Restorative Endodontics: Combining Two Disciplines For Greater Results

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The endodontic field has undergone significant changes within the last few decades with the introduction of better bonding materials, dental implants, rotary filing tools, and even irrigation systems. And with the advancement of these new materials also comes new disciplines. Today’s healthcare industry is now demanding more from its dentists, and it’s considered rare even to see practices that specialize in only one area of treatment; as more information is shared, many dentists in the field can learn from one another about new techniques and materials that can benefit their practices’ overall success. More patients these days require multi-faceted and customized treatments to their needs, and those who have built up their practices around certain disciplines are now having to adapt to these demands. One of those demands includes the need for cosmetic and restorative work within their specialties, and this also remains true for endodontists. Nowadays, one of the most popular forms of specialties combined is restorative endodontics, a new field that is a hybrid between endodontic and restorative treatments.

Why These Two Specialties Work So Well Together

As more and more patients are looking for multi-disciplined dentists, endodontists in their field are now needing to evolve into more strands of dentistry than ever before. The demand for aesthetics, in particular, is consistently high and growing among younger generations. One of the best ways to meet these demands is by incorporating restorative specialties into their practices. Endodontics and restorative dentistry are the perfect combinations because they combine conservative measures with aesthetic techniques, working not only to cure ailments facing patients but also to perfect them with the patient’s preferences in mind. Treatments such as root canals can then be performed more conservatively, preventing the onset of endodontic failures while maintaining the tooth’s naturally pleasing shape. Restorative dentistry combined with root canals, for instance, can then help preserve the inside dentin and pulp by meeting those biological requirements.

At first glance, it makes sense that these two fields would work together so well. Endodontics handles the internal structures of the tooth, while restorative dentistry attempts to preserve the internal structure by reinforcing it with prosthesis devices such as crowns, veneers, and bridges. Endodontics works to remove problems within the root canals and pulp and can even work alongside restorative methods to prevent bacterial growth inside the tooth, working alongside restorative methods for better success. But even with the combination of these two specialties, failures can come if these methods aren’t properly executed.

While restorative methods can help prevent endodontic failures, it doesn’t exclude them from happening completely. In fact, improper use of restorative techniques can cause endodontic failure. Improper cleanings, preparation methods, and poor removal of natural tooth structure can cause endodontic or restorative failures, leading to significant damage to the affected tooth. To avoid this, it requires a fine balance of both of these specialties, especially if the patient faces issues with enamel strength and has poor tooth structure overall. The primary result of these types of failures is excessive removal of tooth layers and poor technique.

What Restorative Methods Work Within Endodontics?

Because of the obstacles faced within the endodontic technique, there need to be numerous clinical considerations to handle cases of complex tooth decay and damage properly. Endodontically-repaired teeth need special consideration to repair any signs of lost structural integrity. To meet these demands, endodontists working within restorative methods have been developing new ways to approach the restorative process. Through observational studies and clinical trials, more options have come out to approach this issue more thoroughly, including:

  • EndoCrowns: Endocrowns are a relatively new type of restorative procedure that helps patients with significant coronal structure loss to reinforce the pulp chamber with adhesive. These treatments have become an alternative to traditional crowns, especially for those with extensive dentin removed.
  • Fiberglass Composite Restorations: Some studies have looked into using fiberglass to reduce the amount of microleakage and found that in certain cases, fiberglass composite restorations work better than composite resin, zirconia-based, and metal restorations. Through this increasing trend of fiberglass restorations, more endodontists can potentially provide better adhesion to the dentin layers and protect the inner pulp from decay.
  • Post-And-Core Restorations: Some endodontists have begun incorporating post-and-core techniques to salvage the remaining tooth. Post-and-core restorations work to anchor the crown on top of the tooth after extensive removal of the pulp and dentin when performing a root canal. Through these restorations, many endodontists have been able to eliminate the need for extractions and full restorations.
  • Dental Air-Abrasion Techniques: Air-abrasion is a technique that uses a narrow stream of aluminum-oxide particles to remove small amounts of dentin without the need for heat, noise, and vibration. It’s a nonmechanical technique that’s been gaining traction within the last few years, and many patients have reported a positive experience with their treatment.
  • Bulk-Fill Adhesive Materials: A popular method that both endodontists and restorative dentists use is bulk-fil adhesives, where those within both fields work to use these materials as a preparation for other restorations such as crowns.
  • Light Curing Regimes: Alongside bulk-fill adhesives, light-curing regiments have also been used to strengthen the bond between the materials used. For endodontic restorations, these devices provide more accurate curing times and easily bond with the dentin layer with ease. It also allows for more accurate results that can adjust for angles and air-cooling techniques to protect the tooth from mishaps during treatment.

While many of the endodontic techniques and restorative treatments listed above can help blend the two specialties, one of the current challenges faced by endodontists is finding techniques that mend the two disciplines together. Some of the techniques listed above are only a small part of the requirements needed to make these specialties work with one another. In order to resolve this conflict, these specialties need precise shaping, predictable obturation, and study-verified materials to establish a better relationship with one another for the future. As endodontic restorations continue to rise, dentists everywhere will soon find unique systems to restore oral health with better accuracy and care. 

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