The Journal of Contemporary Dental Practice

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 22 , ISSUE 4 ( April, 2021 ) > List of Articles


A Thorough Analysis of the Endocrown Restoration: A Literature Review

Dimokritos Papalexopoulos, Theodora-Kalliopi Samartzi, Aspasia Sarafianou

Citation Information :

DOI: 10.5005/jp-journals-10024-3075

License: CC BY-NC 4.0

Published Online: 00-04-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Aim: The aim of this literature review is to determine whether endocrowns are a reliable alternative for endodontically treated teeth with extensive loss of tooth structure, the indications and contraindications of this restorative choice, the principles that should be followed for tooth preparation and which material is most appropriate for endocrown fabrication. Background: Rehabilitation of endodontically treated teeth with severe coronal destruction has always been a challenge for the dental clinician. Until recently, the fabrication of a metal-ceramic or all-ceramic full-coverage crown along with a metal or glass fiber post has been the “gold standard” proving its efficacy via numerous clinical studies. With the development of CAD/CAM technology and the evolution of dental materials, new minimally invasive techniques have been introduced with less need for adjustments and less incorporation of structural defects. One of them, the “monoblock technique,” proposed by Pissis in 1995, was the forerunner of endocrown restoration, a term used by Bindl and Mörmann to describe an all-ceramic crown anchored to the internal portion of the pulp chamber and on the cavity margins, thus obtaining macromechanical retention provided by the axial opposing pulpal walls and microretention attained with the use of adhesive cementation. Review results: Endocrowns require a decay-oriented preparation taking advantage of both the adhesion and the retention from the pulp-chamber walls, they are strongly indicated in endodontically treated molars in cases where minimal interocclusal space and curved or narrow root canals are present and they should be manufactured from materials that can be bonded to the tooth structure. Conclusion: Endocrowns are a reliable alternative to traditional restorative choices, given that the clinicians respect the requirements and indications describing this technique. Clinical significance: Traditional restorative techniques demanding tooth substance removal and minimizing the opportunity for reinterventions should be reconsidered.

  1. Reeh ES, Messer HH, Douglas WH. Reduction in tooth stiffness as a result of endodontic and restorative procedures. J Endod 1989;15(11):512–516. DOI: 10.1016/S0099-2399(89)80191-8.
  2. Lander E, Dietschi D. Endocrowns: a clinical report. Quintessence Int 2008;39(2):99–106. PMID: 18560648
  3. Papa J, Cain C, Messer HH. Moisture content of vital vs endodontically treated teeth. Endod Dent Traumatol 1994;10(2):91–93. DOI: 10.1111/j.1600-9657.1994.tb00067.x.
  4. Sedgley CM, Messer HH. Are endodontically treated teeth more brittle? J Endod 1992;18(7):332–335. DOI: 10.1016/S0099- 2399(06)80483-8.
  5. Huang TJ, Schilder H, Nathanson D. Effects of moisture content and endodontic treatment on some mechanical properties of human dentin. J Endod 1992;18(5):209–215. DOI: 10.1016/S0099- 2399(06)81262-8.
  6. Plotino G, Tocci L, Grande NM, et al. Symmetry of root and root canal morphology of maxillary and mandibular molars in a white population: a cone-beam computed tomography study in vivo. J Endod 2013;39(12):1545–1548. DOI: 10.1016/j.joen.2013.09.012.
  7. Pissis P. Fabrication of a metal-free ceramic restoration utilizing the monobloc technique. Pract Periodontics Aesthet Dent 1995;7(5):83–94. PMID: 7548896.
  8. Ferrari M, Vichi A, Grandini S. Efficacy of different adhesive techniques on bonding to root canal walls: an SEM investigation. Dent Mater 2001;17(5):422–429. DOI: 10.1016/s0109-5641(00)00102-0.
  9. Salameh Z, Sorrentino R, Papacchini F, et al. Fracture resistance and failure patterns of endodontically treated mandibular molars restored using resin composite with or without translucent glass fiber posts. J Endod 2006;32(8):752–755. DOI: 10.1016/j.joen.2006.02.002.
  10. Bindl A, Mormann WH. Clinical evaluation of adhesively placed Cerec endo-crowns after 2 years--preliminary results. J Adhes Dent 1999;1(3):255. PMID: 11725673.
  11. Mormann WH, Bindl A, Luthy H, et al. Effects of preparation and luting system on all-ceramic computer-generated crowns. Int J Prosthodont 1998;11(4):333–339. PMID: 9758997.
  12. Sedrez-Porto JA, Rosa WL, da Silva AF, et al. Endocrown restorations: a systematic review and meta-analysis. J Dent 2016;52:8–14. DOI: 10.1016/j.jdent.2016.07.005.
  13. Biacchi GR, Mello B, Basting RT. The endocrown: an alternative approach for restoring extensively damaged molars. J Esthet Restor Dent 2013;25(6):383–390. DOI: 10.1111/jerd.12065.
  14. Biacchi GR, Basting RT. Comparison of fracture strength of endocrowns and glass fiber post-retained conventional crowns. Oper Dent 2012;37(2):130–136. DOI: 10.2341/11-105-L.
  15. Bindl A, Richter B, Mormann WH. Survival of ceramic computer-aided design/manufacturing crowns bonded to preparations with reduced macroretention geometry. Int J Prosthodont 2005;18(3):219–224. DOI: 10.1016/j.prosdent.2005.09.002.
  16. Fages M, Bennasar B. The endocrown: a different type of all-ceramic reconstruction for molars. J Can Dent Assoc 2013;79:d140. PMID: 24309044.
  17. Rocca GT, Krejci I. Crown and post-free adhesive restorations for endodontically treated posterior teeth: from direct composite to endocrowns. Eur J Esthet Dent 2013;8(2):156–179. PMID: 23712338.
  18. Atash R, Arab M, Duterme H, et al. Comparison of resistance to fracture between three types of permanent restorations subjected to shear force: An in vitro study. J Indian Prosthodont Soc 2017;17(3):239–249. DOI: 10.4103/jips.jips_24_17.
  19. Einhorn M, DuVall N, Wajdowicz M, et al. Preparation ferrule design effect on endocrown failure resistance. J Prosthodont 2019;28(1):e237–e242. DOI: 10.1111/jopr.12671.
  20. El-Damanhoury HM, Haj-Ali RN, Platt JA. Fracture resistance and microleakage of endocrowns utilizing three CAD-CAM blocks. Oper Dent 2015;40(2):201–210. DOI: 10.2341/13-143-L.
  21. Ghajghouj O, Tasar-Faruk S. Evaluation of fracture resistance and microleakage of endocrowns with different intracoronal depths and restorative materials luted with various resin cements. Materials (Basel) 2019;12(16):2528. DOI: 10.3390/ma12162528.
  22. Perdigao J. Dentin bonding-variables related to the clinical situation and the substrate treatment. Dent Mater 2010;26(2):e24–e37. DOI: 10.1016/
  23. Magne P, Kim TH, Cascione D, et al. Immediate dentin sealing improves bond strength of indirect restorations. J Prosthet Dent 2005;94(6):511–519. DOI: 10.1016/j.prosdent.2005.10.010.
  24. Magne P, Knezevic A. Thickness of CAD-CAM composite resin overlays influences fatigue resistance of endodontically treated premolars. Dent Mater 2009;25(10):1264–1268. DOI: 10.1016/
  25. Belleflamme MM, Geerts SO, Louwette MM, et al. No post-no core approach to restore severely damaged posterior teeth: an up to 10-year retrospective study of documented endocrown cases. J Dent 2017;63:1–7. DOI: 10.1016/j.jdent.2017.04.009.
  26. Aktas G, Yerlikaya H, Akca K. Mechanical failure of endocrowns manufactured with different ceramic materials: an in vitro biomechanical study. J Prosthodont 2018;27(4):340–346. DOI: 10.1111/jopr.12499.
  27. Rigolin FJ, Miranda ME, Florio FM, et al. Evaluation of bond strength between leucite-based and lithium disilicate-based ceramics to dentin after cementation with conventional and self-adhesive resin agents. Acta Odontol Latinoam 2014;27(1):16–24. PMID: 25335361.
  28. Bankoglu Gungor M, Turhan Bal B, Yilmaz H, et al. Fracture strength of CAD/CAM fabricated lithium disilicate and resin nano ceramic restorations used for endodontically treated teeth. Dent Mater J 2017;36(2):135–141. DOI: 10.4012/dmj.2016-017.
  29. Magne P, Schlichting LH, Maia HP, et al. In vitro fatigue resistance of CAD/CAM composite resin and ceramic posterior occlusal veneers. J Prosthet Dent 2010;104(3):149–157. DOI: 10.1016/S0022-3913(10)60111-4.
  30. Aversa R, Apicella D, Perillo L, et al. Non-linear elastic threedimensional finite element analysis on the effect of endocrown material rigidity on alveolar bone remodeling process. Dent Mater 2009;25(5):678–690. DOI: 10.1016/
  31. Awada A, Nathanson D. Mechanical properties of resin-ceramic CAD/CAM restorative materials. J Prosthet Dent 2015;114(4):587–593. DOI: 10.1016/j.prosdent.2015.04.016.
  32. Zoidis P, Bakiri E, Polyzois G. Using modified polyetheretherketone (PEEK) as an alternative material for endocrown restorations: a short-term clinical report. J Prosthet Dent 2017;117(3):335–339. DOI: 10.1016/j.prosdent.2016.08.009.
  33. Zimmermann M, Valcanaia A, Neiva G, et al. Three-dimensional digital evaluation of the fit of endocrowns fabricated from different CAD/CAM materials. J Prosthodont 2019;28(2):e504–e509. DOI: 10.1111/jopr.12770.
  34. Mormann WH, Stawarczyk B, Ender A, et al. Wear characteristics of current aesthetic dental restorative CAD/CAM materials: two-body wear, gloss retention, roughness and Martens hardness. J Mech Behav Biomed Mater 2013;20:113–125. DOI: 10.1016/j.jmbbm.2013.01.003.
  35. Tzimas K, Tsiafitsa M, Gerasimou P, et al. Endocrown restorations for extensively damaged posterior teeth: clinical performance of three cases. Restor Dent Endod 2018;43(4):e38. DOI: 10.5395/rde.2018.43.e38.
  36. Salis SG, Hood JA, Stokes AN, et al. Patterns of indirect fracture in intact and restored human premolar teeth. Endod Dent Traumatol 1987;3(1):10–14. DOI: 10.1111/j.1600-9657.1987.tb00165.x.
  37. Gregor L, Bouillaguet S, Onisor I, et al. Microhardness of light- and dual-polymerizable luting resins polymerized through 7.5-mm-thick endocrowns. J Prosthet Dent 2014;112(4):942–948. DOI: 10.1016/j. prosdent.2014.02.008.
  38. Muller JA, Rohr N, Fischer J. Evaluation of ISO 4049: water sorption and water solubility of resin cements. Eur J Oral Sci 2017;125(2):141–150. DOI: 10.1111/eos.12339.
  39. Trajtenberg CP, Caram SJ, Kiat-amnuay S. Microleakage of allceramic crowns using self-etching resin luting agents. Oper Dent 2008;33(4):392–399. DOI: 10.2341/07-101.
  40. Carvalho MA, Lazari PC, Gresnigt M, et al. Current options concerning the endodontically-treated teeth restoration with the adhesive approach. Braz Oral Res 2018;32(Suppl. 1):e74. DOI: 10.1590/1807- 3107bor-2018.vol32.0074.
  41. Rocca GT, Saratti CM, Poncet A, et al. The influence of FRCs reinforcement on marginal adaptation of CAD/CAM composite resin endocrowns after simulated fatigue loading. Odontology 2016;104(2):220–232. DOI: 10.1007/s10266-015-0202-9.
  42. Dogui H, Abdelmalek F, Amor A, et al. Endocrown: an alternative approach for restoring endodontically treated molars with large coronal destruction. Case Rep Dent 2018;2018:1581952. DOI: 10.1155/2018/1581952.
  43. Robbins JW. Restoration of the endodontically treated tooth. Dent Clin North Am 2002;46(2):367–384. DOI: 10.1016/s0011- 8532(01)00006-4.
  44. Dietschi D, Duc O, Krejci I, et al. Biomechanical considerations for the restoration of endodontically treated teeth: a systematic review of the literature, Part II (Evaluation of fatigue behavior, interfaces, and in vivo studies). Quintessence Int 2008;39(2):117–129. PMID: 18560650.
  45. Zhu J, Rong Q, Wang X, et al. Influence of remaining tooth structure and restorative material type on stress distribution in endodontically treated maxillary premolars: a finite element analysis. J Prosthet Dent 2017;117(5):646–655. DOI: 10.1016/j.prosdent.2016.08.023.
  46. Govare N, Contrepois M. Endocrowns: a systematic review. J Prosthet Dent 2020;123(3):411–418 e9. DOI: 10.1016/j.prosdent.2019.04.009.
  47. Assif D, Gorfil C. Biomechanical considerations in restoring endodontically treated teeth. J Prosthet Dent 1994;71(6):565–567. DOI: 10.1016/0022-3913(94)90438-3.
  48. Krejci I, Duc O, Dietschi D, et al. Marginal adaptation, retention and fracture resistance of adhesive composite restorations on devital teeth with and without posts. Oper Dent 2003;28(2):127–135. PMID: 12670067.
  49. Mjor IA, Smith MR, Ferrari M, et al. The structure of dentine in the apical region of human teeth. Int Endod J 2001;34(5):346–353. DOI: 10.1046/j.1365-2591.2001.00393.x.
  50. Tay FR, Loushine RJ, Lambrechts P, et al. Geometric factors affecting dentin bonding in root canals: a theoretical modeling approach. J Endod 2005;31(8):584–589. DOI: 10.1097/
  51. Dietschi D, Duc O, Krejci I, et al. Biomechanical considerations for the restoration of endodontically treated teeth: a systematic review of the literature--Part 1. Composition and micro- and macrostructure alterations. Quintessence Int 2007;38(9):733–743. PMID: 17873980.
  52. Jotkowitz A, Samet N. Rethinking ferrule--a new approach to an old dilemma. Br Dent J 2010;209(1):25–33. DOI: 10.1038/sj.bdj.2010.580.
  53. Skupien JA, Luz MS, Pereira-Cenci T. Ferrule effect: a meta-analysis. JDR Clin Trans Res 2016;1(1):31–39. DOI: 10.1177/2380084416636606.
  54. Motta AB, Pereira LC, Duda FP, et al. Influence of substructure design and occlusal reduction on the stress distribution in metal ceramic complete crowns: 3D finite element analysis. J Prosthodont 2014;23(5):381–389. DOI: 10.1111/jopr.12119.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.