry, where there is a very active research going on FRCs (Sticktech Everstick and EverX posterior / Xenius are invented here for example). Some recent unpublished results on very large endo-restorations seem to point out that the fracture pattern of IPN network containing glass fibre reinforced restorations is much more favourable than without the fiber base. Perhaps in the future we could see improvements in this are a as well.

(disclaimer: I do not personally work on FRC research but removing FRC clinically is quite easy, have done this on many occasions)

Dear All,

Just below a clinical publication i wrote with my friend Gil Tirlet just to illustrate the potential of adhesive dentistry for endodontically treated teeth. No crown, no post..just try to avoid to remove more sound dental tissues with a bur...  . Less invasive. Unfortunatelly, we didn't find enough time to perform a clinical study regarding this kind of direct or indirect composite or ceramic restorations.

the link: https://www.researchgate.net/publication/51428556_Contemporary_aesthetic_care_for_nonvital_teeth_conservative_treatment_options?ev=prf_pub

Article Contemporary aesthetic care for nonvital teeth: conservative...

Nice paper doctor Bukiet, but what about cuspal deflection after Root Canal treatment and the belief that "all endodontically treated teeth require extracoronal coverage" either ovelay or total coverage crown ? 

Dear Alaa, The cuspal deflection is a reality and we have to take this parameter into account as much as the patient occlusion. Having said that i think that the dogma you cited in your statement is not reliable anymore. Each clinical situation is different and moreover this dogma and these old principles were right many years ago. A lot of progress have been made. At the moment, the bonding procedures and the less invasive dentistry permit to perform partial restorations instead of full coverage. Likewise, we try to avoid to place a post which can trigger more problems than advantages. Of course it doesn't concern the most of clinical cases but we have to keep in mind that the crown can be sometimes avoided.  In case of wide cavity and if the occlusion is favorable, you can sometimes indicated a bonded partial restoration with a cuspal coverage (ceramic or composite only or overlay). Sorry not to be in accordance with evidence based dentistry regarding this topic but i believe that we have to preserve the dental tissues and unfortunately the worst enemy of the tooth is often the dentist himself. Finally, the dogma you cited is a good point for the dentist business but not necessary for the patient...but it's an other topic...

The technique was called the "Richmond Crown" 

Smith CT, Schuman N. Prefabricated post-and-core systems: an overview. Compend Contin Educ Dent. 1998;19:1013-1020.

From my opinion endo crown is best choice when interocclusal space is not adequate as crown lengthening lead to furcation involvment and post with core fabrication interfere with opposing teeth and adequate space at least 4mm can not achieved.

Endocrown is more and more popular and widely used in China although it is a controversial issue.  

Endo crown is very helpful in cases when there is loss of interocclusal space and difficylty of post and core placement and also if we do gingivectomy there may be furcation involvement so endo crown with Cerec aid in rehabilitation of endodontically treated tooth.regards

Maybe because most dentists are familiar with post core and crown technique. Endocrown is best successful in molars than premolars and incisors.

Endocrown is a time-consuming process, in this era of advancements, people are focused on smart, affordable, and easy procedures for teeth with compromised restorability.