Alternative conservative approach for tooth build-up in patients with special healthcare needs

Purpose: The success of an artificial crown mainly depends on the biomechanical factors such as bonding capacity of cement between the crown and abutment tooth, and root strength of the abutment tooth. In this case series, we aim to provide insight on the potential use of the cast metal post and cost for patients with intellectual disabilities and severely compromised tooth structure. Material and methods: The first patient was a 41-year old male with the chief complaint of a dislodged porcelain fused metal (PFM) crown of tooth #20 (mandibular left second bicuspid). The patient was informed about the advantages, disadvantages, and risks of each option. After further consideration and discussion with the parents and the patient, we decided to rebuild the coronal tooth structure with the cast metal post and core and prosthetic restoration with the same crown. Patient satisfaction was measured on the visual analog scale as 10/10. The second case involves a 26-year old female, who presented with a chief complaint of chronic lingering pain on tooth #9. The tooth structure was extensively damaged and un-supportive of the ferrule, therefore, it was decided to build a metal post and core instead of a fiber post. The prosthetic restoration was made with a monolithic zirconia crown and the patient was followed up twice in 6 months and graded the satisfaction as 10/10 on a visual analog scale. Results: The most common type of posts used in dentistry has been cast post and cores in the last decade which generally includes an additional laboratory stage where a custom post is prepared according to the impression taken from the prepared post space. Conclusions: Both the presented cases explain an interesting advantage of restoring a root canal treated tooth with a metal post and core system which implies that in a prefabricated post and core restored tooth failure, a metal post, and core can potentially be the treatment of choice instead of extracting the tooth. Keywords: post and core; special needs; cast metal post.

Alternative Conservative Approach for Tooth Build-Up in Patients with Special Healthcare Needs

Purpose: The success of an artificial crown mainly depends on the biomechanical factors such as bonding capacity of cement between the crown and abutment tooth, and root strength of the abutment tooth. In this case series, we aim to provide insight on the potential use of the cast metal post and cost for patients with intellectual disabilities and severely compromised tooth structure. Material and Methods: The first patient was a 41-year old male with the chief complaint of a dislodged porcelain fused metal (PFM) crown of tooth #20 (mandibular left second bicuspid). The patient was informed about the advantages, disadvantages, and risks of each option. After further consideration and discussion with the parents and the patient, we decided to rebuild the coronal tooth structure with the cast metal post and core and prosthetic restoration with the same crown. Patient satisfaction was measured on the visual analog scale as 10/10. The second case involves a 26-year old female, who presented with a chief complaint of chronic lingering pain on tooth #9. The tooth structure was extensively damaged and un-supportive of the ferrule, therefore, it was decided to build a metal post and core instead of a fiber post. The prosthetic restoration was made with a monolithic zirconia crown and the patient was followed up twice in 6 months and graded the satisfaction as 10/10 on a visual analog scale. Results: The most common type of posts used in dentistry has been cast post and cores in the last decade which generally includes an additional laboratory stage where a custom post is prepared according to the impression taken from the prepared post space. Conclusions: Both the presented cases explain an interesting advantage of restoring a root canal treated tooth with a metal post and core system which implies that in a prefabricated post and core restored tooth failure, a metal post, and core can potentially be the treatment of choice instead of extracting the tooth.

Customizing the prefabricated fiber post: A case report

Customizing the prefabricated fiber post to direct anatomic post possesses advantages of intimate adaptation of the cast metal post and similar modulus of elasticity of prefabricated fiber post, thus optimizing the properties of both. This report presents the case of a 30-year-old female patient with a grossly decayed upper right central incisor having a history of intermittent pain and swelling since 2 weeks. Patient presented with a history of trauma 2 years back and recurring sinus formation since 6 months. A diagnosis of chronic periapical abscess was established and the endodontic treatment followed by direct anatomic post and crown were recommended for the affected tooth. One year conclusive outcome of the presented case highlights that customizing the prefabricated fiber post is relatively simple, minimally invasive and requires only few additional steps in single appointment beyond those needed to lute a prefabricated fiber post.

Detection of vertical root fractures in the presence of artefacts by digital radiography and cone beam computed tomography

The correct diagnosis of vertical root fractures (VRF) in the presence of artifacts is a challenge for clinicians and endodontists. Moreover, there is controversy about which imaging technique is best for this purpose. In an in vitro model, we evaluated the diagnosis of VRF in teeth treated endodontically with and without intraradicular metal posts, using the Clark technique and cone beam computed tomography (CBCT), as well as the interference of artifacts with the diagnosis. Twenty-two first or second maxillary or mandibular premolars were included. Teeth were randomly allocated to three groups: G1 (two teeth without fracture with endodontic treatment and one with an intraradicular metal post); G2 (10 fractured teeth with endodontic treatment); and G3 (10 fractured teeth with endodontic treatment plus a metal post). The examiners recorded the presence or absence of fracture and its location and classified its type. There was no statistically significant difference between image acquisition systems. When differentiating the teeth (first vs. second premolars), there was a statistically significant difference among the examiners (p=0.020). However, when comparing the values obtained by the examiners regarding the visualization of the fracture site as well as the presence of fracture correlated with the presence of a metal post and angulation, there were no statistically significant differences (p>0.05). Digital radiographs and CBCT were similar for the diagnosis of VRF. High sensitivity was observed by CBCT image reconstructions. Therefore, the presence of metal posts generated artifacts, resulting in low sensitivity, specificity and accuracy.

Analysis of endodontic success using a Periapical Index in teeth with different types of intraradicular posts

This randomized clinical trial evaluated the influence of the type of intraradicular posts (glass fiber post or cast metal post) in the success of endodontic treatment in teeth that received single metal-ceramic restoration. The sample consisted of adult patients, who presented for the first time seeking routine dental care at the dental school over a period of 5 years. Seventy-six out of ninety-six teeth that received endodontic treatment and intraradicular post were analyzed, randomly distributed in two groups – glass fiber post (n=38), and cast metal post (n=38). The quality of the endodontic treatment was radiographically evaluated, and the apical status was assessed using the periapical index (PAI). Statistical Analyses were performed to a significance level of 5%. Descriptive analyses were used to characterize the teeth and survival curves were created using the Kaplan–Meier method. The success rate of endodontic treatment was 90.8% (n=69) including glass fiber post and cast post. When appropriate endodontic treatment was performed is possible to conclude that the success of endodontic treated teeth that received posts was not related to the post type.