Abstract Title

Endodontic Re-treatment, Fiber Post & Build-up, & Emax Crown

Lead Author Affiliation

DDS

Lead Author Status

DDS Year 3

Expected Graduation Date

2019

Presentation Category

Endo, Restorative (Direct/Indirect)

Introduction/Context/Diagnosis

A long-term patient of record presented to me with a tooth #7 that had prompted many conflicting opinions over the years. The patient's #7 had a questionable endodontic treatment causing mild symptoms of tingling and pressure around the area of the apex and a root canal that was short of the apex due to a distinct curvature in the apical few milimeters (not clearly visible radiographically as it curved in a lingual dimension as well as distal). The tooth also presented with a significant gingival defect at the mid-facial yielding a very un-aesthetic appearance as well as exposed dentin that was more susceptible to caries, likely due to a very apically placed rubber damn clamp during the previous endodontic treatment. Additionally, the tooth presented with a failing composite restoration retained with a metal pin, and after removal of the restorative material and all decay the remaining tooth structure was insufficient and the tooth required a post and core buildup.

Methods/Treatment Plan

I completed an endodontic re-treatment on #7 using chloroform to dissolve the existing gutta percha. I successfully instrumented past the apical curvature to clean the remaining portion of canal past the curve to the apex. After endodontic re-treatment I placed a fiber post and an AnchorCore buildup with the prelude bonding system before cementing a full coverage Emax crown that extended to the gingival defect to improve aesthetics and restore function.

Results/Outcome

The patient is very happy with the results of the restoration and says that her symptoms have now gone away. She says she also feels an improvement in general health and energy and believes that her body was fighting this subtle remaining infection for years. She is also glad that we opted for a longer clinical crown as opposed to layering pink porcelain as she has other teeth with comparable recession and we feel this has a more natural look that the pink porcelain would have had.

Significance/Conclusions

Sometimes a tooth may not have a significant radiograph periapical radiolucency but may still require treatment. The diagnosis of this phenomenon is further complicated when the tooth has been previously treated as there is no nerve conduction within the tooth to provide response to the various forms of temperature and electric testing. We also must be careful to instrument the canal fully as to not leave remaining bacteria, and must also be conscientious of clamp placement as to not cause gingival trauma. Furthermore we must thoroughly analyze the structural integrity of the remaining tooth structure so as to correctly identify when a tooth is in need of further stabilization of the buildup by way of a post.

Comments/Acknowledgements

Thank you to my endo faculty Dr. Fond for guiding me through instrumenting a curve!

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Endodontic Re-treatment, Fiber Post & Build-up, & Emax Crown

A long-term patient of record presented to me with a tooth #7 that had prompted many conflicting opinions over the years. The patient's #7 had a questionable endodontic treatment causing mild symptoms of tingling and pressure around the area of the apex and a root canal that was short of the apex due to a distinct curvature in the apical few milimeters (not clearly visible radiographically as it curved in a lingual dimension as well as distal). The tooth also presented with a significant gingival defect at the mid-facial yielding a very un-aesthetic appearance as well as exposed dentin that was more susceptible to caries, likely due to a very apically placed rubber damn clamp during the previous endodontic treatment. Additionally, the tooth presented with a failing composite restoration retained with a metal pin, and after removal of the restorative material and all decay the remaining tooth structure was insufficient and the tooth required a post and core buildup.