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Esthetic restorations in severely darkened anterior teeth using dental post

Authors: Raphael Monte Alto, Juliana Ferreira Batista Pereira, Mariana Ferreira Silva Ventura, Priscilla Carvalhal de Oliveira and Fabrício Perucelli.

 

Darkened teeth are always a challenge in the clinical routine, and when deciding the type of treatment, one should always select the most conservative one. In this context, whitening becomes an interesting alternative. However, due to the great relapse of this type of treatment, the patient usually ends up choosing a more definite solution such as crowns and veneers.

 

CASE REPORT

A female patient attended the subject of Integrated Clinic of the Fluminense Federal University (Rio de Janeiro – Brazil) indicated by the Discipline of Orthodontics with the application of an anterior crown with the appropriate format for future orthodontic finalization.

 

Endodontically treated teeth are susceptible to biomechanical failures especially when there is a significant loss of dental structure1. In such cases, the use of intraradicular retainers is necessary, mainly because the remnant structure is insufficient to adequately support and retain the final restoration2,3. Several techniques are available for the restoration of teeth with endodontic treatment and within this context choosing an inadequate method when restoring these teeth may compromise their longevity.

 

The tooth to be restored presented a good amount of coronal structure and conservative endodontic treatment, and the direct technique was indicated (see table 1).

 

The root canal was cleaned and dried with paper cones for the adhesive procedure and light-curing was performed for 40 seconds. With the aid of an insertion tip, Allcem Core dual cement (FGM) was applied in the root canal from the apical region to the coronary chamber.

 

The dental post Whitepost (FGM) DC-E 2 was inserted and the set was light cured for 40 seconds. The excess of the dental post was cut and the occlusal adjustments were performed. The patient was submitted to periodontal surgery by Professor Ronaldo Barcellos at the Fluminense Federal University (Rio de Janeiro – Brazil). After 90 days, total crown preparation and molding were performed and sent to the laboratory. A total crown was made with composite for CAD/CAM with external characterization. After tests and adjustments the crown was cemented.

 

Technique Indications Advantages Disadvantages
Direct. Teeth with a lot of coronary remnants. • Single section.
• Low cost.
Large amount of resinous cement.
Anatomical or direct modeling • Teeth with little remnants.
• Broad root canals.
• Single session.
• Low cost.
• Less quantity of cement.
• Less effect of the shrinkage stress.
• Certainty of polymerization of the composite throughout the post.
• Most critical technique.
• Need to create expulsivity in the root canal.

Table 1 – Indications, advantages and disadvantages of each technique. Table from the book “Reabilitação estética anterior: o passo a passo da rotina clínica (Raphael Monte Alto e Colaboradores)”.

 

CLINICAL PHOTOS

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