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Keep the Root and Rebuild the Tooth

21 Mar
Dental checkup in Hamilton


So often, patients present with fractured teeth due to large restorations that have undermined the tooth structure. There can also be cases involving trauma where the coronal portion of the tooth has fractured. In addition, pre-existing endo teeth that have not been restored adequately can fracture significantly due to weakened tooth structure. On these occasions, we are left with a clinical situation in which there is inadequate residual tooth structure to place a definitive crown. What shall we do? Extract the root and place a dental implant, or construct a fixed bridge? Implant Supported Bridge keep natural teeth at their places and replace teeth without support.Both of those options are more invasive, more time consuming, and more prone to long-term maintenance issues. We cannot replace osseous support and the beautiful soft-tissue architecture as the crown emerges from the sulcus. However, there is a better method—one that is more predictable and with good long-term prognosis, that also provides the optimal physiologic and aesthetic outcome. Preserve the root, build up a foundation, and place a definitive restoration.

Clinical Protocol

Before any dehydration of the teeth took place from our clinical procedures, an accurate shade was taken utilizing a spectrophotometer (VITA Easy Shade V [VITA North America]) (Figure 4). A photo was taken (Nikon 3300 DSLR camera) and printed out (Lester Dine).

The first step in the placement of a post was to analyze the radiograph to gain a sense of length and width of the canal for proper post selection. There are many recommendations regarding this matter. The clinician should remove as little intraradicular dentin as possible so as not to weaken the root; this is dependent on the endodontic preparation and calcification level. For long-term success, it is important to leave at least 5.0 mm of apical gutta-percha to act as a seal, with placement of the post approximately two thirds down the root. The initial access opening had a temporary filling which was removed using an electric handpiece (Forza ELM [Brasseler USA]). The access area was then enlarged somewhat to follow tooth morphology and to act as an anti-rotation component (Figure 5). The author prefers an electric handpiece due to controlled torque, RPM reduction, and the quieter nature of the procedure.

The process of canal preparation was initiated using a flexible Gates Glidden end-cutting drill to remove the desired amount of gutta-percha (Figure 6). Once the gutta-percha was removed, the appropriate size post was selected. The size selection was done through measurements of the canal and careful review of the radiograph.

The kit to be utilized in this case was the very latest 3-D Fiber Post from 3M. This clinical product represents a true advancement in post design. The key enduring feature of the 3-D fiber-reinforced glass post is that the inherent flexural modulus is similar to that of dentin. The post has a knurled coronal portion to engage the core material. It is 60% parallel glass fibers in a resin matrix that has been presilanated to enhance chemical bonding. The microstructure creates an ideal surface for mechanical interlock. The components of this system include the 3-D post, 35% phosphoric acid gel (Scotchbond Etchant [3M]), bonding adhesive (Scotchbond Universal [3M]), self-etching dual-cured resin cement (RelyX Unicem 2 [3M]), bulk-fill core material (Filtek Bulk Fill [3M]), and reamers.

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