ITENA Products Video, Procedures & Studies Events Distributors Contact
ESTHETIC RESTORATION OF DEVITALIZED MAXILLARY INCISORS : A CLINICAL CASE
Simon PERELMUTER
Francine LIGER

The restoration of single-root teeth having undergone root canal treatment often requires the use of a root post whose essential function is to ensure retention. The success shown by fibreglass posts is owed to several performance features:
- elimination of metal alloys with resultant absence of corrosion risks
- physical properties close or similar to those of dentin
- and finally, in the era of Aesthetics, an optical behaviour that is not the least of its qualities.
 
ADVANTAGES
DISADVANTAGES
Core with cast metal post
  • Physical resistance
  • "Proven" technique
  • Risks of longitudinal root cracks/fracture
  • Optical interference under the all-ceramics
  • Corrosion with non-precious alloys
Ceramic core with cast post
  • Physical resistance
  • Good aesthetic outcome
  • Risks of longitudinal root cracks/fracture
  • Corrosion with non-precious alloys
  • Relatively complex and costly procedure
Pressed ceramic cores on zirconia posts
  • Aesthetic
  • Resistant
  • Almost impossible to dismantle
  • High rigidity
  • Relatively complex and costly procedure
Pressed ceramic core with transfixing fibre post (IVOCLAR)
  • Aesthetic
  • Resistant
  • Rigidity of post matching that of root dentin
  • Easily dismantled
  • Relatively complex and costly procedure
  • Delicate adhesive sealing
Dual composite crown and root restoration with fibre post
  • Aesthetic
  • Resistance to flexion matching that of root dentin
  • Relatively non-costly
  • Ergonomic quality of materials
  • Necessity for dental clasp up to 1/3 of core height
  • Complexity of bonding of post and restored core
  • Relative difficulty of core build-up

The following solution is proposed. Although it fits in with the overall trend, it does not claim to be a tailor-made solution.

 

ADVANTAGES

DISADVANTAGES

Restoration of crown and root with laboratory composite and fibre post
  • Aesthetic
  • Resistance to flexion matching that of root dentin
  • Ease of procedure
  • Indirect technique
  • Double bonding procedure


"The aesthetic and functional efficacy of the root/root-post/restored-core system is based on the consistent physical performance of both the individual and the overall components especially".

An appropriate step would be to associate a laboratory composite with physical qualities superior to those of a direct composite with fibre post, so as to avail of the advantages of these components.

1.The fibre post (Dentoclic) is composed of an epoxy resin matrix that binds the glass fibres together resulting in a post having performance characteristics close to those of dentin. Its elasticity module is 15 Gpa, whereas that of dentin is 20 Gpa. The surface of the post is optimised to allow effective bonding:
    - a.microretentions 5 to 15 µm in size provide the necessary components for physical anchoring
    - b.the epoxy resin of the post matrix exhibits chemical affinity with composites and cement resins.

2.The belleGlass (Kerr) composite is a composite made of silica nanoparticles (50 nm), whose prepolymerised hybrid binder confers high-level mechanical properties and low polymerisation contraction. Its elasticity module is 21 Gpa, which is close to those of dentin and fibre posts. Its resistance to flexion is very high (158 MPa).

Clinical case No. 1

Fig. 3. Ouverture du logement radiculaire avec un foret Largo.
Fig.1		 Fig. 4 Foret pilote utilisé manuellement.
Fig.2

Fig. 1 Composite restorations of central incisors are inappropriate both in shape and shade.
Fig. 2 Pre-operative X-ray: the quality of the endodontic treatment is checked.
Fig. 3. Ouverture du logement radiculaire avec un foret Largo.
Fig.3		 Fig. 4 Foret pilote utilisé manuellement.
Fig.4
Fig. 3 After removal of the restorations, the cores still have sufficient residual substance to allow restoration to take place using root-post components. The rather wide diameter of the root opening is due to the fact that the patient was very young when her teeth were given root canal treatment.
Fig. 4 Impression with preforms used as material support.
Fig. 3. Ouverture du logement radiculaire avec un foret Largo.
Fig.5a		 Fig. 4 Foret pilote utilisé manuellement.
Fig.5b
Fig. 5 Choix du foret calibré et du tenon avec une grille millimétrée et une radiographie de la morphologie canalaire
Fig.5c		 Fig. 4 Foret pilote utilisé manuellement.
Fig.5d
Fig. 5 a, b, c and d. Basic preparations to be refined after the crown restorations have bonded include a cervical limit in the shape of a broad chamfer. Root post restorations are carried out using fibre posts (Dentoclic) on which the laboratory composite aggregates (belleGlass KERR).
The opposing surfaces are prepared in two stages:
  • the dentin of the root and of the preparation are cleaned using EDTA for the first and phosphoric acid for the second. The self and light cure adhesive is a mixture of equal parts of DentoBond Adhesive and of Activator, which is applied in a thin layer on the root cavity walls and those of the preparation.
  • the surfaces of the post and inner surface of the prosthetic component are etched using 7.5% hydrofluoric acid (Dentoclic) and then silane-treated (Dentobond Porcelain Silane). The silane is left to dry after which the same adhesive is applied, air dried and light cured.

Fig. 6 Bonding procedure.

The cement (DentoCem) is injected into the root cavity with a self-mixing tip followed by a lentulo. It is then spread on the preparation and inner surface of the prosthetic component. The setting time is 5 minutes. Any surplus is eliminated with a probe.
Fig. 5 Choix du foret calibré et du tenon avec une grille millimétrée et une radiographie de la morphologie canalaire
Fig.7		 Fig. 4 Foret pilote utilisé manuellement.
Fig.8

Fig. 7 End of preparation: the cervical limits are sub-gingival on the visible faces. The shape of the core satisfies the criteria for all-ceramic crown preparations.
Fig. 8 Clinical testing of dense fritted ceramic caps.
Fig. 5 Choix du foret calibré et du tenon avec une grille millimétrée et une radiographie de la morphologie canalaire
Fig.9		 Fig. 4 Foret pilote utilisé manuellement.
Fig.10

Fig. 9 End of treatment X-ray: inspection prior to components fixation.
Fig.10 The all-ceramic crowns are sealed on translucent cores using cement glue (Rely X). Integrated biological and optical factors confer a high level of success to these all-ceramic crowns. This was possible thanks to the common effort of the manufacturers, the prosthetic laboratory and the practitioner, as well as the active collaboration of the patient.

Clinical case No. 2

Fig. 3. Ouverture du logement radiculaire avec un foret Largo.
Fig.1		 Fig. 4 Foret pilote utilisé manuellement.
Fig.2

Fig. 1 The left maxillary central incisor has to be reconstructed.
Fig. 2 Pre-operative X-ray: endodontic treatment has to precede prosthetic treatment.
Fig. 3. Ouverture du logement radiculaire avec un foret Largo.
Fig.3a		 Fig. 4 Foret pilote utilisé manuellement.
Fig.3b

Fig. 3 a and 3b Peripheral crown preparation and preparation of fibre post housing.
Fig. 3. Ouverture du logement radiculaire avec un foret Largo.
Fig.4
Fig. 4 Impression: the material carries the root post. It is the same as that used to produce the core.

Fig. 3. Ouverture du logement radiculaire avec un foret Largo.
Fig.5a		 Fig. 4 Foret pilote utilisé manuellement.
Fig.5b

Fig. 5 a and 5b Cores in belleGlass on model. The root fibre post must transfix the core as much as possible so as to optimise the robustness of the overall structure.
Fig. 3. Ouverture du logement radiculaire avec un foret Largo.
Fig.6		 Fig. 4 Foret pilote utilisé manuellement.
Fig.7

Fig. 6 Laboratory-prepared composite core (belleGlass) with fibre root post (Dentoclic).
Fig. 7 The core is made to aggregate by bonding and the preparation finished using fine-grained diamond burrs (red ring)..
Fig. 3. Ouverture du logement radiculaire avec un foret Largo.
Fig.8		 Fig. 4 Foret pilote utilisé manuellement.
Fig.9

Fig. 8 Clinical testing of dense fritted ceramic cap.
Fig. 9 The crown is sealed onto the translucent core using cement glue (Rely X). The challenge posed by the reconstruction of this maxillary central incisor was met thanks to the efforts and patience of the dental team. Likewise, the quality of the different materials used and preservation of the surrounding tissues are essential requirements for success.




ACKNOWLEDGEMENTS
The authors would like to acknowledge:
Renaud Malherbe and his team for their ability to simulate reality when producing the all-ceramic crowns used for illustration purposes in this article.
Itena and KERR (France) for their availability and technical advice.


Site Map
Copyright ITENA CLINICAL 2005-2008

Conception et réalisation : Agence MLM Communication©