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Forced orthodontic extrusion and use of CAD/CAM for reconstruction of grossly destructed crown: A multidisciplinary approach

Kumar R, Patil S - J Conserv Dent (2012)

Bottom Line: Aesthetic rehabilitation of a fractured maxillary right central incisor was performed employing a multidisciplinary approach i.e. conventional endodontic treatment followed by orthodontic extrusion and final restoration using CAD-CAM and one piece milled zirconia post and core with full coverage zirconia crown.After the procedure being completed, periapical radiographs taken at 3 month follow up period demonstrated that the post and core remained well adapted to post space and there was a complete healing of periapical lesion.This technique can provide a complete aesthetic rehabilitation of a grossly destructed tooth without hampering the biological width and thus has a better prognosis.

Affiliation: Department of Conservative Dentistry and Endoodontics, Vasantdada Patil Dental College and Hospital, A/P Kavalapur, Tal- Miraj, Dist- Sangli, Maharashtra, India.

ABSTRACT

The aim of this study is to present a report of a case where forced orthodontic extrusion and computer-aided design and computer-aided manufacturing (CAD/CAM) technique was used for reconstruction of right maxillary central incisor with grossly destructed crown. Aesthetic rehabilitation of a fractured maxillary right central incisor was performed employing a multidisciplinary approach i.e. conventional endodontic treatment followed by orthodontic extrusion and final restoration using CAD-CAM and one piece milled zirconia post and core with full coverage zirconia crown. After the procedure being completed, periapical radiographs taken at 3 month follow up period demonstrated that the post and core remained well adapted to post space and there was a complete healing of periapical lesion. This technique can provide a complete aesthetic rehabilitation of a grossly destructed tooth without hampering the biological width and thus has a better prognosis.

Clinical photographs of the maxillary right central incisor. (a) Facial view. (b) Occlusal view. (c): Preoperative diagnostic radiograph showing gross destruction of crown of #8 with wide canal and periapical radiolucency and deep proximal caries with #9. (d) Post obturation radiograph.
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Figure 1: Clinical photographs of the maxillary right central incisor. (a) Facial view. (b) Occlusal view. (c): Preoperative diagnostic radiograph showing gross destruction of crown of #8 with wide canal and periapical radiolucency and deep proximal caries with #9. (d) Post obturation radiograph.

Mentions: A 22 year old male reported to department of Conservative dentistry and endodontics with the chief complaint of fractured maxillary right central incisor due to trauma 5 years back [Figure 1a]. On clinical examination, a grossly destroyed carious crown with minimal remaining dentin was present with tooth # 8 [Figure 1b]. Preoperative intraoral periapical radiographs showed gross destruction of crown of # 8 with wide canal and periapical radiolucency and deep proximal caries with # 9 [Figure 1c]. Pulp vitality tests (electric and cold tests) revealed that tooth # 9 was non vital. The patient was concerned about aesthetics and unwilling to undergo extraction. Hence it was decided to restore the tooth with conventional endodontic treatment and post and core restoration. After excavation of caries it was seen that supragingival crown height both labially and palatally was 0.5- 1 mm. The crown: root ratio and occlusal clearance was adequate. Hence in order to gain crown height for fabrication of a customized post and core with full coverage crown, it was decided to treat the tooth by forced orthodontic extrusion. The tooth was isolated under rubber dam (Hygienic Dental Dam, Colténe Whaledent, Germany). Adequate endodontic access cavity was prepared after excavation of caries and working length radiograph was taken after initial identification of canal with # 15 K-files (Kerr Manufacturing Co., Romulus, MI). Cleaning and shaping of the root canal was performed by using stainless steel file with a crown-down technique under copious irrigation with saline, 5.25% sodium hypochlorite solution (Dentpro, Chandigarh, India) and 17% Ethylenediaminetetraacetic acid (EDTA) (Glyde File Prep, Densply, France).[12] In the next visit master cone radiograph was taken. Before obturation, the canal was finally rinsed with saline, dried and sectional obturation was performed using cold lateral compaction of gutta-percha using AH Plus resin sealer (Maillefer, Dentsply, Konstanz, Germany) [Figure 1d].[12] An IRM (Caulk, Dentsply, Milford, DE) temporary restoration was placed in the access cavity. The routine endodontic treatment was completed for maxillary left central incisor.

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Forced orthodontic extrusion and use of CAD/CAM for reconstruction of grossly destructed crown: A multidisciplinary approach

Kumar R, Patil S - J Conserv Dent (2012)

Clinical photographs of the maxillary right central incisor. (a) Facial view. (b) Occlusal view. (c): Preoperative diagnostic radiograph showing gross destruction of crown of #8 with wide canal and periapical radiolucency and deep proximal caries with #9. (d) Post obturation radiograph.
© Copyright Policy - open-access
Figure 1: Clinical photographs of the maxillary right central incisor. (a) Facial view. (b) Occlusal view. (c): Preoperative diagnostic radiograph showing gross destruction of crown of #8 with wide canal and periapical radiolucency and deep proximal caries with #9. (d) Post obturation radiograph.
Mentions: A 22 year old male reported to department of Conservative dentistry and endodontics with the chief complaint of fractured maxillary right central incisor due to trauma 5 years back [Figure 1a]. On clinical examination, a grossly destroyed carious crown with minimal remaining dentin was present with tooth # 8 [Figure 1b]. Preoperative intraoral periapical radiographs showed gross destruction of crown of # 8 with wide canal and periapical radiolucency and deep proximal caries with # 9 [Figure 1c]. Pulp vitality tests (electric and cold tests) revealed that tooth # 9 was non vital. The patient was concerned about aesthetics and unwilling to undergo extraction. Hence it was decided to restore the tooth with conventional endodontic treatment and post and core restoration. After excavation of caries it was seen that supragingival crown height both labially and palatally was 0.5- 1 mm. The crown: root ratio and occlusal clearance was adequate. Hence in order to gain crown height for fabrication of a customized post and core with full coverage crown, it was decided to treat the tooth by forced orthodontic extrusion. The tooth was isolated under rubber dam (Hygienic Dental Dam, Colténe Whaledent, Germany). Adequate endodontic access cavity was prepared after excavation of caries and working length radiograph was taken after initial identification of canal with # 15 K-files (Kerr Manufacturing Co., Romulus, MI). Cleaning and shaping of the root canal was performed by using stainless steel file with a crown-down technique under copious irrigation with saline, 5.25% sodium hypochlorite solution (Dentpro, Chandigarh, India) and 17% Ethylenediaminetetraacetic acid (EDTA) (Glyde File Prep, Densply, France).[12] In the next visit master cone radiograph was taken. Before obturation, the canal was finally rinsed with saline, dried and sectional obturation was performed using cold lateral compaction of gutta-percha using AH Plus resin sealer (Maillefer, Dentsply, Konstanz, Germany) [Figure 1d].[12] An IRM (Caulk, Dentsply, Milford, DE) temporary restoration was placed in the access cavity. The routine endodontic treatment was completed for maxillary left central incisor.

Bottom Line: Aesthetic rehabilitation of a fractured maxillary right central incisor was performed employing a multidisciplinary approach i.e. conventional endodontic treatment followed by orthodontic extrusion and final restoration using CAD-CAM and one piece milled zirconia post and core with full coverage zirconia crown.After the procedure being completed, periapical radiographs taken at 3 month follow up period demonstrated that the post and core remained well adapted to post space and there was a complete healing of periapical lesion.This technique can provide a complete aesthetic rehabilitation of a grossly destructed tooth without hampering the biological width and thus has a better prognosis.

Affiliation: Department of Conservative Dentistry and Endoodontics, Vasantdada Patil Dental College and Hospital, A/P Kavalapur, Tal- Miraj, Dist- Sangli, Maharashtra, India.

ABSTRACT

The aim of this study is to present a report of a case where forced orthodontic extrusion and computer-aided design and computer-aided manufacturing (CAD/CAM) technique was used for reconstruction of right maxillary central incisor with grossly destructed crown. Aesthetic rehabilitation of a fractured maxillary right central incisor was performed employing a multidisciplinary approach i.e. conventional endodontic treatment followed by orthodontic extrusion and final restoration using CAD-CAM and one piece milled zirconia post and core with full coverage zirconia crown. After the procedure being completed, periapical radiographs taken at 3 month follow up period demonstrated that the post and core remained well adapted to post space and there was a complete healing of periapical lesion. This technique can provide a complete aesthetic rehabilitation of a grossly destructed tooth without hampering the biological width and thus has a better prognosis.

View Similar Images In: Results  - Collection
View Article: PubMed Central -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=3339019&rFormat=json&query=null&req=5