Operative dentistry aje qualtrough, jd satterthwaite la morrow, pa brunton

Mechanical considerations
When insufficient coronal dentine remains to provide for retention
and resistance, placement of a restoration is problematic. In this 
situation, placement of a corono-radicular core will allow for the
retentive and resistance form to be provided by the radicular dentine.
This may be achieved through placement of the restorative material
alone (such as an ‘amalgam–dowel core’) or in combination with 
an intra-radicular post. Obviously, using the radicular dentine for
retention will necessitate root canal treatment.
When a tooth is extensively restored and/or has a poor crown to
root ratio due to bone loss arising from periodontal disease, elective
devitalisation and crown reduction will reduce the influence of any
lateral forces acting upon the tooth. This is of particular relevance
when the tooth in question is a potential abutment for a partial 
denture. The reduced tooth may then be utilised as an overdenture
abutment, providing support and stability for the prosthesis as well 
as maintenance of alveolar bone.
Aid to treatment
Occasional situations may arise in which devitalisation of teeth will
aid provision of treatment. Although uncommon, such situations
include gross adjustment of occlusal irregularities or major realign-
ment of tooth axes.
Risks and complications
Although the above arguments for elective devitalisation are per-
suasive for some situations, such a procedure is not without its 
drawbacks. The primary consideration is that the success of root canal
treatment cannot be guaranteed. Despite advances in endodontic
treatment, the potential for failure of the root canal treatment should
be weighed carefully against the risks/problems of restoring the tooth
Endodontics – further considerations


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without devitalising it. Although root canal treatment and placement
of an intra-radicular post was once thought to strengthen a root (even
being advocated for otherwise healthy teeth that were planned to 
act as bridge abutments!) it is now accepted that this will, in fact, pre-
dispose to root fracture
8
. Although there is no conclusive evidence
that endodontically treated teeth are more brittle, the procedure itself
will weaken the tooth due to the amount of coronal and radicular 
dentine that will be removed.
Teeth that have been root filled have shown poor performance 
as bridge abutments and especially so if an intra-radicular post is 
present. Such poor performance is even more likely when root-filled
teeth support a distal extension, whether this is a removable partial
denture or a cantilever bridge
9,10
. This may in part be as a result of a
decreased proprioceptive mechanism following pulpectomy.
It should also be remembered that elective devitalisation before
definitive treatment will increase the time required to complete the
treatment and also increase costs.