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SHARONLAYAnewonlaydesignforendodonticallytreatedpremolar

JConservDent.2015MarApr18(2):172175.

PMCID:PMC4379662

doi:10.4103/09720707.153062

SHARONLAYAnewonlaydesignforendodonticallytreatedpremolar
SiddapurMathadaSharathChandra
DepartmentofConservativeandEndodontics,KrishnadevarayaCollegeofDentalSciences,Hunasamaranhalli,Bengaluru,Karnataka,India
Addressforcorrespondence:Dr.S.M.SharathChandra,Prof.andHOD,DepartmentofConservativeandEndodontics,Krishnadevaraya
CollegeofDentalSciences,Hunasamaranhalli,ViaYelahanka,Bengaluru562157,Karnataka,India.Email:sharath.sm@hotmail.com
Received2014Oct10Revised2014Dec2Accepted2014Dec29.
Copyright:JournalofConservativeDentistry
ThisisanopenaccessarticledistributedunderthetermsoftheCreativeCommonsAttributionNoncommercialShareAlike3.0Unported,which
permitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperlycited.

Abstract
Rootcanaltreatedteetharestructurallycompromisedasaresultoflossoftoothstructureduetocaries,
iatrogeniccavitypreparation,anddehydration.Giventhatadirectrelationshipexistsbetweentheamountof
remainingtoothstructureandtheabilitytoresistocclusalforces,itisvitaltoprovidearestorationallowing
cuspalcoverageassoonaspossiblefollowingcompletionoftherootcanaltreatment.Adecisiontoprovidea
fullcrownoranonlaydependsontheremainingtoothstructureifthecuspalwidthtolengthratiois1:2or
more,anonlaycanbeplaced.Whentheratioislessthan1:2,afullcrownhastobeplanned.Insinglerooted
teethrequiringpostendodonticrestorationcastpostandcoreoraprefabricatedpostcanprovideresistanceto
fracturewithcomparableresults.However,incaseofpremolarscontradictorytothepracticeofproviding
onlycuspalcoveragethroughOnlays,itwouldinadditionrequirecervicalreinforcementalsotocounter
horizontalforcesactingincervicalregion.AnewonlaydesignSHARONLAYpatenteddesignwithI.P.no
1956475dated27/04/2010withapostextendingintotheradicularportionofthepremolarprovidingthe
requiredreinforcementinaconservativemannerandprotectingitagainstbothverticalandhorizontalforces
isproposedherewith.
Keywords:Postendodonticrestoration,premolar,Sharonlay
INTRODUCTION
Rootcanaltreatedteetharestructurallycompromisedasaresultoflossoftoothstructureduetocaries,
iatrogeniccavitypreparation,anddentindehydration.Adirectrelationshipexistsbetweentheamountof
remainingtoothstructureandtheabilitytoresistocclusalforces,[1]itisvitaltoprovideapostendodontic
restorationallowingcuspalcoverageassoonaspossiblefollowingcompletionoftherootcanaltreatment.[2]
Adecisiontoprovideafullcrownoranonlaydependsontheremainingtoothstructureifthecuspalwidth
tolengthratiois1:2ormore,anonlaycanbeplaced.[3]
Whentheratioislessthan1:2,afullcrownhastobeplanned.Insinglerootedteeth,castpostandcoreora
prefabricatedposthaveshownsimilarlongtermresults.[4]Howeverincaseofpremolars,wheremostly
cuspalcoverageisbeingpractised,itbecomesimperativetoprovidesufficientcervicalreinforcementto
counterthehorizontalforceatcervicalregion.[5,6,7,8,9,10]
Anewonlaydesign(SHARONLAY)withapostextendingintotheradicularportionofthepremolar
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providingtherequiredreinforcementinaconservativemannerandprotectingitagainstbothverticaland
horizontalforcesisproposedherewith.Inthisdesign,theonlaycomponentprotectstheendodontically
treatedpremolarfromsplittingundercompressiveloadingandtheradicularextensionservesdualfunctionof
retentionaswellasprotectionfromfractureattheneckduetotensile(horizontal)forces.
INDICATIONS
Insinglerootedpremolars,Sharonlaycanbefabricatedformesioocclusal,distoocclusal,ormesiooccluso
distallesionsinvolvingthepulpasapostendodonticrestoration.Incaseofteethwithshortclinicalcrown
requringadditionalretention.Itisalsoindicatedinpremolarswithtworootswhereatleastoneoftherootsis
paralleltothelineofdrawplannedfortheonlay.Alsoindicatedinsinglerootedmolarswhereadditional
retentionbymeansofextentionintorootcanalisrequired.Alsobestsuitedforteethwithshortclinical
crown.
Stepwiseclinicalprocedure

Oncompletionofrootcanaltreatment,thechosencanalisenlargedtoaminimumdepthof7mmfromthe
canalorifice.Additionalretentionmaybeachievedwithincreaseindepthtomorethan7mmifthecanal
configurationandrootlengthpermits.ThecanalisminimallyenlargeduptoPeesoreamer#3
(correspondingtofilesize110)(Dentsply).Thecanalisfurtherenlargedtopeeso4(correspondingtofile
size130)or5(correspondingtofilesize130)dependingontheinitialcanaldiameteravoidingexcessive
toothstructureremovalatthecervicalregion.
SinceSHARONLAYisindicatedforcaseswithadequatecoronaltoothstructure,postextensionbeyond7
mmintotherootcanalmaynotberequiredbecausethepostprovidesreinforcementattheneckofthetooth,
butincaseswithcompromisedcoronaltoothstructure(whereoneofthecuspsisbadlydamaged)maximum
apicalextensionofthepostwithoutjeopardizingtheapicalsealandradiculardentinhastobeundertakenfor
betterresistanceandretention.Internalwallsofthecoronalcavityarefinishedwith5taperoneachwalland
thebuccalandlingualcuspsarereducedfrom12mmdependingonthematerialusedfortherestorationi.e.
metal/zirconiarespectively.
Acounterbevelof0.5mmonbuccalcuspsforestheticreasonsand1mmonlingualcuspsisplacedforthe
estheticrequirementsandtoobtainthehoodingeffect.Postspaceisreproducedinwax(GCFujiInlaywax)
orwithlightbodyrubberbase(Additionalsilicone,Zhermack)materialandfullarchimpressionismade
withrubberbase(Additionalsilicone,Zhermack).Aremovabledieispreparedandanindirectwaxpattern
made(TypeIIwax,GCFuji)andcastingisdone.Tryinisdoneonthediebeforetryinginthepatients
mouth.Oncetheocclusion,contourandcontacthavebeenchecked,thecastingispolishedandcemented
intothetoothwithalutingcement(Type1,GICFujiI).
SHARONLAYcanbefabricatedusingbasemetalalloy,goldalloy,aswellasceramic(CADCAM).
Clinicalcases
Case1 A25yearoldmalepatientreportedforpostendodonticrestorationinrelationto35(rootcanal

treatmentwasdoneelsewhere).Onremovaloftemporaryaccessfilling,thetoothwasexaminedclinically
andradiographicallyandwasfoundsuitableforSHARONLAYandthetreatmentwasrendered[Figure1a
d].
Case2 Patientreportedwithpaininrelationto25,whichwasdiagnosedasacuteirreversiblepulpitisand

plannedforroutineendodontictreatment.
Analyzingtheremainingtoothstructureandtheeconomicconditionofthepatientitwasplannedfor
SHARONLAYasthepostendodonticrestoration.Thetoothhasonepalatalandonebuccalcanal.After
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completionofendodontictreatment,itwasdecidedtopreparethepalatalcanaltoreceivethepostandthe
buccalwasblockedwithpolycarboxylatecementandthecoronaltoothstructurepreparedtoreceivethe
onlay.Inthisdesign,sincethepalatalcanalisinlinewiththelineofdrawoftheonlay,asinglecomponent
restorationwaspossible[Figure2a].Therestorationcastinchromecobaltalloywasmade[Figure2b]and
cementedintheendodonticallytreated25[Figure2c].Thepostcementationradiographshowsthatthe
restorationisseatedandcontouredandalsotheradicularextensionofthepostisadequateforthiscase[
Figure2d].
Case3 Thismalepatientaged35yearsreportedwithsignsandsymptomssuggestiveofperiapicalabscessin

relationto35,aftercompletionofendodontictreatmentitwasplannedforSHARONLAYtogivethepatient
theadvantageofradicularreinforcementandafunctionalpostendodonticrestorationwhichwaslacking
onlyintheestheticparameterswhichdidnotmatterasitwasalowersecondpremolarandpatientwasa
middleagedmalepatient.Thepostspaceandthecoronaltoothstructurewasprepared[Figure3a]the
SHARONLAYfabricated[Figure3b]andtherestorationwascementedwithlutingglassionomercement
(GCFuji1)[Figure3c].TheimmediateradiographshowstheSHARONLAYinplacewithgoodadaptation
[Figure3d].
Case4 A30yearoldmalepatientreportedtomyclinicwithcomplainoffracturedlingualcuspinrelationto

25(maxillaryleftsecondpremolar),patientgavehistoryofrootcanaltreatment5yearsback.Takinginto
considerationtheestheticrequirementofpatient,SHARONLAYinzirconiausingCADCAM(Cerec)was
planned[Figures4ac].TheonlydisadvantagewithSHARONLAYwithceramicisthatitrequiresextensive
toothpreparationthereispossibilityoffractureatthepostonlayjunctionincasethepostisnarrow.Hence,
thepostspacepreparationalsohastobegreatertoavoidthefractureofthepostandalsopostlengthof>7
mmisdifficulttofabricatethroughCADCAMprocedure.Thefollowupinthiscaseisnotlong,asithas
beendeliveredinJune2012.
DISCUSSION
Anonlayisthemostconservativeposteriorpostendodonticrestorationindicatedwhenadequatetooth
structureisavailableonbuccalaswellaslingualsidesandforposteriorteeththataresubjectedto
compressiveloading.Onlayisalsoindicatedwhentheverticalcrownisinadequateforafullcrown.
Thepremolars,whicharegenerallysinglerootedandlocatedanteriortothemolars,aresubjectedtoboth
compressiveandtensileforces.[11]SHARONLAYisadesignconsistingofanonlaywithpostextending
intotheradicularportioncastedintoasinglecomponentgivingtheadvantagesoftheonlayandradicular
postextension.Singlecomponentrestorationshaveagreatersurfaceareafordissipationofstresses,thereby
takingmoreloadbeforefracturingcomparedtotwounitcomponents.Inconventionalpostandcore
restorations,thepostisextended35mmshortoftheapex,whereasinSHARONLAY,theradicular
extensioncanbekeptasminimalaspossible(minimum7mm)soastoenhanceresistanceatthecervical
region.Since,thepostisusedtoprovideresistanceattheneckretentionisnotamajorconcernhowever,in
caseswherethecoronaltoothstructureisweakened,thelengthofthepostcanbeproportionatelyincreased.
Thediameterofthepostwoulddependuponthefinalpreparationofthecanal,withminimalenlargement
withsize#3peesoreamerinordertoorienttheposttotheoverlyingonlayandprovideadequqtestrengthto
thepost.
Theonlayisdesignedconservingthetoothstructureandpreservinganyhealthymarginalridge.Thedesign
isplannedkeepinginmindtheaestheticrequirementandthehoodingeffectrequiredtopreventsplittingof
thecrown.
Apreliminaryinvitrostudywascarriedoutwhichcomparedthefractureresistanceofendodonticallytreated
toothrestoredusingthisnoveldesign.(GroupI)withatwocomponentrestoration,i.e.,postwithseparate
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onlay(separatedby2mm)(GroupII).SHARONLAYshowedmaximumresistancetofracturewithamean
fractureresistanceof514.67N,whichishigherthanthemaximumvoluntarybiteforcerecordedinthe
premolarregion(42222Ninmalesand34924Ninfemales).Thefracturelinesforbothcontrolgroup
(GroupIIIonlyonlaywithoutradicularextension)andGroupIIwereseenatthecervicallevelsplitting
thecuspswhileintheSHARONLAYgroup,itwasseenattheapicalextentofthepost.Thesefindings
indicatecervicalreinforcementofpremolarswiththisnoveldesign.[12]
CONCLUSION
Premolarsaresubjectedtobothtensileandcompressivestressesatthecervicalregion.Clinicianspay
minimalattentiontocervicalreinforcementespeciallywhenthereisadequatecoronaltoothstructure.Inour
invitrostudy,thefindingsindicatethatthepostgivescervicalreinforcementcontrarytosomeofthestudies.
[13]
SHARONLAYdesignwhichisasinglecomponent(onlaywithpost)hasbeentestedclinicallyformore
thanadecade.Evaluationoftheserestorationsafter10yearsshowspromisinglongtermsuccesshowever,
selectionofappropriatecaseisofprimeconsiderationforthesuccessoftherestoration.
Oneofthelimitationsisthevisibilityofmetalonthepremolars.Alternatively,withtheadvancementand
availabilityofCADCAMtechnology,thesamedesignmaybefabricatedusingzirconiabutthismayrequire
extensivetoothpreparationwhichisunlikelyinanendodonticallytreatedtooth.
Footnotes
SourceofSupport:Nil
ConflictofInterest:Nonedeclared.

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197756:14637.[PubMed:355274]
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FiguresandTables
Figure1

(a)ToothpreparedtoreceiveSHARONLAY(b)Coronaltoothpreparationwithbuccalandlingualreversebevel(c)
CementedSHARONLAYon35(d)Postcementationradiographof35withSHARONLAY
Figure2

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(a)PreparedtoothtoreceiveSHARONLAYonleftmaxillarysecondpremolar(b)FinishedandcontouredSHARONLAY
(c)SHARONLAYaftercementationonleftmaxillarysecondpremolar(d)Postcementationradiographonleftmaxillary
secondpremolars
Figure3

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SHARONLAYAnewonlaydesignforendodonticallytreatedpremolar

(a)PreparedtoothtoreceiveSHARONLAYonleftmandibularsecondpremolar(b)Finishedandcontoured
SHARONLAY(c)SHARONLAYaftercementationonleftmandibularsecondpremolar(d)Postcementationintraoral
periapical(IOPA)onleftmandibularsecondpremolar
Figure4

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SHARONLAYAnewonlaydesignforendodonticallytreatedpremolar

(a)BuccalviewofSHARONLAYonleftmaxillarysecondpremolar(b)OclussalviewofSHARONLAYonleftmaxillary
secondpremolar(c)Postcementationradiographonleftmaxillarysecondpremolar
ArticlesfromJournalofConservativeDentistry:JCDareprovidedherecourtesyofMedknowPublications

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