Weekly Post

The following patient, in his 50’s, had a history of crowns from his teenage years, due to staining and possible enamel defects. The UL1 was root treated and all his crowns changed 10-15 years ago .

The UL1 was removed six months prior to commencing implant treatment, due to an apical abscess with a draining sinus. This region healed with a subsequent bony defect, which required augmentation prior to implant therapy.

Due to the size of the defect and high smile line, after going over all of his options, the patient opted for the gold standard, an autogenous block graft. The only suitable intra-oral donor site available was his mandibular symphysis. The implant was placed 4 months after the block graft and UL1 restored 3 months later. Treatment was successfully carried out with an acceptable aesthetic result the patient was extremely happy with. We also replaced the leaking crown of the UR1.

Periodontal diseases have been classified as: Gingivitis or Periodontitis. Gingivitis, known as a reversible inflammation of the connective tissue around the tooth. Periodontitis, is a irreversible inflammation affecting the connective tissue and alveolar bone affecting supporting tissues of the tooth (1).

A carefully considered periodontal diagnosis is of major importance in the subsequent management of patients periodontal disease. An accurate diagnosis is the first step towards an appropriate treatment plan (1).

The treatment plan is focused on the elimination of the supra gingival and subgingval plaque or calculus. Subgingival mechanical instrumentation is essential to achieve periodontal health (2).

After the appropriate treatment supportive therapy oral hygiene instructions is a key factor for a long term stability on Periodontal Disease (3).

1. Periodontal diagnoses and classification of periodontal diseases GC Armitage – Periodontology 2000, 2004.
2.Periodontal Response to Mechanical Non-Surgical Therapy: A Review G Greenstein – Journal of periodontology, 1992.
3.Supportive care after active periodontal treatment JJ Echeverria, GC Manau… – … of clinical periodontology, 1996.

Patient had a bicycle accident and suffered unrestorable vertical fracture of his UL2

UL2 was extracted atrumatically and immediate Rochette bridge placed, with a cleansable design, ensuring no pressure on the healing socket

UL2 3/12 post healing-NOTE high smile line and height and width defect

CBCT-Simplant planning demonstrates thin ridge of 5-6mm. Patient consented to implant placement with ridge expansion, to manipulate and preserve the buccal plate

These are less likely to cause root fracture than indirect precious metal post cores (3) and leave the referring dentist a superb base for crown preparation.

The canal can be shaped with post preparation in mind to achieve the best long term results for your patients

Using the microscope magnification facilitates excellent surface preparation for bonding.

The use of pre-heated composites allows perfect adaptation of post material for best retention (4, 5)

Just ask on the referral form if you want a post prepared and fitted ready for your permanent crown restoration, or ask for more information

(1) Nicola S, Alberto F, Riccardo MT, Allegra C, Massimo SC, Damiano P, Mario A, Elio B. Effects of fiber-glass-reinforced composite restorations on fracture resistance and failure mode of endodontically treated molars. J Dent. 2016 Oct;53:82-7

(2) Guldener KA, Lanzrein CL, Siegrist Guldener BE, Lang NP, Ramseier CA, Salvi GE. Long-term Clinical Outcomes of Endodontically Treated Teeth Restored with or without Fiber Post-retained Single-unit Restorations. J Endod. 2016 Dec 7 (Ahead of print)

(3) Bolla M, Muller-Bolla M, Borg C, Lupi-Pegurier L, Laplanche O, Leforestier E. Root canal posts for the restoration of root filled teeth. Cochrane Database Syst Rev. 2016 Nov 28;11

(4) Magne P, Goldberg J, Edelhoff D, Güth JF. Composite Resin Core Buildups With and Without Post for the Restoration of Endodontically Treated Molars Without Ferrule. Oper Dent. 2016 Jan-Feb;41(1):64-75

Sometime a tooth has many difficulties and pitfalls when it comes to root treatment, making the outcomes uncertain. The case here has difficulties of access and isolation due to position and subgingival decay, a second mesio-buccal canal (often impossible to detect without a surgical microscope) and severe curvature of the roots.

A pre-endodontic tooth restoration has been done to avoid per and post operative leakage (1)

The use of a surgical microscope enhanced the search of a present fourth canal, hard to detect without magnification (2), modern rotary instruments (3, 4) along with the latest irrigants activation devices (5) and obturation methods (6), make success in these cases more achievable

Let us help with the complex underlying difficulties and return the patient to your care for the pleasure of the final restoration

(1) Heydrich RW. Pre-endodontic treatment restorations. A modification of the ‘donut’ technique. J Am Dent Assoc. 2005 May;136(5):641-2

(2) Buhrley LJ, Barrows MJ, BeGole EA, Wenckus CS. Effect of magnification on locating the MB2 canal in maxillary molars. J Endod. 2002 Apr;28(4):324-7.

(3) Kiran S, Prakash S, Siddharth PR, Saha S, Geojan NE, Ramachandran M. Comparative Evaluation of Smear Layer and Debris on the Canal Walls prepared with a Combination of Hand and Rotary ProTaper Technique using Scanning Electron Microscope. J Contemp Dent Pract. 2016 Jul 1;17(7):574-81.

(4) Cheung GS, Liu CS. A retrospective study of endodontic treatment outcome between nickel-titanium rotary and stainless steel hand filing techniques. J Endod. 2009 Jul;35(7):938-43.

(5) Duque JA, Duarte MA, Canali LC, Zancan RF, Vivan RR, Bernardes RA, Bramante CM.Comparative Effectiveness of New Mechanical Irrigant Agitating Devices for Debris Removal from the Canal and Isthmus of Mesial Roots of Mandibular Molars. J Endod 2016 Dec (Ahead of print)