Custom made post & core used to correct malpositioned maxillary canine - A case report a1 2 3 Ashish Kumar Srivastava , Ujjal Chatterjee , Madhu Ranjan Abstract: Maxillary Canine plays a major role in the esthetic component of an individual. Loss of Canine not only compromises esthetics, but also limits the Prosthodontics option to replace this particular tooth. The presence of poor abutments mesial & distal to the Canine leaves us with the option to use Implants or Removable Partial Denture. However Maxillary Canine when malpositioned can be corrected even if the patient disagrees with Orthodontic treatment due to the time constrains & economic factors. Introduction: Malocclusion is a common problem in today's population. However the degree of severity varies from case to case. O r t h o d o n t i c - P r o s t h o d o n t i c s interrelationship is well documented. Certain factors will always indicate either of the two. The most common deciding factors among others are, the age of the patient, predictable time period for Orthodontic treatment, Loss of permanent tooth / teeth to make way for space. Custom post & core gives us the advantage to change the alignment of the long axis of the tooth & bring it to an acceptable position so as to give a pleasing e s t h e t i c a p p e a r a n c e &ma x i mu m preservation of natural tooth structure a Corresponding author: ashudent@yahoo.com 1 Reader, Department of Prosthodontics, Hazaribagh College of Dental Sciences & Hospital, Hazaribagh 2 Professor & H.O.D. Department of Prosthodontics, Hazaribagh College of Dental Sciences & Hospital, Hazaribagh 3 Reader, Department of Prosthodontics Hazaribagh College of Dental Sciences & Hospital, Hazaribagh Case report: A 20 year old male reported with chief complains of poor esthetics as one of the upper front teeth was discolored, out of shape and alignment. History revealed a prior treatment of cheek laceration in left anterior region due to malpositioned canine which was treated by excessive coronal tooth reduction (Fig.1). This led to the tooth being non-vital. The patient wanted to correct his appearance, but was reluctant to Orthodontic treatment due to time factor. Co-relation of radiographic & clinical examination suggested endodontic treatment of 23. Custom made post & core followed by metal ceramic crown was planned. After evaluation of endodontic treatment, the tooth was prepared for post and core. The coronal tooth structure was modified with rotary instruments (Fig.2). For post space preparation, entire length of the obturated canal was measured & the apical 4- 5 mm of gutta percha was left Journal of Research and Advancement in Dentistry Vol.1 No. 3, July- Oct 2012 134 intact. The canal was prepared in an elliptical shape so as to prevent rotation of the Post. This was done by using rotatory instruments, specific files, Pesso reamers, or gates glidden drills, approximately the size of no. 90 file. The coronal end of the canal is funneled. Remaining coronal tooth structure was prepared to produce ferrule effect. Direct technique was used for making the pattern of the post and core. After lubrication of post space with thin layer of petrolatum jelly, impression was made using prefabricated acrylic post by sprinkle method. After checking the fit & lack of undercut in the post, core was made by adding some more acrylic on the coronal portion, which was then modified to the level of alignment required for correction of the position of the canine (Fig.3). The acrylic pattern was invested in conventional way & the casting done. The procured cast of post & core (Fig.4) was finished, polished and then checked in the mouth for fit, alignment, and any discrepancy. It was then cemented using type I glass ionomer cement. Using high speed rotary hand piece, the core was prepared for further alignment & smoothening (Fig.5). An elastomeric impression was made of the prepared tooth. Acrylic temporary crown was placed. Metal trial on subsequent visit was done & shade selected. The fabricated Metal ceramic crown was cemented using luting Glass Ionomer Cement (Fig.6). Discussion: Prior to treatment an evaluation of endodontic status, periodontal status, 1,2,3 restorability of the tooth must be made. The reinforcement of tooth is essential when selecting a post and core technique. The procedure should not weaken the tooth or risk of the loss of the endodontic seal. Excessive canal enlargement or apical extension that leaves less than 4-5 mm of 4,5 apical gutta percha should be avoided. The cast post and core maintains the integrity of the tooth with a cervical collar exhibiting the 4,6,7,8,9 ferrule effect. The preparation of the tooth should extend 2 mm beyond the cervical margin of the post and core. In direct technique to develop the pattern of the canal acrylic, plastic, tooth pick, nails, paper clips and so on have been reported. Careful consideration of occlusion and load transfer 4,6,7,10,11,12,13 has to be planned. A cast post and core may be indicated when a tooth is misaligned and the core must be angled in relation to the post to achieve proper alignment with the adjacent teeth. Perhaps the biggest disadvantage for cast post and cores is in areas that require an esthetic temporary restoration. Satisfactory result obtained both functionally & esthetically bought to forefront the benefits of cast post & core. It is a prolonged method Journal of Research and Advancement in Dentistry Vol.1 No. 3, July- Oct 2012 135 Fig 1 Nonvital malpositioned 23 with excessive coronal tooth structure loss Fig 2 Gross Reduction of remaining coronal tooth structure & root canal preparation for post impression. Fig 3 Acrylic post & core placed in prepared root canal for final check of alignment Fig 4 Post & core obtained after casting Fig 5 Cast post & core cemented into prepared root canal Fig 6 Final restoration of Porcelain Fused to Metal crown fixed on Canine. Journal of Research and Advancement in Dentistry Vol.1 No. 3, July- Oct 2012 136 including additional laboratory & clinical 4,8,12,13 steps. Conclusion: Conventional custom post & core technique still is advantageous against newer materials in case of altering the alignment of tooth. Its disadvantages are high level of precision & occurrences of casting failure. Rigidity of metal & non parallel alignment to long axis of tooth can lead to fracture provided meticulous steps are taken to prevent occurrences of traumatic forces. References: 1. Rosensteil S.F., Land M. F.,Fujimoto J. rd Contempory Fixed Prosthodontics 4 edition ch-12 pg 336. 2. Malone W.F.P., Koth D.L., Cavozos E. Jr., Kaiser D.A. & Morgano S.M. Tylman's Theory and Practice of Fixed th n Prosthodontics. 8 ed pg no 407. th 3. Cohen. Pathways of the pulp 8 edition; pg 765-793. 4. Richard S. Schwartz and James W. Robbi ns . Pos t Pl acement and Restoration of Endodontically Treated Teeth: A Literature Review. Journal of endodontics: vol. 30, no. 5, May 2004; pg no 289-301. 5. Marwan Abou-Rass. The restoration of endodontically treated teeth: New answers to an old problem. AO vol. 75, fall 1982; pg no. 68-97. 6. Linards Grieznis, Peteris Apse, Una Soboleva. The effect of 2 different diameter cast posts on tooth root fracture resistance in vitro. Stomatologija, Baltic Dental and Maxillofacial Journal, 8:30- 2, 2006. 7. Markus Balkenhol a, Bernd Wostmann a, Christian Rein b, Paul Ferger. Survival time of cast post and cores: A 10 year retrospective study. Journal of dentistry 35 (2007) 5058. 8. Guido Heydecke, Mathilde C. Peters. The restoration of endodontically treated, single rooted teeth with cast or direct posts and cores: A systemic review. J Prosthet Dent 2002; 87:380-6. 9. N. R. Stankiewicz & P. R.Wilson. The ferrule effect: A literature review. International Endodontic Journal, 35, 575^581, 2002. 10. EV Bass. Cast post and core foundation for the badly broken down molar tooth. Australian Dental Journal 2002; 47 :( 1):57-62. 11. Oliver Pontius, Dr med dent, MSD, and Jeffrey W. Hutter. Survival rate and fracture strength of incisors restored with different post and core systems and endodontically treated incisors without coronoradicular reinforcement. Journal of endodontics Vol. 28, no. 10, October 2002; 710-15. 12. Ingrid Peroz, Felix Blekenstein, Klaus- Peter Lang, Michel Newman. Restoring endodontically treated teeth with posts and cores- A review. Quintessence Int 2005; 36; 737-46. 13. Pia K. Wegner, Sandra Freitag, and Matthias Kern. Survival rate of endodontically treated teeth with posts after prosthetic restoration. J Endod 2006; 32, 928-31.
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