Endocrowns in Anterior Teeth: Effect of Cementation Protocols and Restorative Materials on the Clinical Performance of the Restorations

Study Overview
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Brief Summary
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Rehabilitation of anterior endodontically treated teeth with significant coronal damage has been problematic. Adopting endocrown design to treat teeth with this condition is still under investigation. To address this issue, the USPHS criteria were adopted to assess the anterior endocrown restorations manufactured using various ceramic materials and cemented with different protocols.

Detailed Description
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40 participants with anterior endodontically treated maxillary central incisors were enrolled to restore their teeth with esthetic restorations Patients were divided into two groups, zirconia and e-max groups. Each group was, further subdivided into two groups following the cementation protocol. Patients were evaluated immediately (baseline) and at. The clinical marginal accuracy measurements were carried out for all groups at baseline, 3, 6, 9, 12, and 18 months and evaluated by 3 investigators using Modified (USPHS). The patients' satisfaction and potential postoperative discomfort were also assessed and recorded during the same periods. All qualitative data were displayed as frequency (N) and Percentages (%). The chi-square test was utilized for qualitative data comparisons. Results: As to marginal integrity and patient satisfaction, no significant difference were revealed regarding all scores at different intervals as P>0.05. Conclusions: According to the findings of this study, ceramic endocrowns offer a promising restorative solution for the rehabilitation of anterior endodontically treated teeth. Additionally, regardless of the presence of the MDP monomer in its composition, using adhesive resin cement achieved highly successful results when used with MDP-based ceramic primers.

Official Title
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Endocrowns in Anterior Teeth: Effect of Cementation Protocols and Restorative Materials on the Clinical Performance of the Restorations

Conditions
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Endodontically Treated Teeth, Anterior Teeth

Intervention / Treatment
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* Other: resin cement containing phosphate ester monomer 10-methacryloyloxydecyl dihydrogen phosphate
* Other: Non MDP containg resin cement


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: • Freshly extracted teeth. Completely formed apices Minimum root length of 14mm (± 0.5) measured from the cement-enamel junction to the root apex. Straight roots. Teeth with single root canal. Sound teeth with no cracks or fractured parts in its crown or root. Absence of any carious lesions. No signs of internal or external root resorption. Similar bucco-lingual (BL) and mesio-distal (MD) dimensions as determined with a digital caliper. Exclusion Criteria: • Previously endodontically treated teeth. Markedly curved roots. Root contains more than one canal. Presence of canal calcifications or pulp stones. Internal or external root resorption. Presence of cracks, fractures or caries.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: All patients received their treatment at the same time. Follow-up periods were parallel for all participants.
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Group ZA<br>Participants received Zirconia anterior endocrowns. Endocrowns were cemented with MDP-containing primer+ MDP-containing resin cement. | Other: resin cement containing phosphate ester monomer 10-methacryloyloxydecyl dihydrogen phosphate<br>* Adhesive resin cement containing an MDP agent that is added to bonding agents to enhance bonding to ceramics like Ziconia and E-max<br>* Other names: Panavia SA;|
| Experimental: Ggroup ZB<br>Participants received Zirconia anterior endocrowns. Endocrowns were cemented with MDP-containing primer+ Non-MDP-containing resin cement. | Other: Non MDP containg resin cement<br>* Adhesive resin cement not containing an MDP agent<br>* Other names: Duo-link Universal;|
| Experimental: Group EA<br>Participants received E-max anterior endocrowns. Endocrowns were cemented with MDP-containing primer+ MDP-containing resin cement. | Other: resin cement containing phosphate ester monomer 10-methacryloyloxydecyl dihydrogen phosphate<br>* Adhesive resin cement containing an MDP agent that is added to bonding agents to enhance bonding to ceramics like Ziconia and E-max<br>* Other names: Panavia SA;|
| Experimental: Group EB<br>Participants received E-max anterior endocrowns. Endocrowns were cemented with MDP-containing primer+ Non-MDP-containing resin cement. | Other: Non MDP containg resin cement<br>* Adhesive resin cement not containing an MDP agent<br>* Other names: Duo-link Universal;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Marginal Integrity | Using a dental mirror and a dental explorer, endocrowns were checked from every aspect, buccal, mesial, distal and lingual to detect any marginal discontinuity, fractures, or gaps. Endocrown evaluation was carried out against The Modified USPHS criteria | 3-6-9-12 Months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient Satisfaction | Each patient was asked about his opinion regarding the restoration. Patients' answers and/or complaints were assessed and recorded against the USPHS criteria | 3-6-9-12 Months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Digital Dentistry, E-max, MDP, Zirconia