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Int Poster J Dent Oral Med 12 (2010), No. 3     15. Sep. 2010

Int Poster J Dent Oral Med 2010, Vol 12 No 3, Poster 498

Strengthening of fractured devitalized teeth by casted core

Language: English
 

Authors:
Assoc. Prof Dr Srdjan D. Postic,
University of Belgrade, Faculty of Stomatology, Clinic of Dental Prosthetic, Belgrade, Serbia

Date/Event/Venue:
October 1st-3rd, 2009
33rd Annual Congress of European Prosthodontic Association
Innsbruck, Austria
 

Introduction

Essential suggestion of fixed prosthodontic is positioning of casted posts and cores, or dowels, owing to strengthening of devitalized tooth's root (1, 2). Along these lines, fortified roots should be successfully loaded by crowns and bridges (1-4).
 

Objectives

Objective of this study was to present success of strengthening of infrabony fractured roots of devitalized teeth by particularly designed metal cores.
 

Material and Methods

3 patients (2 men and 1 women, aged 31 to 47 yrs.) having devitalized fractured teeth with infrabony lack of a part of root-dentin substance were selected for fabrication of fixed restoration (Fig 1-3). ¾ of root filling were removed in root canal preparations (Fig 4). Mock-up of cores was formed directly in the mouths using self-curing resin (Palavit G, Kultzer, Germany) (Fig 5-8). Bounding surface and borders were prepared in resin material as a shoulder surface of core in supragingival i.e. subgingival areas of dentin-root defects, using retraction cord (Ultrapack #1 and #2, U.S.A.) (Fig. 5), but as the form of chamfer respecting remained coronal surface of devitalized teeth. After casting, 4 cores made of precious alloys (Golden alloy type III, Zlatara Majdanpek; M-Palador cast, Galenika, Serbia) (Fig 9-13) were decidedly polished and cemented, using normal-set zinc-phosphate cement (Cegal-N, Galenika, Serbia) (Fig 14 ). Temporary crowns were not positioned onto cemented cores and these teeth (Fig 15). After finishing of bounding surface (Fine diamond burs NTI-Kahla rotary dental instruments, Germany) (Fig 15-18), dental arches were impressed (Oranwash L, Zhermack) (Fig 19). Metal-ceramic fixed restorations (Vita, Europe) were fabricated and positioned.

Fig 1: Panoramic radiograph of the patient at the beginning of prosthetic treatment Fig 2: Lack of mesial tooth substance towards subgingival area
Fig 3: Defect after tooth fracturing Fig 4: Schematic drawing of cast post and core in tooth with fractured surface of root and crown
Fig 5: Retraction cord in gingival sulcus and area of supragingival defect Fig 6: A form of custom made post and core using self-curing resin (Palavit-G, Kultzer, Germany)
Fig 7: Acrylic form of core substituting previous lack of tooth substance Fig 8: Acrylic core was modeling and formed directly in the mouth, respecting occlusal surfaces of teeth of the patient and providing adequate interocclusal distances with relation to antagonists
Fig 9: Custom made golden cast post and core with flat surface of shoulder towards subgingival (supragingival) defect Fig 10: Cast post and core fabricated using silver-palladium alloy-proximal view of cast form with shoulder in metal surface.
Fig 11: Cast post and core (dowel) for anterior fractured tooth. Fig 12: Cast post and core for reinforcement of fractured tooth - frontal view
Fig 13: Cast post and core to reinforce fractured tooth - oral aspect Fig 14: Position of cast core (cast post and core i.e. dowel) on fractured tooth in the mouth of a patient.
Fig 15: There were predisposition to fracturing of abraded teeth- frontal view of cores in the mouth of a patient. Fig 16: Gold post and core cemented-occlusal view of core in the mouth
Fig 17: Cemented silver-palladium post and core - occlusal view of core in the mouth Fig 18: Metal was cementing in the mouth of a patient, using zinc phosphate cement.
 
Fig 19: Impressing of dental arch and core using light body silicone in custom tray
 
 

Results

Restored teeth with surrounding tissues showed favorable appearance of gingival margins, and functional stability in static occlusion, dynamic occlusion and mastication. There were not bleeding during probing or dispositions of fixed restorations to horizontal functional loading (Fig 20-27). There was not pain at recalls in 1, 2 and 5 years (Fig 28 and 29).

Fig 20: Metal coping for fabrication of the metal-ceramic crown Fig 21: The position of coping on core in the mouth of a patient
Fig 22: Probing Fig 23: Probing circumferentially towards finishing line
Fig 24: Metal-ceramic crown for single tooth\'s restoration after fracturing Fig 25: Check of occlusion in static position of dental arches of jaws, after checking of the position of metal-ceramic crown
Fig 26: Tripod contacts established after checking of occlusion in the articulator and in the mouth of the patient-glazed metal ceramic crown on master cast prior to cementation in the mouth Fig 27: Cementation of metal - ceramic crown on cast core in a mouth in the position of centric occlusion
Fig 28: Metal ceramic crown cemented on the cast core in the mouth-checking of occlusion at recall Fig 29: Two fractured upper teeth restored with esthetic (one ceramic and a one metal-ceramic) crowns
 

Conclusions

Particular studies were illustrating methods of preservation of fractured teeth (1-3, 5-16).
A number of distinct individual clinical cases of restorating of clinical crowns after teeth fracturing, applying rationalized technique of positioning of prefabricated posts with composite restoration in a single visit (the one and same time visit), were reported in the literature (5, 13, 15-35).However, it could be categorically claimed that reliable treatment and restoration of more or less deeply fractured teeth (tooth roots) should have been fabricating and positioning of custom made cast core i.e. alloyed post and core unit. On the basis of experience in dental practice, as well on the basis of certain reports in dental literature, it has been shown, up to now, that the best option for restoration of fractured tooth should have been cast post and core unit or cast dowel fabricated using precious alloy (gold), or semi-precious alloy (silver -palladium), optionally (36, 37). Post and core unit should have been high polished. Precious dental alloy (gold) exposes sufficient hardness and resistance to stress and load on fractured tooth. Moreover, precious alloy absolutely would not cause any inflammation or other complications to adjacent periodontal tissue and soft tissues, as well as gingiva around fractured tooth.
Post component must be extended in a sufficient amount, removing adequate quantity of root's filling (1, 38, 39).
If cast post and core unit could be a part of definite treatment and work out of restoration of fractured tooth, preparation of a part of the cervical margin should have been supplied directly on (or within) the metal surface. Cervical margin of cast post and core (dowel) could be prepared as a flat (shoulder) cervical margin, groove or chamfer marginal surface (Fig 8, Fig 9, Fig 12, Fig 13, Fig 16-18). Because of that, it should be necessary that shapes of core build-ups should have been planned so if there would be enough space available, after casting, in purpose of providing extended and/or flat preparation of cervical margin, but preparation of axial surface of core too. It seems that shoulder's flat form should have provided the best marginal fit of a single crown, as well as retention, stability and optimal stress distribution through core towards apex of root. Continuum of cervical margin of cast post and core (dowel) and cervical margin of a rest of natural tooth substance should be also provided.
Additionally, slope, bevel and contra-bevel of bounding surface towards cervical margin of fractured and damaged teeth could be considered in custom made post and core element (2). For the both of gold-precious and silver-palladium-semiprecious casts, it looks as if bevel could be helpful in providing of fitting and retention of a single crown in restorating of fractured tooth.
Cast post and core piece absolutely must reinforce fractured tooth prior to positioning of metal-ceramic crown or any aesthetic crown (1, 3, 40, 41).
Conclusion
On the basis of the results of the present study it is concluded that ultimate providing of shoulder in subgingival area of metal core surface, decided core polishing and good quality of alveolar bone withstand fractured root and core completing the capability of functional loading and rehabilitation by fixed restoration.
 

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This Poster was submitted by Assoc. Prof Srdjan D. Postic, PhD, MSc.
 

Correspondence address:
Assist. Prof. Dr. Srdjan Postic
University of Belgrade
Faculty of Stomatology, Clinic of Dental Prosthetic
Ranekova 4
11000 Belgrade, Serbia