Placement of two tapered posts

From: Marga Ree To: ROOTS Sent: Saturday, October 29, 2005 11:46 AM Subject: [roots] post placement Here is an example of a case in which I placed 2 tapered posts of Pentron with Build-it. I used the available space without removing extra tooth structure with using a post space bur. Try-in of posts after finishing the canal filling, acid etch, prime and bond, cementation of posts, application of plastic core form of Kuraray, build-up of Build-it, adjusting shape of build-up with diamonds and rubber points - Marga

Free hand. Neat, Marga. A lost art. Guy 1 question? why not we always clamp the adjacent unaffected teeth instead of the one with a weaker structure? - Vipin Thanks Vipin! I like to clamp the adjacent teeth with the rubber dam slit technique, that gives me more freedom to manipulate the matrix band. I these cases I like to use a core build-up of Kuraray, cut the upper part away with a scalpel, and turn it upside down, insert it in the sulcus, so that the smallest diameter is at the cervical part of the tooth that has to be restored, and the widest part is going to be at the occlusal surface. This gives you a kind of a tooth model. A wedge is usually not necessary, and don't bother with the weird form after you have removed the form, you can easily adjust the shape with a diamond. I don't mind if I don't have a contact point. Usually it is better to have no contact point at all than a loose contact point, it is only a temporary restoration. Concerning the post placement, I try not to remove extra tooth structure to make room for the post, I try to accomodate the post in the availabe space. If the smallest post will not fit, I take a post drill and first try to use it with handforce, that gives me more control. I use the same composite (in this case Build-it, which is a dual cure core material) to cement the post and to make the build-up, this gives me one material in which the post is embedded - Marga I've never seen a tooth fracture because of a rubber dam clamp. If it did, then it would be a pretty poor option for a long term restorative plan anyway. I do like to clamp distal to the tooth I'm working on if I need to place a matrix, then I tend to dam an entire quadrant, just makes things easy - Bill what in a case like Marga's, Bill, in which (if you do not clamp the tooth in question) either 1/ the hole in the dam will not expose the tooth completely because of the lack of tooth structure, or 2/ you have to do partial isolation by enlarging the dam's hole? I think I'd matrix and then clamp the tooth in question (in this specific case, at least) - Marcos Arenal very nice case again, hope terry is not coming mad about using the pentron "crap" . Marga, what kind of cement are you using for placing posts - Bart Thanks Bart, I used Build-it (a dual cure core material) in this case to cement the post and make the core. I also use LuxaCore self cure for both procedures. - Marga This is a case where I may use the Brinker set of clamps as an additional clamp simply to retract the dam around the tooth that is broken down. I think that placing a sectional matrix or auto matrix type can be done with this clamp in place - Bill Any chance you could post the part #'s on those clamps Bill? I've been trying to order them but can't find the info to do so. - Mark Dreyer Bill can you please take a shot of how this works out ? It's very interesting, as I have problems like this as well. Thanks, - Thomas Mark, Thomas, this is from the Schein Catalogue, apologies for the poor scan,- Bill Marga: I just had a patient not 10 minutes ago who horizontally fractured an endo treated max 1st bi nearly where yours was that I have as part of a clinical study I’m involved with. I took the original case out of the study, did the buildup using fiberkor posts and build-it, did a surgical crown lengthening, and put it back into the study as a new case. Eerily similar - gary Nicely done case Marga......WOW. Neat use f the platic core form. Havent seen these before but it worked out nice. I noticed that you didnt do any wedges so I would imagine that this is just a core buildup for the crown. Not alot of tooth left to get a ferrule but perhaps under the tissue. These are the ones in my office that always are the ones where the patient comes back with the crown, posts and cores inside the crown when it comes loose! Congrats.......did the first molar need endo after you built it up (the distal had big decay) - Glenn Marga, in cases like this one, have you tried placing the matrix beforehand on the target tooth, placing the butterfly clamp and a single-holed r-dam around it, and then opening the tooth? - Marcos arenal Marga, Nice endo and nice post(s) placement. Is a BWX available to see what is left to avoid non restorable fracture after a crown? Might it be prudent to keep the nice BU as the definitive restoration? - Alan Cady