A Systematic Approach to Restore Endodontically Treated Grossly Decayed Teeth - A Case Report

Background: Loss of coronal tooth structure, secondary caries and soft-tissue overgrowth frequently compromise the longevity of full-coverage restorations. This case report describes a biologically driven, staged rehabilitation of maxillary premolar–molar units (-25 and -26; FDI) in which a dislodged crown with recurrent decay was managed by re-establishing ferrule, stabilising tissues and delivering individual zirconia crowns.Case Presentation: An adult presented with a dislodged joint crown on -25–26, recurrent caries and gingival proliferation around -25. After pre-operative planning, selective caries removal and margin access were achieved by gingivectomy and surgical crown lengthening at 25 to respect biological width. Tooth 25 was rebuilt with a post and core under absolute isolation. Provisional crowns were used to sculpt soft tissues before definitive preparation, impression and cementation.Interventions: The sequence comprised (1) removal of the failed crown and caries control; (2) soft-tissue recontouring and crown lengthening to gain sound tooth structure for ferrule; (3) postand core build up for -25 under rubber dam isolation; (4) biologically contoured temporaries; and (5) definitive individual zirconia crowns with careful interproximal cement removal and occlusal refinement.Outcomes: The workflow generated circumferential ferrule on -25 and a sound post retained core on -25. Gingival tissues stabilised around well-contoured provisionals, and the definitive prosthesis delivered accurate marginal integrity and harmonious occlusion. The patient reported restored function and comfort at review.Conclusion: Complex fixed rehabilitation adjacent to compromised periodontium can be predictably executed using a sequenced, biologically respectful strategy: complete caries removal, crown lengthening to recover ferrule, meticulous isolation for post and core procedures, soft-tissue conditioning with provisional crowns and careful finishing at cementation. Respecting biological width and achieving a 1.5–2.0 mm ferrule, together with rigorous contamination control, underpin long-term stability for teeth restored with full coverage crowns and function.