Pre-endodontic treatment restorations. A modification of the 'donut' technique.

O ne of the most critical elements in endodontic treatment is proper tooth isolation. With the exception of teeth that have undergone a traumatic event and remain intact, teeth requiring endodontic treatment fall into one of the following categories: previously restored, carious, fractured or a combination of the three (Figure, A). Before starting endodontic treatment, it is important to remove all caries down to the sound tooth structure and remove any restorations showing marginal leakage, instability or both. If these procedures are followed, the practitioner can be left with a tooth having little remaining tooth structure. Several techniques have been used to overcome this problem, including using a deep-reaching clamp; clamping adjacent teeth for multiple tooth isolation; placing clamp beaks on gingival tissue; cementing a preformed copper band, temporary crown or orthodontic band; or using pin-retained amalgam buildups, glass ionomer cements or composites. Some practitioners may consider some of these techniques to be unstable, complex or time-consuming. Although opinions vary, most practitioners agree that a stable, preendodontic treatment buildup provides one less variable about which to be concerned before, during and after treatment, pending a definitive restoration. The purpose of this article is to provide the reader with a rapid, stable, predictable technique for provisionally restoring Pre-endodontic treatment restorations A modification of the ‘donut’ technique