Knowledge and Practice of Endocrown Application Among Dentists in Saudi Arabia
Endocrown; postendodontic restoration; knowledge; clinical practice; dentists; Saudi Arabia; questionnaire survey; CAD/CAM; adhesive cementation.
AuthorsABSTRACTBackground: Among the different restorative options, the endocrown has emerged as
an adhesive and minimally invasive alternative for restoring endodontically treated posterior teeth. However, how well these principles were understood and translated into routine practice among dentists in the Kingdom of Saudi Arabia had not been consistently quantified. Methods: In this study, a crosssectional, online questionnaire survey was carried out among licensed dentists practicing in Saudi Arabia. Data collection pertained to sociodemographics, knowledge related to endocrowns, and selfreported practice patterns. Results: A total of 400 dentists participated. At least one endocrown cemented, representing endocrown adoption, equated to 94.5% (378/400). Adoption significantly varied with clinical experience, including 88.9% (144/162) among dentists with ≤5 years, 98.2% (223/227) among those with 6–10 years, and 100.0% (11/11) among those with >10 years (χ²=16.56, df=2, p<0.001). By experience, the intensity of endocrown use also varied (χ²=51.86, df=6, p<0.001), with 61.5% (240/390) reporting 6–10 endocrowns cemented in the past year, followed by <5 (30.0%, 117/390), >10 (3.1%, 12/390), and none (5.4%, 21/390). Conclusion: The adoption rate of the endocrown among the surveyed dentists in Saudi Arabia was high; however, its adoption and annual use intensity varied with clinical experience and knowledge, the latter remaining an independent predictor after adjustment.
INTRODUCTIONRestoration of endodontically treated posterior teeth remains a central challenge in contemporary restorative dentistry due to frequent extensive loss of coronal tissue from caries, previous restorations, access cavity preparation, and endodontic procedures. This tissue depletion results in reductions in stiffness and altered stress distribution under occlusal loading [1]. In this context, endocrowns have gained popularity as a conservative, adhesive alternative to conventional post–core–crown workflows for severely compromised molars and premolars, especially when radicular preparation is undesirable or unnecessary and when modern adhesive protocols and CAD/CAM fabrication are available. Recent questionnairebased studies conducted in the Saudi Arabia context have reported variable levels of awareness, conceptual understanding, and perceived indications for endocrowns among dentists and trainees, reflecting ongoing diffusion of the technique with heterogeneity across practitioner groups and settings [2–4]. Conceptually, the endocrown is envisaged as a monolithic indirect restoration that derives retention and resistance through a combination of intracoronal extension within the pulp chamber and adhesive bonding to enamel and dentin, by this means minimizing or avoiding post space preparation and conserving radicular dentin [5]. The related biomechanical concept considers a “monoblocklike” restoration–tooth complex in which functional loads are dissipated through a broad cervical buttjoint margin and internal walls, potentially simplifying the procedure without compromises regarding the iatrogenic risks of post placement [67]. However, the clinical outcome of an endocrown relies on several interconnected variables, such as the amount and quality of the remaining tooth structure, the geometry and depth of the pulp chamber, cervical margin design, occlusal concept, and the chosen restorative material and bonding approach [8]. Observational studies conducted in the Saudi environment emphasized that awareness of these determinants and confidence in adhesive procedures are not uniform and might therefore lead some clinicians to underindicate endocrowns where they would be the material of choice or to apply them in incomplete accordance with established principles of preparation and cementation [1, 9]. ••••••••••••••••••••••••••••••••
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