USE OF ZIRCONIA POSTS FOR RESTORING SEVERELY DAMAGED ANTERIOR TEETH J D MATANI1, M G KHEUR1, S JAMBHEKAR2
Introduction Endodontically treated teeth often need to be restored with partial or complete coverage restorations. The choice of restoration depends on the amount of residual coronal tooth structure. Various post systems have been used in the recent past. These include custom cast posts and prefabricated posts. However, the gold standard regarding the choice of posts is still not clear. A custom cast post and core is routinely fabricated in base metal alloy, which can produce a greyish discoloration through a translucent allceramic crown. Additionally, biocompatibility concerns in relation to the use of various metal alloys in dental restorations have led to the development of ceramic post and core systems for the restoration of endodontically treated teeth.
For a highly aesthetic outcome, the material of the post and core should transmit and refract light in much the same manner as a natural tooth. This helps to preserve the normal optical properties and the final colour of the all-ceramic restoration. Michalakis et al (2004) reported that zirconium posts with ceramic cores showed better light transmission properties compared to cast-metal post and cores.1 Sorensen and Engelman (1990) suggested that the accurate fit of the posts into the root canals increases the fracture resistance of the endodontically treated teeth,2 thus the use of custom posts is preferred in cases of severe coronal destruction. Various authors have reported favourable results with the use of zirconia posts.3-9
Prim Dent J. 2014;3(1):26-27
Figure 1a
Figure 1b
1
Figure 1a: Provisional restorations Figure 1b: Severely mutilated maxillary incisors
Case report A male patient, 25, was referred for treatment. He had unaesthetic provisional anterior restorations that had been fabricated two years previously (Figure1a). Endodontic treatment was performed on teeth UR1, UR2 and UL1. On removal of the provisional restorations, clinical crowns with inadequate tooth structures were observed (Figure 1b). The periodontal status of the teeth was satisfactory. The treatment plan was for custom-made zirconia post-core with all-ceramic crowns for teeth UR1, UR2 and UL1, and a porcelain laminate for the peg-shaped UL2.
JD Matani and MG Kheur
Department of Prosthodontics, MA Rangoonwala College of Dental Sciences and Research Centre, Camp, Pune, India 2
S Jambhekar
Department of Prosthodontics Terna Dental College, Nerul, Navi Mumbai, India
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P R I M A R Y D E N TA L J O U R N A L
Figure 2a
Figure 2b
Figure 3 Figure 2a: Cosmopost fabricated Figure 2b: Cosmopost in situ Figure 3: All-ceramic restorations in situ
Zirconia post-and-core fabrication The post space was shaped with Peeso reamers for the appropriate post length, leaving 5mm of the gutta percha in the apical third of the canal. An impression was made of the post space using addition silicone elastomeric impression material (Aquasil, Denstply India, Mumbai). A stone die (Ultrarock, Kalabhai, Mumbai) was poured from the impression. Prefabricated zirconia ceramic posts (Cosmopost, Ivoclar Vivadent, Liechtenstein) were layered with Empress Cosmo (Ivoclar Vivadent, Liechtenstein) (Figure 2a). The customised posts were verified clinically and radiographically.
REFERENCES 1
2
3
Michalakis KX, Hirayama H, Sfolkos J, Sfolkos K. Light transmission of posts and cores used for the anterior esthetic region. Int J Periodontics Restorative Dent. 2004;24:462-9. Sorensen JA, Engelman MJ. Effect of post adaptation on fracture resistance of endodontically treated teeth. J Prosthet Dent. 1990;64:419-24. Toksavul S, Toman M, Uyulgan B,
4
5
The posts were sandblasted using 80µ Al2O3 particles at 2-bar pressure and were subsequently cleaned in an ultrasonic bath. They were bonded using resin cement (Multilink N, Ivoclar Vivadent, Liechtenstein) following the manufacturer’s instructions (Figure 2b). After final preparation of the tooth, an impression was made using addition silicone (Aquasil, Denstply India, Mumbai). E.max (Ivoclar Vivadent, Liechtenstein) crowns were bonded onto the teeth. A ceramic laminate (E.max, Ivoclar Vivadent, Liechtenstein) was placed on the peg-shaped lateral incisor UL2. The bonding procedure for the crowns
Schmage P, Nergiz I. Effect of luting agents and reconstruction techniques on the fracture resistance of pre-fabricated post systems. J Oral Rehab. 2005; 32:433-40. Nothdurft FP, Pospiech PR. Clinical evaluation of pulpless teeth restored with conventionally cemented zirconia posts: A pilot study. J Prosthet Dent. 2006;95:311-4. Ozkurt Z, Iseri U, Kazazoglu E. Zirconia ceramic post systems: a
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7
and laminate was performed using an adhesive technique similar to that for the zirconia post (Figure 3). The patient is being followed up for two years and is very satisfied with the outcome of the treatment.
Conclusion For this clinical situation, customised zirconia posts with ceramic cores were a good option for restoring severely mutilated teeth in the aesthetic zone.
literature review and a case report. Dent Mater J. 2010;29:233-45. Heydecke G, Butz F, Hussein A, Strub JR. Fracture strength after dynamic loading of endodontically treated teeth restored with different post-and-core systems. J Prosthet Dent. 2002;87:438-45. Heydecke G, Butz F, Strub JR. Fracture strength and survival rate of endodontically treated maxillary incisors with approximal cavities after restoration with different post
8
9
and core systems: an in-vitro study. J Dent. 2001;29:427-33 El Guindy J, Fouda MY. Effect of obturating systems, dowel materials, and adhesive luting techniques on the resistance to fracture of endodontically treated teeth. J Prosthodont. 2010;19:544-52. Dilmener FT, Sipahi C, Dalkiz M. Resistance of three new esthetic post-and-core systems to compressive loading. J Prosthet Dent. 2006;95:130-6.
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Introduction Endodontically treated teeth often need to be restored with partial or complete coverage restorations. The choice of restoration depends on the amount of residual coronal tooth structure. Various post systems have been used in the recent past. These include custom cast posts and prefabricated posts. However, the gold standard regarding the choice of posts is still not clear. A custom cast post and core is routinely fabricated in base metal alloy, which can produce a greyish discoloration through a translucent allceramic crown. Additionally, biocompatibility concerns in relation to the use of various metal alloys in dental restorations have led to the development of ceramic post and core systems for the restoration of endodontically treated teeth.
For a highly aesthetic outcome, the material of the post and core should transmit and refract light in much the same manner as a natural tooth. This helps to preserve the normal optical properties and the final colour of the all-ceramic restoration. Michalakis et al (2004) reported that zirconium posts with ceramic cores showed better light transmission properties compared to cast-metal post and cores.1 Sorensen and Engelman (1990) suggested that the accurate fit of the posts into the root canals increases the fracture resistance of the endodontically treated teeth,2 thus the use of custom posts is preferred in cases of severe coronal destruction. Various authors have reported favourable results with the use of zirconia posts.3-9
Prim Dent J. 2014;3(1):26-27
Figure 1a
Figure 1b
1
Figure 1a: Provisional restorations Figure 1b: Severely mutilated maxillary incisors
Case report A male patient, 25, was referred for treatment. He had unaesthetic provisional anterior restorations that had been fabricated two years previously (Figure1a). Endodontic treatment was performed on teeth UR1, UR2 and UL1. On removal of the provisional restorations, clinical crowns with inadequate tooth structures were observed (Figure 1b). The periodontal status of the teeth was satisfactory. The treatment plan was for custom-made zirconia post-core with all-ceramic crowns for teeth UR1, UR2 and UL1, and a porcelain laminate for the peg-shaped UL2.
JD Matani and MG Kheur
Department of Prosthodontics, MA Rangoonwala College of Dental Sciences and Research Centre, Camp, Pune, India 2
S Jambhekar
Department of Prosthodontics Terna Dental College, Nerul, Navi Mumbai, India
26
P R I M A R Y D E N TA L J O U R N A L
Figure 2a
Figure 2b
Figure 3 Figure 2a: Cosmopost fabricated Figure 2b: Cosmopost in situ Figure 3: All-ceramic restorations in situ
Zirconia post-and-core fabrication The post space was shaped with Peeso reamers for the appropriate post length, leaving 5mm of the gutta percha in the apical third of the canal. An impression was made of the post space using addition silicone elastomeric impression material (Aquasil, Denstply India, Mumbai). A stone die (Ultrarock, Kalabhai, Mumbai) was poured from the impression. Prefabricated zirconia ceramic posts (Cosmopost, Ivoclar Vivadent, Liechtenstein) were layered with Empress Cosmo (Ivoclar Vivadent, Liechtenstein) (Figure 2a). The customised posts were verified clinically and radiographically.
REFERENCES 1
2
3
Michalakis KX, Hirayama H, Sfolkos J, Sfolkos K. Light transmission of posts and cores used for the anterior esthetic region. Int J Periodontics Restorative Dent. 2004;24:462-9. Sorensen JA, Engelman MJ. Effect of post adaptation on fracture resistance of endodontically treated teeth. J Prosthet Dent. 1990;64:419-24. Toksavul S, Toman M, Uyulgan B,
4
5
The posts were sandblasted using 80µ Al2O3 particles at 2-bar pressure and were subsequently cleaned in an ultrasonic bath. They were bonded using resin cement (Multilink N, Ivoclar Vivadent, Liechtenstein) following the manufacturer’s instructions (Figure 2b). After final preparation of the tooth, an impression was made using addition silicone (Aquasil, Denstply India, Mumbai). E.max (Ivoclar Vivadent, Liechtenstein) crowns were bonded onto the teeth. A ceramic laminate (E.max, Ivoclar Vivadent, Liechtenstein) was placed on the peg-shaped lateral incisor UL2. The bonding procedure for the crowns
Schmage P, Nergiz I. Effect of luting agents and reconstruction techniques on the fracture resistance of pre-fabricated post systems. J Oral Rehab. 2005; 32:433-40. Nothdurft FP, Pospiech PR. Clinical evaluation of pulpless teeth restored with conventionally cemented zirconia posts: A pilot study. J Prosthet Dent. 2006;95:311-4. Ozkurt Z, Iseri U, Kazazoglu E. Zirconia ceramic post systems: a
VOL 3 NO 1 FEBRUARY 2014
6
7
and laminate was performed using an adhesive technique similar to that for the zirconia post (Figure 3). The patient is being followed up for two years and is very satisfied with the outcome of the treatment.
Conclusion For this clinical situation, customised zirconia posts with ceramic cores were a good option for restoring severely mutilated teeth in the aesthetic zone.
literature review and a case report. Dent Mater J. 2010;29:233-45. Heydecke G, Butz F, Hussein A, Strub JR. Fracture strength after dynamic loading of endodontically treated teeth restored with different post-and-core systems. J Prosthet Dent. 2002;87:438-45. Heydecke G, Butz F, Strub JR. Fracture strength and survival rate of endodontically treated maxillary incisors with approximal cavities after restoration with different post
8
9
and core systems: an in-vitro study. J Dent. 2001;29:427-33 El Guindy J, Fouda MY. Effect of obturating systems, dowel materials, and adhesive luting techniques on the resistance to fracture of endodontically treated teeth. J Prosthodont. 2010;19:544-52. Dilmener FT, Sipahi C, Dalkiz M. Resistance of three new esthetic post-and-core systems to compressive loading. J Prosthet Dent. 2006;95:130-6.
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