Repair technique for a fractured crowned tooth

Repair Joseph Medical s. c.

technique

for

a fractured

crowned

T. Richardson, D.D.S., M.A.T.,* and J. Thomas University of South Carolina, College of Dental

tooth Sox, D.M.D.** Medicine, Charleston,

I

n a previously published article, a technique was presented in which a ceramicmetal crown was used for a matrix for making a cast post and core for a fractured anterior to0th.l This technique proved satisfactory but required two appointments. When time and expense are important, a one-appointment technique may be desirable. The current use of composite resins for crown buildups encouraged the authors to try such a technique. Composite resins do not have the crushing strength of amalgam, but they do pcssess shear strength. Since they adapt easily and possess shear strength, they are suitable for core buildups for full-coverage restorations.? This is especially true if the composite resin foundation is reinforced with a metal dowel which will resist horizontal forces3 A PATIENT

PRESENTATION

The patient had a platinum-reinforced porcelain jacket crown placed some 10 years previous to this writing. Shortly after the crown was cemented, endodontic treatment was necessary. About 3 years later, the coronal portion of the preparation fractured, causing dislodgment of the porcelain jacket crown. Five parallel pins were placed into the root facing, and the crown was filled with zinc phosphate cement and was re-placed. After about 5 years, the crown again became dislodged and the procedure was repeated. This lasted another year, and the procedure was repeated again. Approximately a year previous to writing this article, the patient returned to our clinic. The crown was off, including all of the pins and cement (Fig. 1) . All finish lines were intact. A slight, lingual reduction of the crown was necessary to eliminate a deflective occlusal contact. It was decided that a composite buildup reinforced with a metal dowel could be used to repair the existing crown.4 *Professor **At

and Acting

this writing,

Senior

Chairman, Dental

Department

of Crown

and

Bridge

Dentistry.

Student.

547

540

RichardJon

and Sax

Fig.

Fig. into

2. After it.

Fig.

3. The

the wire

pulp dowel

canal

1. The

tooth

is enlarged

is seated

into

with

the crown

to receive

the enlarged

a wire pulp

missing.

dowel,

composite

resin

is injected

canal.

TECHNIQUE (1) A piece of clasp wire* was fitted into the enlarged pulp canal. (The wire dowel should be as long as the clinical crown to provide for adequate retention and to prevent root fracture.J) (2) Composite resin? was injected into the canal (Fig. 2). The metal dowel was inserted in such a way as to insure proper seating of the crown (Fig. 3) . The existing pinholes provided for additional retention. (3) The crown was placed in position. More composite resin was injected into the hole in the lingual portion of the crown, vvhich was used for endodontic treatment (Fig. 4). The patient was instructed to close into centric occlusion to prevent supraocclusion. (4) Excess resin was removed from the margins with an explorer or scaler. *Ortho +Adaptic,

clasp

wire

Johnson

No.

2, Baker

& Johnson,

Dental, Dental

Carteret, Division,

N. J. New

Brunswick,

N. J.

Volume Number

37 5

Repair

Fig. 4. The crown is placed on the preparation, opening. The occlusion is checked, and excess Fig.

5. After

(5) After and polished,

the lingual

opening

is finished,

crowned

tooth

and additional resin is injected into resin is removed from the margins.

the repair

setting, the excess composite the occlusion was rechecked,

of fractured

549

the lingual

is complete.

resin on the lingual aspect was trimmed and the patient was dismissed (Fig. 5).

SUMMARY .A simple technique is presented in which an existing broken endodontically treated tooth in one appointment. ing time and expense required for a new crown.

crown can be replaced on a This can reduce the work-

References 1. 2. 3. 4. 5.

Richardson, J. T., and Padgett, J. G.: Repair Technique for a Fractured, Crowned Anterior Tooth, J. PROSTHET. DENT. 31: 409-410, 1974. Rose, L. A.: Composite Buildup Offers Advantages in Crown Procedures, Dent. Survey 49: 50-51, 1973. Steele, G. D.: Reinforced Composite Resin Foundations for Endodontically Treated Teeth, J. PROSTHET. DENT. 30: 816-819, 1973. Frederick, D. R.: An Application of the Dowel and Composite Resin Core Technique, J. PROSTHET. DENT. 32: 420-424, 1974. Spanauf, A. J.: Dowel and Core Foundations Using the Composite Adaptic, Quintessence Int. 3: 49-51, 1972. DR.

RICHARDSON

MEDICAL COLLEGE

UNIVERSITY OF DENTAL

S. C. 29401

CHARLESTON, DR.

Sox

10116 COLUMBIA,

OF SOUTH MEDICINE

BURWELL

LN.

S. C. 29205

CAROLINA