Presented By Dr M Arsalan Zubair

MDS residentD.D.C( Dow Dental College)

D.U.H.S (Dow University Of Health Sciences)

Case PresentationProstho-Restorative approach

Philosopher Earl Nightingale once said, “If you’re in a situation and you don’t

have any clear way forward and want for clear advice, look around and see what everyone else is doing and

do the opposite.”

Brief Overview of Topics used in my Case

What is a “Post” and "core“ ?

Kennedy Class IV(going for the removable approach)This describes a patient with

a SINGLE, ANTERIOR BOUNDED saddle. This is the rarest of the classifications.

COMPOUND FIXED BRIDGE (going for the Fixed prosthesis approach)

A combination fixed partial denture which employs two or more of the simple type in one restoration

Age:18yrSex: FemaleResidence: Malir khokraparkOccupation: StudentHeight: 5 feet 1inchWeight:52 kgMarital status: Single

Patient Personal Data

Accurate assessment,examination and investigation leads to accurate diagnosis leads to accurate treatment plan.

Patient AssessmentInfection Control: Environmental and general protocol

Chief Complain & HOPC: Pain in lower anterior teeth. Sharp pain. Aggravates during hot and cold stimuli. Pain persist for an hour and often relives on taking

Panadol. Nocturnal pain. Difficult to localize. Radiate towards neck. Pain was from last 15 days. Esthetic issues.

Medical review:Communicable disease, Allergies, Cardiac abnormalities:

Not significant

Sociologic and Psychological review:Not significant

Dental history: 2 Restored with composite,

Extraction respectively 1 1

Clinical ExaminationExamination of Oro-facial soft tissue Not significant

Examination of teeth:

Carious: 32,33,35,36,37,42,43,47

Missing: 41,31,18,28,48,38

Filled teeth: 12

Stains: Generalized

Periodontal examination:

Gingival color : normalGingival shape : knife edgePocket depth:

Gingival recessionBone loss was below crestal level

33 32 42 43

2-3mm 2-3mm 1-2mm 2-3mm

Examination of occlusion:

Class I canine relationship

Proclined Incisors.

Class I molar relationship.

Frontal view

Mandibular view

Left quadrant

Rlight Quadrant

Mandible right quadrant Mandible left quadrant

Treatment Planning:

1.Control Phase

3.Definitiv

e Phase2.Re-evaluation Phase

Urgent & Control Phase Primary complain of the

patient is resolved first. Pulpectomy is done with barbed broaches(WL was not taken at that stage.

After 2 days, patient’s other stages of R.C.T was completed and then obturation was done.

Re-evaluation Phase Then patient was recalled after 4 days in

order to evaluate R.C.T, patient symptoms and pain.

This time is also utilized by the clinician to plan what treatment options we have, to treat this condition.

Extraction

Why not???

Implant

Why not???

Acrylic Partial denture Why not???

Cast Partial denture

Why not???

Post

Porcelain fused to metal labial bridge

Why the post is selected in my case? The remaining coronal tooth structure

is Insufficient. More weaker after it has received

root-canal treatment. Anterior teeth must resist lateral and

shearing types of forcesThe pulp chambers are too small to

provide adequate retention and resistance without a post

JOURNAL OF ENDODONTICS by The American Association of Endodontists 2005, 2010

Which Post was selected?Glass Fiber PostThey were more flexible than metal

postsHad approximately the same modulus

of elasticity (stiffness) as dentin.Easy to removeMost fiber posts are relatively

radiolucent and have different radiographic appearance than traditional posts

Offer the same advantages as the carbon fiber posts, but with better esthetics.

JOURNAL OF ENDODONTICS by The American Association of Endodontists 2005, 2010

why this post was selected in my case? Excessive loss of coronal structure after the removal of

effected part which made it to categorize in class 4 and 5 categories ( which has only 1 or no walls present )

Ferrule is also indicated in class 4 and 5 of about 2 to 3 mm

(quintessence International 2005)

Minimally invasive because they are bonded and need only be seated to a depth of approximation

(dentistry today 2008)

Design Of the Post for this casePassive Post is more likely because it will

introduce less forces in the canal.

Along with tapered design which require less dentine removal, so more conservation of tooth structure

JOURNAL OF ENDODONTICS by The American Association of Endodontists 2005, 2010

Glass Fiber Posts and drills 

  Color coding

Length Diameter apical

Diameter coronal

Conicity / Taper

Size 0White

20 mm 0.6 mm 1.1 mm 2,86° (5%)

Size 1Yellow

20 mm 0.7 mm 1.3 mm 3,44° (6%)

Size 2Red

20 mm 0.8 mm 1.6 mm 4,58° (8%)

Size 3Blue

20 mm 0.9 mm 1.9 mm 5,72° (10%)

Luting Agent with respect to caseBonded resin cements

have been recommended for their strengthening effect in roots with thin walls

they have low solubility, high mechanical quality and adhesive properties

Good when light penetration is an issue to cure resin especially in canals of root

Core buildup can also be proceed with it

J Applied Oral Science. 2011

CompendiumJanuary 2013, Volume 34, Issue 1

Published by AEGIS Communications

Definitive PhasePost was placed.

Core build up was done along with composite.Coronal portions finishing were done.

THANK YOU