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Special Issues
July/August 2023
Volume 44, Issue 1
Peer-Reviewed

The Art of Saving Teeth: Restoring a Central Incisor With a New Post and Crown

Andrés López, DDS

A 39-year-old male patient who previously had suffered dental trauma in his maxillary right central incisor presented with esthetic concerns. He had a metal cast post and ceramic metal crown and was seeking a more esthetic alternative. A clinical evaluation, photographs, and x-rays were carried out for diagnosis and planning. Digital planning and a mock-up were generated for esthetic analysis, which showed the negative impact of the darkened gingiva. A carious lesion and peripheral sealing failure of the porcelain-fused-to-metal (PFM) crown were evident. The treatment plan included the removal of the PFM crown and cast metal post and endodontic retreatment. A fiberglass post and new ceramic crown were indicated. After placement of the fiberglass post, a provisional acrylic crown was placed for 6 weeks, with clinical evaluations performed every 15 days to assist in the gingival recontouring of the soft tissue. Impressions were taken after the gingival tissue healed. To ensure the final ceramic restoration was properly prepared before cementation, etching was performed with 9.5% hydrofluoric acid Porcelain Etchant (BISCO, bisco.com). Silane (Porcelain Primer™, BISCO) was applied after rinsing and drying the restoration. A dual-cured universal adhesive (Universal Primer™, BISCO) and adhesive resin cement (Duo-Link Universal™, BISCO) were used to cement the crown.

Key Takeaways

Digital planning and mock-up are essential when restoring the anterior region. Gingival recontouring with provisional restorations will aid in the proper healing and placement of the gingival tissue.

The use of pure silane as a primer for glass-containing ceramic restorations will yield high bond strength.

In restorations that are 1.5 mm in thickness or more, the use of a dual-cured cement is indicated.

 

About the Author
Andrés López, DDS
Private Practice, Buenos Aires, Argentina

Fig 1. Extraoral photographs were taken to examine the patient’s facial features and the relation of the teeth and lips at smile and rest positions.

Figure 1

Fig 2. Smile analysis.

Figure 2

Fig 3. Intraoral images, including this lateral view, showed the maladaptive metal-ceramic crown. Darkening and inflammation of the gingival tissue was evident.

Figure 3

Fig 4. Tooth No. 9 was used as a digital guide to achieve proper design of No. 8.

Figure 4

Fig 5. Darkening and inflammation of the gingival tissue were still evident.

Figure 5

Fig 6. Full digital mock-up, which serves as an excellent non-invasive digital treatment planning tool.

Figure 6

Fig 7. PFM and cast metal post removal; a fiber post and core build-up would then be performed and impressions taken.

Figure 7

Fig 8. A fiberglass post was placed.

Figure 8

Fig 9. Provisionalization was performed.

Figure 9

Fig 10. Clinical evaluation 1 week after seating the temporary acrylic crown.

Figure 10

Fig 11. Universal Primer dual-cured universal adhesive and Duo-Link Universal adhesive resin cement were used to cement the final crown.

Figure 11

Fig 12. Extraoral view, immediate postoperative.

Figure 12

Fig 13. Intraoral view, 10 days after cementation.

Figure 13

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