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JCD

10.5005/jp-journals-10031-1148
Masking Conventional Metallic Cast Post
Case Report

Masking Conventional Metallic Cast Post
for Enhancing Esthetics
1
Naisargi P Shah, 2Amit Mahadeo Gaikwad, 3Sabita M Ram, 4Jyoti B Nadgere

ABSTRACT The zirconia post and core may be used for their
Loss of tooth structure occurs due to caries, endodontic esthetic outcome but are more expensive and difficult
treatment, or fracture caused by trauma; restoring these teeth to fabricate.4 A metal post and core is used routinely
is difficult task for a clinician. Post and core is an option for in practice; however, its esthetic outcome when placed
teeth when excessive tooth structure is lost and teeth need under all ceramic restorations is not acceptable due to the
to be restored with crown and bridge procedure. They can
be prefabricated post with composite built up or a one-piece grayish hue imparted to the final restoration. The labial
custom-made post. The custom-made cast metal post and core surface of the metal core can be masked with ceramic
have disadvantage due to their color that imparts grayish hue layer after the casting of cast post and core. This will
to overlying ceramic restorations. Masking the metal core can enhance the outcome of the final all ceramic restorations
enhance the esthetic of all ceramic restorations that are placed
and give a successful esthetic result.
over the cast post and core. A case report is being presented
where the metallic core was masked with ceramic built up on A case wherein anterior fracture teeth were restored
labial surface of metal core. with a masked metal core and all ceramic crown and
Keywords: All ceramic restorations, Lithium disilicate, Metal bridge is presented in this article.
cast post, Post and core.
How to cite this article: Shah NP, Gaikwad AM, Ram SM, CASE REPORT
Nadgere JB. Masking Conventional Metallic Cast Post for A 28-year-old male patient reported to the Department
Enhancing Esthetics. J Contemp Dent 2016;6(1):85-89.
of Prosthodontics with the chief complaint of dislodged
Source of support: Nil anterior crowns, swelling, and pain in upper anterior
Conflict of interest: None region. He desire relief of pain and improvement of
esthetic. Past dental history revealed that the patient
INTRODUCTION had undergone root canal treatment with 11, 12, and 21;
Post and core are regarded as the foundation restoration periapical surgery was done with 11 and 12 and restored
for mutilated dentition.1 Post is required for retention with porcelain fused to metal crowns. The crowns along
of core and reinforcement of tooth structure. For post with the prepared teeth were dislodged. Family, medical,
and core to be successful, a ferrule of 2 mm is man- and personal history was not relevant.
datory; this can be achieved by preservation of remaining Extraoral examination showed that the patient had
tooth structure, crown lengthening, or orthodontic square facial form and flat facial profile due to loss of
extrusion.2 anterior teeth. The lip length was average. On smiling, a
The post and core can be prefabricated post with space of anterior missing teeth was visible (Fig. 1).
composite built-up core or a one-piece custom-made post
and core that can be in metal or zirconia material.3 The
custom-made post and core are indicated in situations
wherein gross tooth structure is lost, teeth having
wide canals, anterior deep bite, and where a change
in angulation is required for enhancing esthetic by
repositioning of restoration in the arch.3

1,3,4
Professor, 2Postgraduate Student (3rd Year)
1-4
Department of Prosthodontics, Crown and Bridge, MGM
Dental College and Hospital, Navi Mumbai, Maharashtra, India
Corresponding Author: Naisargi P Shah, Professor
Department of Prosthodontics, Crown and Bridge, MGM Dental
College and Hospital, Navi Mumbai, Maharashtra, India, Phone:
+91 9819238483, e-mail: drnaisargi69@gmail.com
Fig. 1: Extraoral

Journal of Contemporary Dentistry, January-April 2016;6(1):85-89 85

2: Intraoral Fig. and prosthetic rehabilitation. as adequate tooth structure was not available for restoration and tooth preparation would have led to exposure of pulp as the pulp horn was large. which was already fabricated. removed to achieve space for masking material and Preoperative radiograph showed incomplete obturation with 11 and 21 and large periapical lesion with 11. Provisional area with 12 showed loss of vertical height that would restoration. A to achieve the desired ferrule. Wax patterns were fabricated with casting wax. 3). therefore. of the cast post (Fig. The connective 11 and pain on percussion was positive with 11 and 21.6 Tooth preparation was done on the study model and putty index was prepared. management. 6). The patient had of the deformity in order to correct buccolingual ridge poor oral hygiene along with gingival inflammation in defect. The edentulous out with 11 and 21 to achieve adequate ferrule. A diagnostic mock-up was done tooth and shade was noted. modified Abrahams technique was followed to overcome the ridge defect and to achieve the desired emergence profile. root canal treatment was repeated with 11 and 21 and periapical surgery was carried out with 11. Study models were made from diagnostic impression as he had high esthetic demand. An all-ceramic restoration was planned for the patient. Fracture palatal flap was dissected and a pedicle was displaced with 11 and 21 was till gingival level. 3: Provisional restoration with ovate pontic design placed after surgery Intraoral examination showed missing 12.5 Crown lengthening was simultaneously carried relation to upper anterior region (Fig. periodontic cast and intraoral trail of cast post was done (Fig. 46. and 47. Metal on the labial surface was Scaling and polishing was done for both the arches. immediately after the surgery. Shade selection was and analyzed for determining treatment plan for anterior done using spectrophotometer by placing it on adjacent all-ceramic restoration. A multidisciplinary treatment was planned for the casted. Provisional restoration with ovate pontic design was made with the help of putty index. 2).Naisargi P Shah et al Fig. lesion with 11. Ridge defect was observed in relation with 12 that would have affected final esthetic outcome. and finished. 7). 4: Acrylic post into the canal 86 . Their fit was checked on the master patient that involved endodontic treatment.3 A custom-made resin the putty index and Protemp for diagnostic planning of post was fabricated to fit the canal two-third its length final restoration and approval of patient was taken on and picked up in an irreversible hydrocolloid impression esthetic outcome of the provisional restoration prior to material (Figs 4 and 5). Following Radiograph was taken to determine the length and fit treatment was carried for the patient. So. planning the other procedure. was cemented make it difficult to place an esthetic pontic. Intraoral sinus with toward the buccal aspect of the ridge.5 In this method. tissue was then rolled below the buccal flap in the area Caries was seen with 26. Indirect technique was mock-up trail was done directly into patient mouth using followed for cast postfabrication. Patient was on provisional Intraoral periapical radiographic examination showed restoration for 6 months for the development of pontic incomplete obturation with 11 and 21 and large periapical site (Fig. 36. 37. a de-epithelialized Fig. Intentional root canal treatment was carried out with 13.

5% of orthophos- by pressed technique using lithium disilicate ingots. and dentin (Fig. It showed white frosted appearance Journal of Contemporary Dentistry. 7: Rvg before cementation of cast post sandblasted with aluminum oxide powder to achieve rough surface. The wax pattern planned for the was carried out and was ready for cementation. 6: Intraoral trial of cast post Fig. 11). 8: Cast post and core after sandblasting Fig. JCD Masking Conventional Metallic Cast Post Fig. lithium disilicate restoration replicated the provisional For cementation procedure. 5: Impression for cast post fabrication Fig. esthetic. Simultaneously. Final crown and bridge was fabricated ing tooth structure was etched with 37. etching of ceramic was restoration in its form specially the pontic that was carried out with 10% hydrofluoric acid for 15 seconds an ovate pontic contoured well to fit the developed (Fig. The final glazing of the restoration crown and bridge. intraorally canine and remain- edentulous site. 10).7 Final impression was made with Fig. It did not as it was rough. occlusion of the crown and bridge restoration.6(1):85-89 87 . 9: Cast post and core after application of ceramic opaquer addition silicone in two stages and cast was poured in Type IV gypsum for the fabrication of lithium disilicate masked metal core. Metal core of cast post was not etched. Etched surface was thoroughly washed reveal the underlying unesthetic metal because of the with water and dried. Ceramic opaquer was fired on it to mask the color of the metal (Figs 8 and 9). as the preparation was in bisque trail was done to determine the fit. January-April 2016. The phoric acid for 15 seconds. Cementation of cast post was done with zinc phosphate cement.

12).Naisargi P Shah et al of both tooth and ceramic. Final crown and bridge cementation 24 hours. 12: Light curing of dual-cure resin cement Fig. and 3 months. 13: Postoperative intraoral Fig. 1 week. 14: Preoperative extraoral Fig. 1 month. 11: Etching of tooth with orthophosphoric acid Fig. simultaneously. 10: Silane application Fig. 15: Postoperative extraoral 88 . bonding agent was applied 200 (Fig. It was light treatment (Figs 13 to 15). Patients recall was done after cured for 10 seconds. Silane application was done was done with dual cure resin cement using Rely X U on ceramic. Patient was happy and satisfied with the on canine and remaining tooth structure. Fig.

whereas in case of 10. several approaches 4. Galhano GA.9 However. Prefabricated post-and-core systems: bricated post and composite core built up. Concepts of design for contemporary anterior ceramic. Samet N. papillae. Use of a modified ovate pontic in area defects: a report Metal core can be masked either with composite or of two cases. Pavanelli CA. post was not selected. Bottino MA. The different cements.16(5):273-283. Fracture resistance of teeth metal restoration.3 In this case. Thus. as it is difficult to fabricate and 19(10):1013-1020.1(3):205-213. The the desired esthetic output.4(1):10-14. Dental colour matching instruments and system— All ceramic restorations are trending in recent review of clinical and research aspects. Rethinking ferrule—a new approach emerge from gingiva. for adherence of it to metal core. expensive. masked metal cast post was suggested as the treat- ment option for 11 and 21. was used.22(3):264-269.6(1):85-89 89 . at least 2 mm of ferrule is essential. January-April 2016. Libera SD.209(1):25-33. JSM Dent 2014.5 Immediate provisional lous ridge for fixed prosthesis. Smith CT. Compend Contin Educ Gen restoration with ovate pontic design helped in developing Dent 1980 May-Jun. Augmentation of the deformed residual edentu- more conservative procedure. J Ahmedabad Dent Coll Hosp 2013.10 Composite requires specialized metal primer all ceramic restorations. metal core needs to be sandblasted to create Masking the metal color of cast post and core restoration by a rough surface. 8. the demand for all-ceramic restoration is increas- the remaining tooth structure of both central incisors ing. and many others. Adhesive cementation of zirconia the techniques.3 2. support soft tissue and adjacent to an old dilemma. the pontic site. 1. 9. Melo RM. a little the amount of remaining tooth structure. as the amount of remaining REFERENCES tooth structure was inadequate to restore with prefa. as blood supply is maintained and it is a 5. Kazakova R. as it has better esthetic advantage over porcelain 7. Patel SS. Restoration options with post and core: review article. Liu CL. Schuman N. Thus. Jotkowitz A. an ideal pontic should 3. Mezzomo E. J Cosm Dent 2013.2(2):1024. For post and core restora- tion. J Esthet Restor Dent 2004. position modification gives better results and helps in achieving of teeth.38 (Suppl 2): e2-e16. so crown affect the esthetic value of all-ceramic restoration. J Dent 2010. Abraham technique of palatal flap posts to root dentin: evaluation of the mechanical cycling effect. To achieve maximum esthetic. Zirconia an overview. This lengthening was carried out in 11 and 21 to achieve article presented a technique to mask the metallic hue desire ferrule. Post and core restoration are boon CONCLUSION for managing such teeth. Among all Valandro LF. dentistry. Quintessence Int 2003 Apr:34(4):301-306. JCD Masking Conventional Metallic Cast Post DISCUSSION masking the all-ceramic restoration that enhanced the esthetic of final restoration. Gross destruction of teeth poses a restorative challenge for the clinician. Massa F. Kissov. namely giving a life-like appearance to restoration. of cast post to restore teeth with all-ceramic restoration Selection of post depends on several factors. Baldissara P. metal core needed to be mask to enhance the esthetic. a ceramic opaque was used for metal ceramic caps: a clinical report. occlusion of patient. using such restoration over restored with cast post and core designs cemented with two the metal core gives grayish hue to final restoration. But such restorations are difficult to use in cases was inadequate for post and core restoration. Vlahova A. To manage ridge defect. Shah DN. Today. Braz Oral Res 2008 Jul-Sep. wherein there is underlying metallic structure that will dontic extrusion require long time period. Chu SJ. Journal of Contemporary Dentistry. Raigrodski A. Ortho. Scotti R. Popova and Todorov G. of pontic site development are available.8 6.28:46-58. ceramic. Compend Contin Educ Dent 1998 Oct. Br Dent J 2010 Jul 10. Abrams L.