Root-Treated Molar Restoration — ORE Part 1 MCQ

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ModerateRestorative DentistryRoot-Treated Molar RestorationORE Part 1

A 45-year-old patient presents with an extensive composite restoration on the upper right first molar that has fractured and is leaking. The tooth has previously been root treated but has no post. Approximately 60% of the coronal tooth structure is missing. What is the most appropriate restorative option?

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Correct answer: C — Indirect cuspal coverage restoration (onlay or crown)

Explanation lettering: D = shown as A · C = shown as B · A = shown as C · B = shown as D

The answer is A: Indirect cuspal coverage restoration (onlay or crown). With 60% of coronal structure missing, this tooth exceeds the threshold for direct composite restoration alone. Randomised controlled trials demonstrate that metal-ceramic crowns and indirect restorations have better success rates and lower need for re-intervention than direct composite in teeth with extensive coronal damage. The absence of a post means an endocrown (bonded full-coverage ceramic restoration seated on the internal pulp chamber walls and cavity margins) or a crown with a composite core buildup are both appropriate options—both provide cuspal coverage. Options B (composite), C (pins), D (sealant) and E (no restoration) fail to address the structural deficit. Direct composite cannot provide adequate retention and resistance form for this extent of loss; pins are biomechanically inadequate and outdated; sealants do not restore structure; and leaving a failed tooth untreated risks further deterioration.

Reference: Mannocci F, Semiglia A, De Sanctis M, Lorenzi C, Marrocchi V, Setti R, et al. Crown vs. composite for post-retained restorations: a randomized clinical trial. J Dent Res. 2016;95(5):500–506. doi:10.1177/0022034515622126. See also: Qvist V, et al. Single crowns versus conventional fillings for the restoration of root-filled teeth. Cochrane Database Syst Rev. 2015(12):CD009956. https://pubmed.ncbi.nlm.nih.gov/26403154/