Clinical case by MUDr. Marek Šupler, MPH
Age: 32 years old
Area of restoration: Premolar
Tooth number: 14
Reason for treatment: High passion for aesthetic treatment due to daily customer contact
One visit dentistry is becoming more and more popular among patients nowadays. The reasons behind are various – lack of time due to work, unwillingness to come several times, parking issues, and many others. A rising demand for treatment that includes as few steps as possible is becoming a strong trend among patients. In some cases, all that needs to be done is acquire more knowledge on endodontic treatments, a suitable rinse protocol and usage of FRC pins. As far as the prosthetic work is concerned, modern chairside CAD/CAM systems allow to achieve a very efficient and rapid post-endodontic completion and reinforcement of the tooth.
This study reports how one visit treatment can cover endodontic, endodontic retreatment, through usage of FRC pin, and permanent cementation of full ceramic crown, using MyCrown.
Patient first contact
32 y.o. woman came to our dental clinic with broken tooth no. 14 and asked for emergency treatment as the tooth is in the smile area and the patient stated she felt deficient and uncomfortable when working and speaking with people. (Fig. 1, Fig. 2) After taking an intraoral X-ray and status analysis, we suggested RCRT (root canal endodontic retreatment), followed by treatment with FRC (fiberglass-reinforced composite) post and reconstruction with ceramic crown, made by CAD/CAM system MyCrown
Figure 1: Subgingival tooth fracture
Figure 2: First patient check
During the treatment with Zeiss Opmi Pico microscope, it was found, that the palatal root canal was not treated at all. Subsequently, the vestibular root canal retreatment and palatal root canal treatment were performed using a standard rinse protocol using 5% NaOCl, 0.2% CHX and EDTA. To fill the root canals M-Two system ISO 25/06% – gutta-percha and Bee-Fill system were used. (Fig. 3)
Immediately after the endodontic treatment, the palatal part of the gingiva was removed by electrotome. The FRC ENA post was placed in the palatal root canal. After removing a portion of gutta-percha from the filled root canal, 6mm deep, the dentin was etched with orthophosphoric acid for 30 seconds and then rinsed with water from syringe for 30 seconds. The ENA bond was mixed with the polymerization activator in a 1:1 ratio and applied to the dentin with microbrush and also to the pre-silanised pin. Subsequently, ENA CEM – dual curing resin cement was applied to the duct and FRC post was introduced. Enlightenment with curing light 30 seconds. The crown part of the tooth was rebuilt by the same ENA CEM – dual curing cement. Thus, the tooth was ready for shoulder preparation before the digital impression. (Fig. 4)
Figure 3: During endo with FRC endodontic posts
Figure 4: After endodontic treatment
After shoulder preparation and preservation of all parameters for the next restoration, the tooth was prepared for digital impression. Firstly, it is most important to make the edge of the preparation as clear as possible. This is the most important thing in defining the future restoration. This has resulted in proper gingival management. In this case, a two-cord technique was used. (Fig. 5) A thinner fibre was first put into sulcus without haemostasis solution. Subsequently, a fibre with thickness 3, impregnated with aluminium chloride, was put for faster and better haemostasis and retraction. After 5 minutes, the thicker fibre is drawn, the thinner one is left and the edge of the preparation is clearly visible.
Figure 5: Two-cord technique
Treatment with MyCrown
The scanning area must be dry before every digital impression. For better access to the oral cavity we use OptraGate. By using DryTips, the saliva of gl. parotis is stopped. LinguaFix fixes the tongue while removing saliva with suction from the sublingual gland. (Fig. 6)
Figure 6: Saliva isolation (other patient)
After drying the area of interest and applying sufficient amount of HD FONA spray, scanning can begin. First, the area of restoration is scanned, then the opposite jaw, and finally a buccal scan to register the occlusion. After correlating the models with the software, the edge of preparation is drawn (Fig. 7) and after defining the insertion axis, the crown is designed.
MyCrown Design software calculates the first proposal based on the surrounding teeth and gives a patient-specific and aesthetic restoration proposal. A quick adjustment was required due to a small improvement of contact points with neighbouring teeth. (Fig. 8)
Figure 7: Margin draw
Figure 8: First crown proposal
After crown modelling, contact points and occlusal contact points satisfaction, we went to the next step – Manufacture (Milling process). Once the milling was over, we polished the tooth and sat it on the preparation. After checking the points of contact and occlusion, the crown could be cemented. Cementation was done by Variolink by Ivoclar due to its great cementation shade/opacity control and adhesive attributes.
The colour of the crown seems to be darker after cementation. Lighter shade of the neighbouring teeth is caused by loss of moistness due to the length of the procedure. (Fig. 9) We asked the patient to come in several hours or the next morning to check the colour. She called only to say everything is perfect and she is very satisfied with this restoration. We have to rely on her judgment and believe that the colour really is satisfying.
Figure 9: Aesthetic final result and happy patient
This clinical example demonstrates, that if we have sufficient knowledge of latest dental trends and suitable equipment, we can help the patient in one session, even in more complicated cases that would otherwise require multiple appointments.
MyCrown allowed to create a perfectly fitting restoration within one visit. The initial software proposal of the crown design was approved allowing to place the restoration into the patient mouth within minutes of its completion.
We should always consider every patient is different and should be treated with a unique approach, based on the indication. MyCrown illustrated the benefit of being able to offer restorative treatment in a single visit.
MUDr. Marek Šupler
Owner of dental practice dedicated to microscopic endodontics, aesthetic, prosthetic, surgical dentistry and implantology in Bratislava, Slovakia
Graduated Medical Faculty in Košice, specialisation Dentistry and Public Health Management