An innovative treatment approach using digital workflow and CAD-CAM part 1: The restoration of endodontically treated molars in children

Abstract

Stainless steel crowns are the most popular restoration technique for young permanent first molars treated endodontically. However, these restorations are not aesthetically appealing and need to be replaced. Endocrowns constitute a reliable approach for restoring severely damaged molars and premolars. Intraoral scanners (IOSs) are well tolerated by children and are easily and quickly implemented. We present an innovative treatment approach for endodontically treated teeth in children, using a digital workflow with IOS and computer-aided design/computer-assisted manufacturing (CAD/CAM) fabrication of the restoration. The protocol involves a thorough diagnostic phase and comprehensive treatment planning. Among the factors to be considered are the child’s behavior, the parents’ cooperation and compliance, and initial preparation including inhalation sedation, effective local anaesthesia and the use of a rubber dam. Full attention should be given to 1–2 mm of ferruling by the endocrown, which should be appropriately prepared to accommodate endocrowns for molars. IOSs include scanning of the prepared tooth and its antagonist, and scanning of the bite. CAD-CAM preparation of the restoration is followed by restoration bonding and follow up. Digital workflow should be considered in the treatment of endodontically treated molars since the high accuracy of the scanning enables definitive restoration in young patients.