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Placement of two tapered posts
From: Marga Ree
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 Iím 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