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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 4  |  Issue : 1  |  Page : 24-26

Esthetic rehabilitation of grossly mutilated endodontically treated teeth


Department of Conservative Dentistry and Endodontics, Regional Dental College, Guwahati, Assam, India

Date of Web Publication19-Nov-2018

Correspondence Address:
Dr. Proxima Bora
Regional Dental College, Guwahati, Assam
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijohr.ijohr_7_18

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  Abstract 


The goal of restorative dentistry and endodontics is to retain the natural teeth with maximal function and pleasing esthetics. It is generally agreed that the successful treatment of a badly broken tooth with pulpal disease depends not only on endodontic therapy but also on good prosthetic reconstruction of the tooth following endodontic therapy. Various methods are available for the same, but a good intraoral examination is of utmost importance on deciding the treatment plan and choosing between direct and indirect restoration. The aim of this article is to discuss cases of grossly mutilated endodontically treated teeth (ETT) which need esthetic and functional rehabilitation by the use of indirect intraradicular devices. ETT with excessive loss of coronal tooth structure of more than 75% and fractured teeth which require a change in angulation of the teeth can be restored with a customized post and core to enhance the strength and durability of the tooth and to achieve retention and esthetics of the restoration.

Keywords: Cast post and core, custom metallic post and core, fractured anterior, postobturation restoration


How to cite this article:
Bora P, Kanodia A, Kataki R, Bhuyan AC. Esthetic rehabilitation of grossly mutilated endodontically treated teeth. Indian J Oral Health Res 2018;4:24-6

How to cite this URL:
Bora P, Kanodia A, Kataki R, Bhuyan AC. Esthetic rehabilitation of grossly mutilated endodontically treated teeth. Indian J Oral Health Res [serial online] 2018 [cited 2018 Dec 10];4:24-6. Available from: http://www.ijohr.org/text.asp?2018/4/1/24/245676




  Introduction Top


The goal of restorative dentistry and endodontics is to retain the natural teeth with maximal function and pleasing esthetics.[1] Comprehensive treatment plan is required before the start of endodontic treatment. When the decision is made to treat the teeth endodontically, consideration must be given to the placement of the subsequent restoration.[2] It is generally agreed that the successful treatment of a badly broken tooth with pulpal disease depends not only on endodontic therapy but also on good prosthetic reconstruction of the tooth following endodontic therapy.[3]

The rehabilitation of teeth with a history of trauma or extensive dental caries poses a challenge to the clinician. The presence of reduced circumferential dentin, immature root canals, loss of moisture, and coronal destruction from dental caries weaken the tooth structure, making it susceptible to fracture under normal masticatory forces.[4] Endodontically treated teeth (ETT) are more prone to fractures than the vital teeth.[5] It is a challenging clinical situation to restore excessively damaged tooth, especially when there is an inadequate coronal structure to provide retention and resistance for crown restoration.[6],[7] The broken teeth often require extra support from the root canal for the additional retention of the restoration.[8] Wherever remaining crown structure is insufficient to retain full-coverage crown, a post and core is necessary means to increase retention and resistance form of a tooth.[9],[10]

There are two main categories of post: custom-fabricated (indirect) and prefabricated (direct). The first system involves with the cast dowel and core that closely reproduces the morphology of the root canal space. In the second system, adhesive materials and techniques are used for the intraradicular cementation of prefabricated systems.


  Case Reports Top


Case 1

A 28-year-old female patient presented to the Department of Conservative Dentistry and Endodontics with a chief complaint of fractured maxillary central incisors caused by an accidental fall 1 month back. Thorough intraoral examination revealed Ellis Class III fracture with respect to both the central incisors. It was also observed that the teeth that were fractured were originally proclined and there was crowding with respect to lower anteriors. Root canal treatment of 11 and 21 was considered as the pulp was involved. Since an esthetic rehabilitation was important in this case, the treatment planning included the fabrication of post and core followed by porcelain-fused-to-metal crown.

As the teeth were proclined, to change the angulation of the central incisors for better esthetics, cast metallic post and core (indirect) was planned.

Teeth were prepared with a circumferential shoulder preparation including a 1.5–2-mm ferrule preparation. More tooth structure was reduced in the labial front than the palatal to correct the angulation of the teeth. Wax pattern for the post and core was made with inlay wax in the corrected angulation and was invested immediately after which the casting was carried out. Custom-made post and core unit was cemented with glass ionomer luting cement in the canal space of the maxillary anterior teeth 11 and 21 followed by the cementation of porcelain-fused-to-metal crown.

The treatment outcome fulfilled the patient's expectations concerning the esthetic appearance of the anterior teeth [Figure 1].
Figure 1: (a) Preoperative clinical photograph showing fractured 11 and 21. (b) Radiograph of root canal treated 11 and 21. (c) Crown cutting done with respect to 11 and 21. (d) Cast metallic post and core fabrication with respect to 11 and 21 and cementation of the same. (e) Postoperative radiograph after cementation of porcelain-fused-to-metal crown. (f) Postoperative clinical photograph showing complete rehabilitation

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Case 2

A 32-year-old male patient presented to the Department of Conservative Dentistry and Endodontics with a chief complaint of a fractured tooth in the upper front region and was concerned about the esthetics. The patient gave a history of accidental trauma 2 months back followed by root canal treatment of the maxillary right lateral incisor 1 month ago.

The patient was asymptomatic. On clinical examination, fractured maxillary right lateral incisor with less than two-thirds of the tooth structure remaining was observed. Radiographic examination revealed root canal treated 12 with good apical seal.

Since there was a loss of excessive coronal tooth structure of more than 75%, customized post and core followed by porcelain-fused-to-metal crown was planned.

In the same way as discussed in the above case, cast metal post and core was luted followed by cementation of porcelain-fused-to-metal crown [Figure 2].
Figure 2: (a) Preoperative clinical photograph showing fractured 12. (b) Preoperative radiograph showing root canal treated 12. (c) Post and core fabrication with respect to 12 and cementation of the same. (d) Postoperative radiograph after cementation of porcelain-fused-to-metal crown. (e) Postoperative clinical photograph showing complete rehabilitation

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  Discussion Top


The prognosis of ETT depends not only on the treatment but also on the placement of coronal restorations. One of the treatment options for endodontically treated fractured anterior tooth is to restore it with a custom-made cast post and core or prefabricated posts followed by full-coverage crowns. The customized cast post and core possess superior adaptation to the root canal, associated with little or no stress with installation, and high strength in comparison to the prefabricated post. One advantage of cast post and core is that the core is an integral part of the post and that the core does not depend on any mechanical means of retention on the post.[11] Prefabricated posts are popular because of their ease of placement, less chair-side time, lower cost, and the ability to restore a tooth for immediate crown preparation; they also rely principally on cement for retention.[12]

In the first clinical case, custom-made metallic post and core was planned as the fractured teeth were proclined and hence angulation and the design of the core of the cast post could be modified to produce a more convenient shape for the crown of the proclined teeth. This fulfilled patient's esthetic demand as well as functional rehabilitation.

In the second clinical case, custom-made metallic post and core was planned as there was a severe loss of coronal tooth structure, and this construction prevents the dislodgement of the core from the post and root when minimal tooth structure remains.

Two retrospective studies of ETT with extensive loss of tooth structure reported success rate of 89%–98.5% after at least 7 years, using cast post and core with single crowns as foundation restorations.[13],[14]


  Conclusion Top


In the above-described cases, it can be concluded and highlighted that the two main indications of customized cast post and core for ETT with excessive loss of tooth structure are in cases where the angulation of the teeth needs to be altered and second when there is a loss of >75% of coronal tooth structure, to enhance the strength and durability of the tooth and to achieve retention and esthetics of the restoration.

The treatment described in the above case reports is simple and effective and helps accomplish the patients' esthetic and functional requirement.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rosenstiel SF, Land MF, Fujimoto J. Contemporary Fixed Prosthodontics. 2nd ed. St. Louis: Mosby, 1997; p. 238.  Back to cited text no. 1
    
2.
Peroz I, Blankenstein F, Lange KP, Naumann M. Restoring endodontically treated teeth with posts and cores – A review. Quintessence Int 2005;36:737-46.  Back to cited text no. 2
    
3.
Franklin S. Weine Endodontic Therapy. 6th ed. St. Louis: Mosby; 2004. p. 553-61.  Back to cited text no. 3
    
4.
Silva GR, Santos-Filho PC, Simamoto-Júnior PC, Martins LR, Mota AS, Soares CJ, et al. Effect of post type and restorative techniques on the strain and fracture resistance of flared incisor roots. Braz Dent J 2011;22:230-7.  Back to cited text no. 4
    
5.
Tang W, Wu Y, Smales RJ. Identifying and reducing risks for potential fractures in endodontically treated teeth. J Endod 2010;36:609-17.  Back to cited text no. 5
    
6.
Saupe WA, Gluskin AH, Radke RA Jr. A comparative study of fracture resistance between morphologic dowel and cores and a resin-reinforced dowel system in the intraradicular restoration of structurally compromised roots. Quintessence Int 1996;27:483-91.  Back to cited text no. 6
    
7.
Pontius O, Nathanson D, Giordano R, Schilder H, Hutter JW. Survival rate and fracture strength of incisors restored with different post and core systems and endodontically treated incisors without coronoradicular reinforcement. J Endod 2002;28:710-5.  Back to cited text no. 7
    
8.
Chakravarthy Y, Chamarthy S. Richmond crown for restoration of badly mutilated posterior teeth: A case report. J Evid Based Med Health 2015;2:4500-7.  Back to cited text no. 8
    
9.
Bartlett SO. Construction of detached core crowns for pulpless teeth in only two sittings. J Am Dent Assoc 1968;77:843-5.  Back to cited text no. 9
    
10.
Assif D, Bitenski A, Pilo R, Oren E. Effect of post design on resistance to fracture of endodontically treated teeth with complete crowns. J Prosthet Dent 1993;69:36-40.  Back to cited text no. 10
    
11.
Cohen S, Hargreaves KM. Cohen's Pathways of the Pulp. 10th ed. Mosby Elsevier, St. Louis, Mo, USA, 2010. p. 785.  Back to cited text no. 11
    
12.
Goerig AC, Mueninghoff LA. Management of the endodontically treated tooth. Part II: Technique. J Prosthet Dent 1983;49:491-7.  Back to cited text no. 12
    
13.
Bergman B, Lundquist P, Sjögren U, Sundquist G. Restorative and endodontic results after treatment with cast posts and cores. J Prosthet Dent 1989;61:10-5.  Back to cited text no. 13
    
14.
Balkenhol M, Wöstmann B, Rein C, Ferger P. Survival time of cast post and cores: A 10-year retrospective study. J Dent 2007;35:50-8.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2]



 

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