DENTAL TECHNOLOGY Kenneth D.

Rudd

Direct core buildup using a preformed crown and prefabricated

zirconium oxide post
M. Zalkind, DMD,a and N. Hochman, DMDb
Hadassah School of Dental Medicine, Hebrew University, Jerusalem, Israel
This article describes a procedure that can produce a post and core in a reasonable chair time during
a single session. With a preformed crown for core buildup, and being relatively rapid, this is a fairly
simple procedure that has good results. (J Prosthet Dent 1998;80:730-2.)

E ndodontic therapy allows patients to retain severe-

ly damaged teeth. The restoration of endodontically
treated teeth involves complex procedures. Numerous
post systems and techniques have been described.
Coronoradicular stabilization techniques include cus-
tom-made metal posts and cores or commercially pre-
fabricated intraradicular posts that retain core recon-
structions consisting of silver amalgam, composite,
glass ionomer cement, or modified glass ionomer
cement.1
Nonmetallic posts in combination with all-ceramic
crowns are esthetically preferable for the restoration of
endodontically treated anterior teeth with fractured or
discolored coronal aspects. A prefabricated all-ceramic
post with good mechanical and biocompatible proper- Fig. 1. Coronal portion of tooth prepared for receiving post
and core.
ties, in combination with novel adhesive technology,
will allow direct bonding of the post to the root and
core buildup with composite. Composites offer several
advantages and have therefore become popular for core
reconstruction. These advantages include strength,
bonding capability, ease of manipulation, and rapid set-
ting time, as compared with silver amalgams.2,3 This
allows the dentist to complete a bonded composite
core preparation immediately after placement of a pre-
fabricated post.4
PROCEDURE
1. Prepare the coronal part of the tooth (Fig. 1).
2. Remove gutta-percha to the desired length of the
root canal with a hot instrument.
3. Prepare the root canal with specific cylindrical burs
in accordance with the manufacturer’s instruc- Fig. 2. Zirconium oxide post fitted, seated, and cemented in
tions. place.
4. Select an appropriately sized zirconium oxide (Bio-
post-Incermed, SA, Lausanar, Switzerland) or
other type of prefabricated post. 6. Select a preformed polycarbonate crown closely
5. After roughening and sandblasting the surface of adapted to the prepared tooth.
the zirconium oxide post, cement it with Bond-it 7. After lubrication with petroleum jelly, fill the poly-
material (Jeneric Pentron Inc, Wallingford, Conn.) carbonate crown with Build-it composite (Jeneric
(Fig. 2). Pentron Inc, Wallingford, Conn.) and place it on
the cemented post (Fig. 3).
aSenior Lecturer, Department of Prosthodontics. 8. After polymerization, cut a vertical groove and
bAssociate Professor, Department of Prosthodontics. then remove the preformed crown (Figs. 4 and 5).

730 THE JOURNAL OF PROSTHETIC DENTISTRY VOLUME 80 NUMBER 6

ZALKIND AND HOCHMAN
Fig. 3. Preformed polycarbonate crown filled with compos-
ite tightly placed on cemented post.
Fig. 4. Vertical groove cut in preformed polycarbonate
crown.
9. Prepare the core to receive the appropriate crown
(Fig. 6).
DISCUSSION
Prosthetic restoration of nonvital anterior teeth
often requires making a post and core to support a
crown and restore the remaining tooth structure. Many
techniques are available for post and core reconstruc-
tion.3,5-7 A composite resin core and a prefabricated all-
ceramic post seem to be the esthetic treatment of
choice for anterior teeth when they are to be restored
with an all-ceramic restoration. The core is tooth-col-
ored and the post does not show through.4,8 The short
setting time of composites and glass ionomer renders
them suitable as core build-up materials, and their
advantages and disadvantages have been documented.9
The bond between the zirconium oxide post and the
composite material (Bond-it) was achieved mechanical-
ly by roughening and sandblasting the surface of the
DECEMBER 1998
THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 5. Core immediately after removal of preformed crown.
Fig. 6. Preparation of core and tooth to receive appropriate
crown.
zirconium oxide post, thereby increasing the retention
of the luted components. The use of a preformed
crown for core buildup is a simple 1-stage procedure,
which allows almost immediate preparation of the final
crown. Thus, the procedure is less expensive and less
time-consuming than conventional procedures, and
results in good esthetics.
Building the core free-hand would be more difficult.
By using a preformed crown, the composite can be
compacted, which leaves no voids in the material. The
new bonding systems enhance the usefulness of the
composite.10,11 This technique of post-and-core recon-
struction is best used in combination with all-ceramic
crowns to take full advantage of the proper illumination
of the tissues.4 All types of posts should be of an ade-
quate length and strength and should fit well into the
canal. Therefore, with direct systems, precision drilling
and matching of the post can be carried out.3 Howev-
er, the use of a cast post and core is sometimes neces-
731
THE JOURNAL OF PROSTHETIC DENTISTRY ZALKIND AND HOCHMAN

sary. Metal posts and cores are the most commonly
used, but the metallic gray poses an esthetic problem in
anterior all-ceramic restorations.3,12
REFERENCES
1. Morgano SM, Hashem AF, Fotoohi K, Rose L. A nationwide survey of con-
temporary philosophies and techniques of restoring endodontically treat-
ed teeth. J Prosthet Dent 1994;72:259-6.
2. Cohen BI, Pagnillo MK, Condos S, Dentsch AS. Four different core mate-
rials measured for fracture strength combination with five different
designs of endodontic posts. J Prosthet Dent 1996;76:487-95.
3. Hunt PR, Gogarnoiu D. Evaluation of post and core systems. J Esthet Dent
1996;8:74-83.
4. Meyeberg KH, Luthy H, Scharer P. Zirconium posts. A new all-ceramic
concept for nonvital abutment teeth. J Esthet Dent 1995;7:73-80.
5. Assif D, Gorfil C. Biomechanical considerations in restoring endodonti-
cally treated teeth. J Prosthet Dent 1994;75:565-7.
6. Morgano SM. Restoration of pulpless teeth: application of traditional prin-
ciples in present and future contexts. J Prosthet Dent 1996;75:375-80.
7. Shillingburg HT Jr, Kessler JC. Restoration of the endodontically treated
tooth. Chicago: Quintessence Publishing; 1982. p. 13-73.
8. Zalkind M, Hochman N. Esthetic considerations in restoring endodonti-
cally treated teeth with posts and cores. J Prosthet Dent 1998;79:702-5.
9. Levartovsky S, Goldstein GR, Georgescu M. Shear bond strength of sev-
eral new core materials. J Prosthet Dent 1996;75:154-8.
10. Hinoura K, Miyazaki M, Onose H. Dentin bond strength of light-cured
glass ionomer cements. J Dent Res 1991;70:1542-4.
11. Waknine S, Gable P, Pernugondo B, Schulman A. Bond strength charac-
terization of an experimental series of dentin adhesives. J Biomater Dent
1990;5:25-38.
12. Morgano SM, Milor P. Clinical success of cast metal posts and cores. J
Prosthet Dent 1993;70:11-6.
Reprint requests to:
DR M. ZALKIND
DEPARTMENT OF PROSTHODONTICS
HEBREW UNIVERSITY–HADASSAH MEDICAL SCHOOL
PO BOX 12272
91120 JERUSALEM
ISRAEL
Copyright © 1998 by The Editorial Council of The Journal of Prosthetic
Dentistry.
0022-3913/98/$5.00 + 0. 10/1/94012

Early and intermediate time response of the dental pulp to

Noteworthy Abstracts an acid etch technique in vivo.
of the Gwinnett AJ, Tay FR. Am J Dent 1998;11:534-45.
Current Literature

Purpose. This special issue dealt with pulpal response to restorative techniques. This article pre-
sented the ultrastructural features of pulpal responses after the application of All-Bond 2 to acid-
conditioned, deep, unexposed coronal dentin and exposed pulps in human teeth.
Material and methods. Cylindrical class V cavities approximately 4 mm in diameter were pre-
pared on the buccal surface of 25 noncarious human premolars. The population was divided into
a group where the preparation was approximately 0.5 mm from the pulp and the other with inten-
tional pulp exposures. All teeth were etched with 10% phosphoric acid for 20 seconds, followed
by rinsing for 20 seconds and left moist. Five coats of All-Bond primer was applied to the cavity
preparation and light cured. Dentin-enamel bonding resin was applied and then preparations were
light cured. Restorations were then completed by incremental placement of a hybrid composite.
Specimens were divided into 3 categories according to the time of extraction (0-7, 28-35, and
>90 days) and further into whether they were initially exposed. Sections were then evaluated his-
tologically by light microscopy and transmission electron microscopy.
Results. A characteristic connective tissue response to injury was noticed in a majority of speci-
mens. Irreversible injury to the odontoblasts nearest to the site of the cavity preparations result-
ed in the death of these cells. That process was followed by an early neutrophilic response, a sub-
sequent macrophage response, and a fibroblastic response that led to the deposition of reparative
dentin or formation of a calcific bridge by odontoblast-like cells. Another consistent observation
was that of resin particulates within the dentin-pulp complex. At times the presence of these resin
particulates triggered a foreign body response, characterized by the presence of a mononuclear
inflammatory infiltrate and the appearance of multinuclear giant cells. Persistence of unresolved
chronic inflammation was associated with the lack of calcific bridge formation in these specimens.
Conclusions. Although direct resin pulp capping can be a successful clinical procedure, a suba-
cute, foreign body response can occur in the presence of resin particulates that were introduced
into the pulp after a total etch technique. 76 References. —ME RAZZOOG

732 VOLUME 80 NUMBER 6