Retreatment of a front tooth - Courtesy ROOTS
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From: Marga Ree
Sent: Thursday, June 09, 2011 8:47 PM
Subject: [roots] Retreatment of a front tooth
30 year old woman, with history of previous surgery on 12. Recently the
tooth became symptomatic. I suspected a root fracture, no probing depths
of any significance.
We agreed upon disassembly and inspection what it looked like. Ususally
you cannot use the Metalift to remove crowns on front teeth, because of
the path of insertion, but I managed to remove this crown
with just a little chipping off of the porcelain on the palatal side.
She found her current crown very unsighty, but it had a decent fit, and
we decided to use it as a temporary in between visits, while the tooth
was in CaOH.
After the tooth became asymptomatic, an apical plug of MTA was applied,
and the crown was cemented for the last time. I promised her to make a
nicer temporary after insertion of the post. Today I finished treatment,
post placement and a cosmetic build-up of LuxaCore, veneered with a
flowable composite, a bit of shaping and polishing, she was pretty
satisfied with the result. I explained that we had to follow up till
signs of healing were visible, that she still might need
surgery, and that the prognosis is guarded
I am still not confident that there isn't a fracture, we'll see. - Marga
Beautiful as usual, marga, but Iím confused. Your photos show using the
metalift to retrieve the crown, apparently done successfully with the post
still attached to the tooth. You then show a photo of the crown/post as
one unit, as if it had been pulled as one piece. Did you reassemble it
for phototgraphic purposes. I doubt you were able to remove the crown
and the post with the metalift unit.- gary
Hi Gary, I removed the crown with the Metalift, and the post with
ultrasonics. Because the crown didn't have much retention, I used a temporary
SS post to increase its retention. I inserted the post, filled
the crown with a resin material, seated the crown, and after the material
had set, removed the crown with the temporary post embedded in the crown.
Crown with post embedded were cemented with a temp. cement. - Marga
No white stain to match the contra lateral tooth? Marga absolutely
phenomenal. Please teach me how to work with composites this way. - Keith
Dear Marga, excellence case and fotos as usual. - Lukasz Kwolek
Hi Marga, Looking at clinical photo I see a scar - has this tooth
undergone an apical osteotomy before your re-treatment ?
Re-treatment is perfectly done, but with such type of bone defect prognosis
is really guarded :-(.- Valeri