Who should do the post-endodontic restoration – the restorative dentist or the endodontist?

This question was submitted by a general dentist: Who should do the post-endodontic restoration – the restorative dentist or the endodontist?

Drs. Stephen Ferrier, Manny Friedman, and Suham Alexander prepared the following response

The most important aspect of the post-endodontic restoration is establishing a sound coronal seal to prevent re-infection of the root canal system and to protect the weakened tooth from mechanical failure. Ideally, this should be completed when the endodontic obturation is done. Whether or not this is the ‘final’ or ‘ultimate’ restoration depends upon the tooth.

The coronal seal may take the form of a:

• Core (including postless cores for molar teeth)
• Post and core
• Glass ionomer cement (GIC) seal over the orifice with a provisional restoration (general dentist would place the final restoration)

As an example, if an anterior tooth has only a small access cavity, the best option to avoid failure may be for the endodontist to seal the root canal orifice with GIC and the access cavity/defect with composite resin.  If the tooth does not require any further treatment; then, the endodontist has provided the final restoration.

Conversely, if the tooth is treatment-planned to be an abutment for a bridge or partial denture, it is unlikely that the endodontist will provide the bridge or survey crown.

In all instances where the final restoration is indirect (perhaps weeks away), the endodontist or general dentist should provide the tooth with a provisional restoration rather than a temporary dressing. The newly root canal-treated tooth should be prepared and restored such that the remaining tooth structure and restorative material are sufficiently strong to withstand functional loads. Alternatively, the tooth should be prepared to avoid functional loading. In this case, the coronal seal should be maintained with GIC or resin-modified GIC and not a zinc-oxide eugenol (ZOE) dressing.

The advantage of having the endodontist place the post and core is that he/she has a clear idea of the coronal root anatomy and the direction of the canals. As such, the risk of lateral perforation or creating a post space which is not within the canal space is minimized. If a post space is created by the endodontist, the interim restoration must provide a seal to prevent microleakage.

Additionally, if the final restoration is placed by the endodontist, the patient is no longer required to visit the general dentist for the final restoration in the immediate future.

With respect to efficiency and consideration for the patient, the clinician completing the root canal may be the best candidate to place this restoration. However, it is best to remember that the patient is undergoing treatment with two different clinicians and communication between clinicians and patient is of paramount importance. Synchronize all efforts to outline who will provide the specific treatments and the timing to optimize the success rate of the treatment for the patient.