SECTION
FIXED PROSTHODONTICS OPERATIVE DENTISTRY Combined endodontic considerations Kenneth J. Waliszewoki,
DAVID
EDITORS
E. BEAUDREAU
SAMUEL WILLIAM
E. GUYER LEFKOWITZ
and restorative treatment
D.D.S., M.S.,* and Clyde L. Sabala, D.D.S., MS.**
Marquette University, Schoolof Dentistry, Milwaukee, Wis.
E
ndodontics is a predictably successfultreatment for pulpal diseaseand has produced an increasing number of treated teeth that require restorations. Many of these teeth are badly broken down, and appropriate communication and cooperation between the endodontist and restorative dentist are required to provide the best treatment for the patient.
ENDODONTK
CONSIDERATIONS
Before considering the restoration of an endodontically treated tooth, two questions need to be answered: (1) What is the prognosis of the treatment already performed? (2) If dowel spaceis created, will this change the prognosis? Grossman and Pearson’ consider a tooth to have been successfully treated endodontically when the periapical bone structure and periodontal membrane are radiographically normal in appearance and the tooth remains comfortable. The tooth is unsuccessfully treated when (1) an area of rarefaction develops where none had been present before, (2) an area of rarefaction persists,and (3) on checkup the tooth is uncomfortable or tender to percussion. Teeth in which the area of rarefaction has become smaller but bone repair is incomplete are classified as doubtful. Among doubtful teeth are also included those which show a thickened periodontal membrane that was not present originally. Rud and associate9presented four groups in their radiographic study of healing following endodontic surgery. Their criteria for healing were correlated with the histology and the symptomatology of the teeth
The opinions and assertions contained herein are those of the authors and are not to be construed as reflecting the views of the Navy Department or the naval service. at large. *Assistant Professor, Department of Fixed Prosthodontics. **Captin, (DC) USN, Endodontic Section, San Diego, Caiif.
152
studied and are slightly different than the preceding classifications. Idea1 healing would be demonstrated by an absenceof clinical symptoms, radiographic evidence of restoration to normal architecture (i.e., osteogenesiswith no apical radiolucency), intact lamina dura, a normal periodontal ligament space, and total absence of histologic evidence of inflammation. However, BrynholP believes that a total absence of inflammation histologically occurs in only 7% of treated teeth, In the absenceof clinical symptoms, the main aid in establishing a prognosis is the radiograph. Where the prognosis is questionable, retreatment of the canal should be considered before proceeding with the final restoration (Figs. 1 and 2). A question frequently asked when considering the restoration of an endodontically filled tooth is how much root canal filling material should remain after a dowel spacehas been created. Clinically, 4 or 5 mm of well-sealed filling material that has not been disturbed by preparation of the dowel space should remain. Removal of more than 4 to 5 mm of the remaining seal could conceivably jeopardize the integrity of the root canal filling by dislodgement or by opening accessorycanals which are prevalent in the apical area (Fig. 3). Neagley” demonstrated that preparation of dowels should not be attempted when canals are filled with silver points. Of course a restoration may enhance the prognosis, but the patient should be made aware of the possibility of failure and presented with alternatives. The poasibilities of retreatment of the root canal should be discussedand the absolute need for recall and followup examination stressed.
RESTORATIVE
CONSIDERATIONS
After completion of root canal therapy, the problems facing the restorative dentist often include: (1)
AUGUST
1978
VOLUME
40
NUMLiER
2
ENDODONTIC
Fig.
AND
RESTORATIVE
TREATMENT
obvious inadequate root canal filling. Although the tooth is asymptomatic, a dowel preparation would possibly compromise the treatment. The root canal filling is short, and adequate dowel space would eliminate most of the filling. 1.
An
lack of tooth structure from an original traumatic fracture, the ravages of decay, the extent of existing restorations, and the loss of support because of the endodontic opening; (2) protection of remaining coronal tooth structure against masticatory stresses; (3) reinforcement against crown/root fracture; (4) retention of the final restoration; and (5) location of the restoration’s margin. Since many restorative techniques are available, each should be evaluated in terms of solving these five problems. Cast restorations with full occlusal coverage. Cast restorations providing full occlusal coverage are often suitable to restore a posterior tooth after root canal therapy (Fig. 4)‘.* However, if a considerable amount of dentin has been destroyed, the onlay or crown is not indicated because of insufficient retention. In this situation, use of a dowel and core is indicated before planning a final cast restorationg-‘I Anterior teeth requiring crowns also require dowels or cores because they have a comparatively small
THE
JOURNAL
OF PROSTHETIC
DENTISTRY
Fig. 2. The tooth has been retreated endodontically and is ready for the dowel preparation. A better prognosis has be established. cervical cross-sectional area. The root canal therapy and crown preparation leave very little dentin. To prevent severance of the crown from the root during masticatory stress, vertical reinforcement with a dowel is indicated.‘O, *’
Pin-retained cores with cast restorations providway to help ing full occlusal coverage. Another retain an onlay or crown is with a pin-retained core (Fig. 5). The core replaces lost tooth structure while adding to the support and retention of the final crown. The use of pins to retain cores and restorations is an accepted procedure for vital teeth and is often suggested for pulpless teeth.“, “‘. ” The hazard of using pins is the possibility of dentinal crazing and tooth perforation. Given a choice of retaining a core with pins or a dowel, many dentists favor dowel I”. ‘?. 15, I6 However, a recent article” has retention.“. suggested that pin-retained amalgam cores can be stronger than cast gold dowel-cores. Since not all endodontically treated teeth are receptive to dowel-retained cores,” the use of pins can be an important adjunct in treatment. Pin-retained
153
WALISZEWSKI
AND
SABALA
Fig. 4.
A cast restoration providing complete cuspal protection is often adequate to restore a posterior tooth after endodontics. However, an adequate amount of tooth structure must remain to retain the casting.
Fig. 3. Dowel core and crown completed. The dowel on the central incisor is maximum length. The dowel length on the lateral incisor is excessive and may compromise the endodontic therapy. cores should be covered with cast restorations, and the margins of the casting should terminate on tooth structure.”
Reinforcement dowels for cast restorations with teeth require special full occlusal coverage. Anterior attention because of the small diameter at their cervical neck (Fig. 6). This potential weakness is emphasized by increased brittleness and loss of resiliency after root canal therapy.” An anterior tooth with a nearly intact clinical crown can be reinforced with a premade dowel or steel wire. The dowel or steel wire helps the tooth resist horizontal forces that tend to fracture the crown from the root. A reinforcement dowel is used when the clinical crown of an anterior tooth is nearly intact and no core is needed. This type of dowel is used only for reinforcement, and the final crown completes the restoration of the tooth.
Dowels and cores for cast restorations providing full occlusal coverage. The dowel and core proce-
154
Fig. 5. When insufficient tooth structure remains to retain a routine casting, a posterior tooth may be restored with a pin-retained core followed by a cast crown. dure is needed to support many endodontically treated teeth (Fig. 7). The intraradicular dowel provides retention for the core while it reinforces the tooth and is the most suitable way for an endodontically treated tooth to resist vertical and horizontal forces.“, ‘“. ” This dowel must be of sufficient Iength to distribute the forces of leverage and torque throughout the remaining portion of the tooth.’ Many formulas exist for determining ideal dowel length, including: (1) The dowel is one half of the root length.“. I’ (2) The dowel is two thirds of the root length.20 (3) The dowel is equal to the length of clinical crown.“, IS (4) The dowel is as long as possible but must leave 3 mm of root canal filling undisturbed at the apex.“, ‘l (5) The dowel is at least one half of the length of the root contained in bone.” All of these formulas are thought provoking, but
AUGUST
1978
VOLUME
40
NUMBER
z
ENDODONTIC AND RESTORATIVE TREATMENT
Fig. 6. When an endodontically treated anterior tooth is prepared for a cruwn restoration, even if the clinical crown is intact, reinforcement should be provided to guard against a crown-root severance.
Fig. 7. The cast dowel-core replaces lost tooth structure, and the cast dowel-core adds support to the endodiontically treated tooth and also replaces lost tooth structure. A complete crown finalizes the restoration.
clinically it is most practical to fabricate a dowel that is as long as possible without disturbing the apical seaLzl Some teeth will allow a dowel of maximum length; others, because of tortuous or dilacerated roots, will not permit ideal length to be obtained.
canal. Restorative treatment for the pulpless tooth should provide protection against fracture and the needed resistance against masticatory stress to allow the tooth to resume normal function.
CONCLUSIONS
REFERENCES
The cast dowel and core can be universally applied. It is custom-made to fit a given situation and is specifically indicated when no clinical tooth structure remains and the retention for the core must come from the dowel.“, I2 The fit of a casting, complemented by sufficient dowel length, maximizes the retention. The other dowel and core techniques are most suited to situations where some sound tooth structure remains to assist in the retention of the dowel or core. All dowel and core assemblies must be finalized by placement of a cast restoration which provides full occlusal coverage with the margins of the casting on sound tooth structure. Although occasional heroic efforts are made to restore a tooth with a severe vertical fracture,‘” at best they have a guarded prognosis. Often, due to the depth of the dowel and core the margin of the crown cannot terminate on tooth structure. SUMMARY Endodontic treatment for pulpal pathology should result in an asymptomatic tooth with a sealed
THE JOURNAL OF PROSTHETIC DENTISTRY
1. Grossman, L. I., and Pearson, L. A.: Roentgenologic and clinical evaluation of endodonticaily treated teeth. Oral Surg 17:368, 1964. 2. Rud, J., Andreasen, J. O., and Moller Jensen, J. E.: Radiographic criteria for the assessment of heating after endodontic surgery. Int J Orai Surg 1:195, 1972. 3. Brynholf, I.: A histological and roentgenological study of the periapical region of human upper incisors. Odontol Revy 18~5, 1967. (Suppl 11) 4. Neagley, R. L.: The effect of dowel preparation on the apical seal of endodonticahy treated teeth. Oral Surg 28:739, 5. Sheets, C. E.: Dowel and core foundations. J PROSTHETDENT 23:58, 1970. 6. Baraban, D. J.: The restoration of pulpless teeth. Dent Clin North Am, Nov. 1967, p 633. 7. Healey, H. J.: Restoration of effectively treated pulpless teeth. J PROSTHET DENT 4~842, 1954. 8. Skurnik, H. R.: Rehabilitation rationale for pulpless teeth. ,J PROSTHET DE.NT 15:528, 1965. 9. Shillingburg, H. T., Fisher, D. W., and Dewhirst, R. B.: Restoration of endodontically treated posterior teeth. J PROSTHE.TDENT 24~401, 1971. 10. Silverstein, W.: Reinforcement of weakened pulpless teeth. J PROSTHE.T DENT 14:372, 1964. 11. Tylman, S.: Theory and Practice of Grown and Bridge Prosthodontics, ed 5. St. Louis, 1965, The G. V. Mosby Company, p 722. 12. Johnston, J. F., Phillips, R. W., and Dvkema. R. W.:
155
WALLSZEWSKI
Modern Practice in Crown
13.
14. 15. 16. 17.
18.
and Bridge Prosthodontics, ed 3. Philadelphia, 1971, W. B. Saunders Company, p 608. Markley, M.: Pin reinforcement and retention of amalgam foundations and restorations. J Am Dent Assoc 56:675, 1958. Spalten, R. G.: Composite resins to restore mutilated teeth. J PROSTHET DEHT 25:323, 1971. Kornfeld, M.: Mouth Rehabilitation, ed 2. St. Louis, 1974, The C. V. Moeby Company, p 631. Rosen, H.: Operative procedures on mutilated teeth. J PFCOSTHET DE.NT 11:973, 1961. Lovdahl, P. E., and Nicholls, J. I.: Pin-retained amalgam corn vs. cast gold dowel-cores. J PROSTHET DEXT 38:507, 1977. Johnson, J. K., Schwartz, N. L., and Blackwell, R. T.: Evaluation and restoration of endodontically treated posterior teeth. J Am Dent Assoc 93:597, 1976.
ARTICLES
19.
21. 22. 23.
Reprint requests to: DR. KENNE.TH J. WALISZEWSKI MARQUETTE SCHOOL
UNIVE.RSITY
OF DENTISTRY
WIS. 53233
MILWAIJKLE,,
ISSUES An a&4
d SeYsraI D.D.S., and John H. Hembree,
W. Antes, Jr., D.D.S., Robert
study
Jr., D.D.S.
UW SW~@Q& padal dentare: An altenatdve removable partial denture service Edward
approwh to conventional
P. Renner, D.D.S., and Douglas Foerth, D.D.S.
Band strmgth of t&we cemmts detqrpaimd by ce&rifugal A. I-I. Arfaei, D.D.S., MS.,
SABALA
Becker, S. C.: Crowns. Philadelphia, 1961, W. B. Saunders Company. Christy, J. M., and Pipko, D. J.: Fabrication of a dual-post veneer crown. J Am Dent Assoc 75:1419, 1967. Herschman, J. B. In Weine, F. S.: Endodontic Therapy. St. Louis, 1972, The C. V. Mosby Company, pp 388-410. Perel, M. L., and Muroff, F. I.: Clinical criteria for posts and cores. J PROSTHET DE.NT 28405, 1972. Goerig, A. C.: Restoration of teeth with subgingival and subosseous fractures. J PROSTHET DFNT 34:634, 197.5.
20.
TO APPEAR IN FUTURE
James T. Andrews,
AND
and K. Asgar, MS.,
testing
Ph.D.
Effe$ of occlusal splints upon TMJ sympto~atokqy Juan J. Carraro,
D.D.S., Dr.Odont.,
and Raul G. Caffesse, D.D.S., MS., Dr.Odont.
Functional ocelusal forces: An invest@&& J. A. De &ever,
L.D.S., W. D. McCall,
by telemetry
Jr., Ph.D., S. Holden,
and M. M. Ash, Jr., D.D.S.
The upper antes-h sect&ma1 denture P. M. H. Dummer,
B.D.S., and J. Gidden,
Central papiky
atwphy of the
L.B.I.S.T.
and denture stomt-itis
A. G. Far-man, B.D.S., L.D.S.R.C.S., C. W. van Wyk, F.D.S.R.C.Sc., Ph.D.(Odont), W. P. Dreyer, B.D.S., H.D.D., J. Staz, L.D.S.R.C.S., H.D.D., D.D.S., C. J. Thomas, B.D.S., H.D.D., J. H. Louw, M.B., D.Sc., and D. Bester, B.D.S., H.D.D.
1%
AUGUST
1!~‘8
VOLUME
Qo
NUMBER
2
FIXED PROSTHODONTICS OPERATIVE DENTISTRY Combined endodontic considerations Kenneth J. Waliszewoki,
DAVID
EDITORS
E. BEAUDREAU
SAMUEL WILLIAM
E. GUYER LEFKOWITZ
and restorative treatment
D.D.S., M.S.,* and Clyde L. Sabala, D.D.S., MS.**
Marquette University, Schoolof Dentistry, Milwaukee, Wis.
E
ndodontics is a predictably successfultreatment for pulpal diseaseand has produced an increasing number of treated teeth that require restorations. Many of these teeth are badly broken down, and appropriate communication and cooperation between the endodontist and restorative dentist are required to provide the best treatment for the patient.
ENDODONTK
CONSIDERATIONS
Before considering the restoration of an endodontically treated tooth, two questions need to be answered: (1) What is the prognosis of the treatment already performed? (2) If dowel spaceis created, will this change the prognosis? Grossman and Pearson’ consider a tooth to have been successfully treated endodontically when the periapical bone structure and periodontal membrane are radiographically normal in appearance and the tooth remains comfortable. The tooth is unsuccessfully treated when (1) an area of rarefaction develops where none had been present before, (2) an area of rarefaction persists,and (3) on checkup the tooth is uncomfortable or tender to percussion. Teeth in which the area of rarefaction has become smaller but bone repair is incomplete are classified as doubtful. Among doubtful teeth are also included those which show a thickened periodontal membrane that was not present originally. Rud and associate9presented four groups in their radiographic study of healing following endodontic surgery. Their criteria for healing were correlated with the histology and the symptomatology of the teeth
The opinions and assertions contained herein are those of the authors and are not to be construed as reflecting the views of the Navy Department or the naval service. at large. *Assistant Professor, Department of Fixed Prosthodontics. **Captin, (DC) USN, Endodontic Section, San Diego, Caiif.
152
studied and are slightly different than the preceding classifications. Idea1 healing would be demonstrated by an absenceof clinical symptoms, radiographic evidence of restoration to normal architecture (i.e., osteogenesiswith no apical radiolucency), intact lamina dura, a normal periodontal ligament space, and total absence of histologic evidence of inflammation. However, BrynholP believes that a total absence of inflammation histologically occurs in only 7% of treated teeth, In the absenceof clinical symptoms, the main aid in establishing a prognosis is the radiograph. Where the prognosis is questionable, retreatment of the canal should be considered before proceeding with the final restoration (Figs. 1 and 2). A question frequently asked when considering the restoration of an endodontically filled tooth is how much root canal filling material should remain after a dowel spacehas been created. Clinically, 4 or 5 mm of well-sealed filling material that has not been disturbed by preparation of the dowel space should remain. Removal of more than 4 to 5 mm of the remaining seal could conceivably jeopardize the integrity of the root canal filling by dislodgement or by opening accessorycanals which are prevalent in the apical area (Fig. 3). Neagley” demonstrated that preparation of dowels should not be attempted when canals are filled with silver points. Of course a restoration may enhance the prognosis, but the patient should be made aware of the possibility of failure and presented with alternatives. The poasibilities of retreatment of the root canal should be discussedand the absolute need for recall and followup examination stressed.
RESTORATIVE
CONSIDERATIONS
After completion of root canal therapy, the problems facing the restorative dentist often include: (1)
AUGUST
1978
VOLUME
40
NUMLiER
2
ENDODONTIC
Fig.
AND
RESTORATIVE
TREATMENT
obvious inadequate root canal filling. Although the tooth is asymptomatic, a dowel preparation would possibly compromise the treatment. The root canal filling is short, and adequate dowel space would eliminate most of the filling. 1.
An
lack of tooth structure from an original traumatic fracture, the ravages of decay, the extent of existing restorations, and the loss of support because of the endodontic opening; (2) protection of remaining coronal tooth structure against masticatory stresses; (3) reinforcement against crown/root fracture; (4) retention of the final restoration; and (5) location of the restoration’s margin. Since many restorative techniques are available, each should be evaluated in terms of solving these five problems. Cast restorations with full occlusal coverage. Cast restorations providing full occlusal coverage are often suitable to restore a posterior tooth after root canal therapy (Fig. 4)‘.* However, if a considerable amount of dentin has been destroyed, the onlay or crown is not indicated because of insufficient retention. In this situation, use of a dowel and core is indicated before planning a final cast restorationg-‘I Anterior teeth requiring crowns also require dowels or cores because they have a comparatively small
THE
JOURNAL
OF PROSTHETIC
DENTISTRY
Fig. 2. The tooth has been retreated endodontically and is ready for the dowel preparation. A better prognosis has be established. cervical cross-sectional area. The root canal therapy and crown preparation leave very little dentin. To prevent severance of the crown from the root during masticatory stress, vertical reinforcement with a dowel is indicated.‘O, *’
Pin-retained cores with cast restorations providway to help ing full occlusal coverage. Another retain an onlay or crown is with a pin-retained core (Fig. 5). The core replaces lost tooth structure while adding to the support and retention of the final crown. The use of pins to retain cores and restorations is an accepted procedure for vital teeth and is often suggested for pulpless teeth.“, “‘. ” The hazard of using pins is the possibility of dentinal crazing and tooth perforation. Given a choice of retaining a core with pins or a dowel, many dentists favor dowel I”. ‘?. 15, I6 However, a recent article” has retention.“. suggested that pin-retained amalgam cores can be stronger than cast gold dowel-cores. Since not all endodontically treated teeth are receptive to dowel-retained cores,” the use of pins can be an important adjunct in treatment. Pin-retained
153
WALISZEWSKI
AND
SABALA
Fig. 4.
A cast restoration providing complete cuspal protection is often adequate to restore a posterior tooth after endodontics. However, an adequate amount of tooth structure must remain to retain the casting.
Fig. 3. Dowel core and crown completed. The dowel on the central incisor is maximum length. The dowel length on the lateral incisor is excessive and may compromise the endodontic therapy. cores should be covered with cast restorations, and the margins of the casting should terminate on tooth structure.”
Reinforcement dowels for cast restorations with teeth require special full occlusal coverage. Anterior attention because of the small diameter at their cervical neck (Fig. 6). This potential weakness is emphasized by increased brittleness and loss of resiliency after root canal therapy.” An anterior tooth with a nearly intact clinical crown can be reinforced with a premade dowel or steel wire. The dowel or steel wire helps the tooth resist horizontal forces that tend to fracture the crown from the root. A reinforcement dowel is used when the clinical crown of an anterior tooth is nearly intact and no core is needed. This type of dowel is used only for reinforcement, and the final crown completes the restoration of the tooth.
Dowels and cores for cast restorations providing full occlusal coverage. The dowel and core proce-
154
Fig. 5. When insufficient tooth structure remains to retain a routine casting, a posterior tooth may be restored with a pin-retained core followed by a cast crown. dure is needed to support many endodontically treated teeth (Fig. 7). The intraradicular dowel provides retention for the core while it reinforces the tooth and is the most suitable way for an endodontically treated tooth to resist vertical and horizontal forces.“, ‘“. ” This dowel must be of sufficient Iength to distribute the forces of leverage and torque throughout the remaining portion of the tooth.’ Many formulas exist for determining ideal dowel length, including: (1) The dowel is one half of the root length.“. I’ (2) The dowel is two thirds of the root length.20 (3) The dowel is equal to the length of clinical crown.“, IS (4) The dowel is as long as possible but must leave 3 mm of root canal filling undisturbed at the apex.“, ‘l (5) The dowel is at least one half of the length of the root contained in bone.” All of these formulas are thought provoking, but
AUGUST
1978
VOLUME
40
NUMBER
z
ENDODONTIC AND RESTORATIVE TREATMENT
Fig. 6. When an endodontically treated anterior tooth is prepared for a cruwn restoration, even if the clinical crown is intact, reinforcement should be provided to guard against a crown-root severance.
Fig. 7. The cast dowel-core replaces lost tooth structure, and the cast dowel-core adds support to the endodiontically treated tooth and also replaces lost tooth structure. A complete crown finalizes the restoration.
clinically it is most practical to fabricate a dowel that is as long as possible without disturbing the apical seaLzl Some teeth will allow a dowel of maximum length; others, because of tortuous or dilacerated roots, will not permit ideal length to be obtained.
canal. Restorative treatment for the pulpless tooth should provide protection against fracture and the needed resistance against masticatory stress to allow the tooth to resume normal function.
CONCLUSIONS
REFERENCES
The cast dowel and core can be universally applied. It is custom-made to fit a given situation and is specifically indicated when no clinical tooth structure remains and the retention for the core must come from the dowel.“, I2 The fit of a casting, complemented by sufficient dowel length, maximizes the retention. The other dowel and core techniques are most suited to situations where some sound tooth structure remains to assist in the retention of the dowel or core. All dowel and core assemblies must be finalized by placement of a cast restoration which provides full occlusal coverage with the margins of the casting on sound tooth structure. Although occasional heroic efforts are made to restore a tooth with a severe vertical fracture,‘” at best they have a guarded prognosis. Often, due to the depth of the dowel and core the margin of the crown cannot terminate on tooth structure. SUMMARY Endodontic treatment for pulpal pathology should result in an asymptomatic tooth with a sealed
THE JOURNAL OF PROSTHETIC DENTISTRY
1. Grossman, L. I., and Pearson, L. A.: Roentgenologic and clinical evaluation of endodonticaily treated teeth. Oral Surg 17:368, 1964. 2. Rud, J., Andreasen, J. O., and Moller Jensen, J. E.: Radiographic criteria for the assessment of heating after endodontic surgery. Int J Orai Surg 1:195, 1972. 3. Brynholf, I.: A histological and roentgenological study of the periapical region of human upper incisors. Odontol Revy 18~5, 1967. (Suppl 11) 4. Neagley, R. L.: The effect of dowel preparation on the apical seal of endodonticahy treated teeth. Oral Surg 28:739, 5. Sheets, C. E.: Dowel and core foundations. J PROSTHETDENT 23:58, 1970. 6. Baraban, D. J.: The restoration of pulpless teeth. Dent Clin North Am, Nov. 1967, p 633. 7. Healey, H. J.: Restoration of effectively treated pulpless teeth. J PROSTHET DENT 4~842, 1954. 8. Skurnik, H. R.: Rehabilitation rationale for pulpless teeth. ,J PROSTHET DE.NT 15:528, 1965. 9. Shillingburg, H. T., Fisher, D. W., and Dewhirst, R. B.: Restoration of endodontically treated posterior teeth. J PROSTHE.TDENT 24~401, 1971. 10. Silverstein, W.: Reinforcement of weakened pulpless teeth. J PROSTHE.T DENT 14:372, 1964. 11. Tylman, S.: Theory and Practice of Grown and Bridge Prosthodontics, ed 5. St. Louis, 1965, The G. V. Mosby Company, p 722. 12. Johnston, J. F., Phillips, R. W., and Dvkema. R. W.:
155
WALLSZEWSKI
Modern Practice in Crown
13.
14. 15. 16. 17.
18.
and Bridge Prosthodontics, ed 3. Philadelphia, 1971, W. B. Saunders Company, p 608. Markley, M.: Pin reinforcement and retention of amalgam foundations and restorations. J Am Dent Assoc 56:675, 1958. Spalten, R. G.: Composite resins to restore mutilated teeth. J PROSTHET DEHT 25:323, 1971. Kornfeld, M.: Mouth Rehabilitation, ed 2. St. Louis, 1974, The C. V. Moeby Company, p 631. Rosen, H.: Operative procedures on mutilated teeth. J PFCOSTHET DE.NT 11:973, 1961. Lovdahl, P. E., and Nicholls, J. I.: Pin-retained amalgam corn vs. cast gold dowel-cores. J PROSTHET DEXT 38:507, 1977. Johnson, J. K., Schwartz, N. L., and Blackwell, R. T.: Evaluation and restoration of endodontically treated posterior teeth. J Am Dent Assoc 93:597, 1976.
ARTICLES
19.
21. 22. 23.
Reprint requests to: DR. KENNE.TH J. WALISZEWSKI MARQUETTE SCHOOL
UNIVE.RSITY
OF DENTISTRY
WIS. 53233
MILWAIJKLE,,
ISSUES An a&4
d SeYsraI D.D.S., and John H. Hembree,
W. Antes, Jr., D.D.S., Robert
study
Jr., D.D.S.
UW SW~@Q& padal dentare: An altenatdve removable partial denture service Edward
approwh to conventional
P. Renner, D.D.S., and Douglas Foerth, D.D.S.
Band strmgth of t&we cemmts detqrpaimd by ce&rifugal A. I-I. Arfaei, D.D.S., MS.,
SABALA
Becker, S. C.: Crowns. Philadelphia, 1961, W. B. Saunders Company. Christy, J. M., and Pipko, D. J.: Fabrication of a dual-post veneer crown. J Am Dent Assoc 75:1419, 1967. Herschman, J. B. In Weine, F. S.: Endodontic Therapy. St. Louis, 1972, The C. V. Mosby Company, pp 388-410. Perel, M. L., and Muroff, F. I.: Clinical criteria for posts and cores. J PROSTHET DE.NT 28405, 1972. Goerig, A. C.: Restoration of teeth with subgingival and subosseous fractures. J PROSTHET DFNT 34:634, 197.5.
20.
TO APPEAR IN FUTURE
James T. Andrews,
AND
and K. Asgar, MS.,
testing
Ph.D.
Effe$ of occlusal splints upon TMJ sympto~atokqy Juan J. Carraro,
D.D.S., Dr.Odont.,
and Raul G. Caffesse, D.D.S., MS., Dr.Odont.
Functional ocelusal forces: An invest@&& J. A. De &ever,
L.D.S., W. D. McCall,
by telemetry
Jr., Ph.D., S. Holden,
and M. M. Ash, Jr., D.D.S.
The upper antes-h sect&ma1 denture P. M. H. Dummer,
B.D.S., and J. Gidden,
Central papiky
atwphy of the
L.B.I.S.T.
and denture stomt-itis
A. G. Far-man, B.D.S., L.D.S.R.C.S., C. W. van Wyk, F.D.S.R.C.Sc., Ph.D.(Odont), W. P. Dreyer, B.D.S., H.D.D., J. Staz, L.D.S.R.C.S., H.D.D., D.D.S., C. J. Thomas, B.D.S., H.D.D., J. H. Louw, M.B., D.Sc., and D. Bester, B.D.S., H.D.D.
1%
AUGUST
1!~‘8
VOLUME
Qo
NUMBER
2
