13 Besides, fracture resistance can be enhanced by preserving pericervical dentine through conservative access cavity preparation. Other biomechanical parameters, such as residual cusp thickness and loss of marginal ridges, also need to be assessed as these have been shown to impact on tooth stiffness. The importance of a circumferential 1.5-2 mm band of healthy tooth tissue, namely ferrule effect, is well established for a positive prognosis, yet current evidence suggests that presence of a partial ferrule (1-3 walls) may be sufficient. 11 Therefore, definitive assessment of restorability should be performed only after total removal of previous restorations, caries and unsupported tooth tissue. Structural assessmentĬlinicians should be cognisant that typical clinical and radiographic examination may have limited sensitivity in detection of caries, cracks and marginal deficiencies. 9Ĭertain restorability indices 9, 10 have been developed to aid decision-making by quantifying clinical judgements however, their validity is not sufficiently tested and subjective elements are still included. This should include evaluation of the restorative status of the tooth (structural, periodontal, endodontic), as will be discussed in the following sections, although local and general factors relating to the context of treatment (for example, tooth used as an abutment for fixed or removable prostheses, parafunction, medical history, patient expectations, cost) should also be examined. Restorability assessment is essential before embarking on endodontic treatment. 7, 8 These techniques will not be further considered in this article but the reader may refer to Table 1 for a brief overview. While traditional non-adhesive techniques of pre-endodontic restoration, such as amalgam core build-up, copper bands or temporary crowns, may still prove useful for some clinicians when appropriately performed, 6 they also present with many shortcomings which, along with the development of adhesive approaches, have limited their clinical value for this purpose. Improves aesthetics during the endodontic treatment period, thus enhancing patients' acceptance Prevents fractures of the weakened tooth structure, thus maintaining repeatable reference points 5 Simplifies optimal rubber dam isolation for the subsequent endodontic visits 2Ĭreates space for prolonged function of irrigation solutions 3Īllows for effective inter-appointment temporisation to prevent bacterial microleakage, seepage of intracanal medicaments and gingival ingrowth into the cavity 4 Considering pre-endodontic restoration before initiating endodontic treatment is valuable for compromised teeth as this approach: The limited residual tooth tissue substantially complicates endodontic procedures. Teeth that require endodontic intervention are often structurally compromised due to conditions such as caries, trauma, or root resorption. 1 Rubber dam isolation of the subject tooth is considered mandatory as it prevents ingress of oral bacteria and saliva, precludes inhalation and ingestion of instruments, and averts leaking of irrigation solutions into the oral cavity. The purpose of endodontic treatment is to prevent or treat apical periodontitis by maintaining an aseptic root canal system or disinfecting this when previously infected.

Root endo