Der Stift im Wurzelkanal – differenzialtherapeutische Überlegungen

Wurzelkanalbehandelte Zähne wurden oftmals „reflexartig“ aus vermeintlichen Stabilisierungsgründen mit einem Stift restauriert. In der restaurativen Zahnheilkunde gibt es zahlreiche Möglichkeiten, die den Stift im Wurzelkanal bedingen oder relativieren können. Ziel der hier vorgestellten differenzialtherapeutischen Aspekte ist es, dass wurzelkanalbehandelte Zähne – bei korrekter Indikation oftmals auch ohne Stift – langfristig restauriert werden können.

Kernaussagen

• Endodontisch behandelte Zähne können von einem Stift im Wurzelkanal profitieren, insbesondere bei tief zerstörten Zähnen.

• Dennoch tragen zahlreiche weitere Aspekte zu ihrer langfristig stabilen Restauration bei.

• Oberste Priorität sollte stets der Erhalt gesunder Zahnhartsubstanz sein.

• Vor allem ein Ferrule-Design sollte bei Überkronung stets vorhanden sein, ggf. müssen die Voraussetzungen dafür erst durch eine spezifische Vorbehandlung geschaffen werden.

• Bei einem adäquaten Ferrule nimmt die Relevanz eines Stiftes im Wurzelkanal deutlich ab.

• Als geeignete Techniken gelten hierfür die chirurgische Kronenverlängerung und die Extrusion (chirurgisch, mit Magnet) der Zahnwurzel. Sie sind entsprechend ihrer Indikationsbereiche zu prüfen und gegeneinander abzuwägen.

• Auch wenn die Anwendung dieser Techniken sicherlich keine Standardbehandlung darstellt, können sie für den Behandler eine wertvolle therapeutische Option sein, tief zerstörte Zähne sicher und vorhersagbar – mit oder ohne Stift – zu erhalten.

Schlüsselwörter

Wurzelkanal - Stiftversorgung - Teilüberkronung - Extrusion - Ferrule-Design

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