Journal of Research and Advancement in Dentistry

Vol.1 No. 3, July- Oct 2012 133

Custom made post & core used to correct malpositioned maxillary canine -
A case report
a1 2 3
Ashish Kumar Srivastava , Ujjal Chatterjee , Madhu Ranjan
Abstract:
Maxillary Canine plays a major role in the esthetic component of an individual. Loss of Canine
not only compromises esthetics, but also limits the Prosthodontics option to replace this
particular tooth. The presence of poor abutments mesial & distal to the Canine leaves us with
the option to use Implants or Removable Partial Denture. However Maxillary Canine when
malpositioned can be corrected even if the patient disagrees with Orthodontic treatment due to
the time constrains & economic factors.
Introduction:
Malocclusion is a common problem in
today's population. However the degree of
severity varies from case to case.
O r t h o d o n t i c - P r o s t h o d o n t i c s
interrelationship is well documented. Certain
factors will always indicate either of the two.
The most common deciding factors among
others are, the age of the patient, predictable
time period for Orthodontic treatment, Loss
of permanent tooth / teeth to make way for
space. Custom post & core gives us the
advantage to change the alignment of the
long axis of the tooth & bring it to an
acceptable position so as to give a pleasing
e s t h e t i c a p p e a r a n c e &ma x i mu m
preservation of natural tooth structure
a
Corresponding author: ashudent@yahoo.com
1
Reader, Department of Prosthodontics, Hazaribagh
College of Dental Sciences & Hospital, Hazaribagh
2
Professor & H.O.D. Department of Prosthodontics,
Hazaribagh College of Dental Sciences & Hospital,
Hazaribagh
3
Reader, Department of Prosthodontics Hazaribagh
College of Dental Sciences & Hospital, Hazaribagh
Case report:
A 20 year old male reported with chief
complains of poor esthetics as one of the
upper front teeth was discolored, out of shape
and alignment. History revealed a prior
treatment of cheek laceration in left anterior
region due to malpositioned canine which
was treated by excessive coronal tooth
reduction (Fig.1). This led to the tooth being
non-vital. The patient wanted to correct his
appearance, but was reluctant to Orthodontic
treatment due to time factor. Co-relation of
radiographic & clinical examination
suggested endodontic treatment of 23.
Custom made post & core followed by metal
ceramic crown was planned.
After evaluation of endodontic
treatment, the tooth was prepared for post and
core. The coronal tooth structure was
modified with rotary instruments (Fig.2). For
post space preparation, entire length of the
obturated canal was measured & the apical 4-
5 mm of gutta percha was left
Journal of Research and Advancement in Dentistry
Vol.1 No. 3, July- Oct 2012 134
intact. The canal was prepared in an
elliptical shape so as to prevent rotation of
the Post. This was done by using rotatory
instruments, specific files, Pesso reamers,
or gates glidden drills, approximately the
size of no. 90 file. The coronal end of the
canal is funneled. Remaining coronal tooth
structure was prepared to produce ferrule
effect.
Direct technique was used for
making the pattern of the post and core. After
lubrication of post space with thin layer of
petrolatum jelly, impression was made using
prefabricated acrylic post by sprinkle
method. After checking the fit & lack of
undercut in the post, core was made by
adding some more acrylic on the coronal
portion, which was then modified to the level
of alignment required for correction of the
position of the canine (Fig.3).
The acrylic pattern was invested in
conventional way & the casting done. The
procured cast of post & core (Fig.4) was
finished, polished and then checked in the
mouth for fit, alignment, and any
discrepancy. It was then cemented using type
I glass ionomer cement. Using high speed
rotary hand piece, the core was prepared for
further alignment & smoothening (Fig.5). An
elastomeric impression was made of the
prepared tooth. Acrylic temporary crown
was placed. Metal trial on subsequent visit
was done & shade selected. The fabricated
Metal ceramic crown was cemented using
luting Glass Ionomer Cement (Fig.6).
Discussion:
Prior to treatment an evaluation of
endodontic status, periodontal status,
1,2,3
restorability of the tooth must be made.
The reinforcement of tooth is essential when
selecting a post and core technique. The
procedure should not weaken the tooth or
risk of the loss of the endodontic seal.
Excessive canal enlargement or apical
extension that leaves less than 4-5 mm of
4,5
apical gutta percha should be avoided. The
cast post and core maintains the integrity of
the tooth with a cervical collar exhibiting the
4,6,7,8,9
ferrule effect. The preparation of the
tooth should extend 2 mm beyond the
cervical margin of the post and core. In direct
technique to develop the pattern of the canal
acrylic, plastic, tooth pick, nails, paper clips
and so on have been reported. Careful
consideration of occlusion and load transfer
4,6,7,10,11,12,13
has to be planned.
A cast post and core may be indicated
when a tooth is misaligned and the core must
be angled in relation to the post to achieve
proper alignment with the adjacent teeth.
Perhaps the biggest disadvantage for cast
post and cores is in areas that require an
esthetic temporary restoration. Satisfactory
result obtained both functionally &
esthetically bought to forefront the benefits
of cast post & core. It is a prolonged method
Journal of Research and Advancement in Dentistry
Vol.1 No. 3, July- Oct 2012 135
Fig 1 Nonvital malpositioned 23 with
excessive coronal tooth structure loss
Fig 2 Gross Reduction of remaining
coronal tooth structure & root canal
preparation for post impression.
Fig 3 Acrylic post & core placed in
prepared root canal for final check of
alignment
Fig 4 Post & core obtained after
casting
Fig 5 Cast post & core cemented into
prepared root canal
Fig 6 Final restoration of Porcelain
Fused to Metal crown fixed on Canine.
Journal of Research and Advancement in Dentistry
Vol.1 No. 3, July- Oct 2012 136
including additional laboratory & clinical
4,8,12,13
steps.
Conclusion:
Conventional custom post & core technique
still is advantageous against newer materials
in case of altering the alignment of tooth. Its
disadvantages are high level of precision &
occurrences of casting failure. Rigidity of
metal & non parallel alignment to long axis
of tooth can lead to fracture provided
meticulous steps are taken to prevent
occurrences of traumatic forces.
References:
1. Rosensteil S.F., Land M. F.,Fujimoto J.
rd
Contempory Fixed Prosthodontics 4
edition ch-12 pg 336.
2. Malone W.F.P., Koth D.L., Cavozos E.
Jr., Kaiser D.A. & Morgano S.M.
Tylman's Theory and Practice of Fixed
th n
Prosthodontics. 8 ed pg no 407.
th
3. Cohen. Pathways of the pulp 8 edition;
pg 765-793.
4. Richard S. Schwartz and James W.
Robbi ns . Pos t Pl acement and
Restoration of Endodontically Treated
Teeth: A Literature Review. Journal of
endodontics: vol. 30, no. 5, May 2004;
pg no 289-301.
5. Marwan Abou-Rass. The restoration of
endodontically treated teeth: New
answers to an old problem. AO vol. 75,
fall 1982; pg no. 68-97.
6. Linards Grieznis, Peteris Apse, Una
Soboleva. The effect of 2 different
diameter cast posts on tooth root fracture
resistance in vitro. Stomatologija, Baltic
Dental and Maxillofacial Journal, 8:30-
2, 2006.
7. Markus Balkenhol a, Bernd Wostmann a,
Christian Rein b, Paul Ferger. Survival
time of cast post and cores: A
10 year retrospective study. Journal of
dentistry 35 (2007) 5058.
8. Guido Heydecke, Mathilde C. Peters.
The restoration of endodontically
treated, single rooted teeth with cast or
direct posts and cores: A systemic
review. J Prosthet Dent 2002; 87:380-6.
9. N. R. Stankiewicz & P. R.Wilson. The
ferrule effect: A literature review.
International Endodontic Journal, 35,
575^581, 2002.
10. EV Bass. Cast post and core foundation
for the badly broken down molar tooth.
Australian Dental Journal 2002; 47 :(
1):57-62.
11. Oliver Pontius, Dr med dent, MSD, and
Jeffrey W. Hutter. Survival rate and
fracture strength of incisors restored
with different post and core systems and
endodontically treated incisors without
coronoradicular reinforcement. Journal
of endodontics Vol. 28, no. 10, October
2002; 710-15.
12. Ingrid Peroz, Felix Blekenstein, Klaus-
Peter Lang, Michel Newman. Restoring
endodontically treated teeth with posts
and cores- A review. Quintessence Int
2005; 36; 737-46.
13. Pia K. Wegner, Sandra Freitag, and
Matthias Kern. Survival rate of
endodontically treated teeth with posts
after prosthetic restoration. J Endod
2006; 32, 928-31.