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Coronal restoration - Courtesy ROOTS

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The opinions within this web page are not ours. Authors have been credited for the individual posts where they are. Photos courtesy Dr.Rafael - ROOTS

From: Rafael Marte
Date: Wed, 5 Dec 2007 13:48:33 +0100
Subject: [roots] Almost lost

This #31 (47) was referred by GP, because he could not find the distal canal.
The case was treated in 2 visits, since it took me some time to get an appropriate
temporary filling in place in the first visit.
Ca(OH)2 was used in between the two visits.
Shaping: Profiles up to a 30.06 in the mesials and a 35.06 in the distal. Further finetuning with K-flexofiles.
Cleaning: NaOCl 3% and EDTA 17% (final rinse)
Obturation: Cold lateral condensation with AH+ as sealer
Temporary filling: GIC (Ketac Fill)

What is the best way to restore this tooth definitive coronally?

First radiograph: Pre-op
Second radiograph: Gutta Cone fit
Third radiograph: End result -  Dr.Rafael

Hi Rafael, The final restoration depending mainly upon the amount of the tooth structure left. In your case I suggest to use post and croe and crown. Well done work.- Dr. Adil H. Alani Well done there Rafael. That must have been a fun one. That tooth is going to be tough for someone without high magnification to get a margin on the distal. If you dont get a crown on there it will be lost to recurrent decay with the distal contact being open. In addition, if you dont do a bridge (doesnt look like enough room mesial for an implant) then the contact can open again (ask me how I know). There is a bad overhang on the tooth distal to this so when I look at this, I look at the whole quadrant and see a tough case to restore between the two molars (very deep) but the perio has given you a chance to get a margin on tooth on both molars in this area. Gold crown on the last tooth. 3 unit bridge on the endo and taking care of the space. Rarely do I post a molar, its not needed in my opinion. Just my two cents, but this is the kind of great root canal that can come back a few years later with two teeth needing extraction from interproximal decay if not restored properly. All the best , thanks for sharing - Glenn PS: When I was in dental school teaching there, we always told the students in emergency rotation that before they started to look at doing endo (symptoms needed it) that they had to evaluate three issues. 1. Endodontic prognosis (this was tough because the other doc couldnt find the distal canal and made it a mess for you) ....GUARDED. 2. Restorative prognosis- missing tooth anterior, very deep restoration on the distal.....crown lengthening?.........GUARDED. 3. Periodontal prognosis. .....deep pocketing on the distal of this tooth.......GUARDED. Its a tough tooth long term to keep so the patient has to be made aware of this before you start the endo.- Glenn Thanks for the comments, the patient was informed about the not so good prognosis. She is aware that in the long-term she will lose this tooth. I keep contact with the dentist and I hope he can get a good restoration of the tooth, but I wanted to ask some more opinions on restoring this tooth, because frankly I didn't know what was best in this case. Now I can discuss a bit with the patient and dentist which way we will go. - Raf