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Technique for repair of multiple abutment teeth under preexisting crowns
Technique for repair of multiple abutment teeth under preexisting crowns Daniel C. N. Chan, DDS, MSa Medical College of Georgia, Augusta, Ga. This technique describes a simple procedure for repairing multiple fractured or broken-down abutment teeth under existing crowns. The technique uses a Teflon tape polytetrafluoroethylene (PTFE) as a matrix and separating medium for fabrication of an autopolymerizing composite core material with digital pressure. This technique enables the dentist to solve an emergency clinical situation in a relatively short amount of time, pending further restoration with endodontic treatment and a cast post and core procedure. (J Prosthet Dent 2003;89:91-92.)
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etreatment of previously crowned abutment teeth because of fracture is common.1 Tooth fracture accounts for 56% of retreatments, whereas caries and loss of retention account for only 24% of retreatments. Various techniques have been reported to fabricate or replace cast post and core.2-6 One method uses the original die or its replica, a vinyl polysiloxane matrix, and autopolymerizing resin (Duralay; Reliance Dental Manufacturing, Worth, Ill.). This article describes a simple procedure in which polytetrafluoroethylene (PTFE) is used as a matrix and separating medium to repair multiple fractured or broken-down abutment teeth under existing crowns. After the core buildup is completed, conventional techniques2-6 can be used to restore the dentition.
TECHNIQUE 1. A 6-unit fixed partial denture (FPD) was dislodged because of fracture of the maxillary right canine abutment and carious maxillary left canine abutment. It should be noted that 2 to 3 mm of sound tooth structure remains above the gingival margin of the maxillary right canine (Fig. 1). 2. Clean individual crowns with high-speed carbide round burs (GW6R or GWSL6R; SS White Bur Inc, Lakewood, N.J.), followed by air-abrasion and pressure steaming (remove all remnants of tooth substance and luting cement inside crowns). 3. Lightly coat internal and external aspect of crown with petroleum jelly (Fougera; E. Fougera and Co, Melville, N.Y.) and adapt PTFE tape (TFE Threaded Seal Tape; Oatey, Cleveland, Ohio). Petroleum jelly will help the PTFE adhere to the crown and further protect the exposed surface from excess material sticking (Fig. 2). 4. Remove carious and soft dentin on abutments with a slow-speed No. 6 or No. 8 large round bur (SS White Bur Inc). Prepare tooth substrate surface for bonding by proper etching, priming, and application of adhesive. a
Associate Professor and Director, Division of Operative Dentistry, Department of Oral Rehabilitation.
JANUARY 2003
Fig. 1. Remaining tooth structure on maxillary right canine after crown/tooth fracture. Similar situation exists in maxillary left canine.
Fig. 2. Crown adapted with PTFE tape inside. Note tape material covering margins. Excess material will not adhere to crown and can be removed easily with hand instruments and bur.
5. Add autopolymerizing composite resin for core buildup (Encore with fluoride; Centrix Inc, Shelton, Conn.) to the cavity in the abutment crowns as well as onto the tooth surfaces. Seat the FPD in place under light digital pressure to ensure proper fitting. Allow THE JOURNAL OF PROSTHETIC DENTISTRY 91
THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 3. Crown seated in place. Core buildup material allowed to set under finger pressure.
CHAN
Fig. 4. Six-unit FPD removed with minimal trauma. Excess material trimmed with coarse diamond bur and refined to tooth margins.
of convergence).7 This technique will also work in the fabrication of provisional multiple crowns with a slightly different path of draw. The PTFE also serves as a barrier for petroleum jelly so that the polymerized composite surface will not be contaminated by the petroleum jelly, resulting in a better surface for subsequent bonding.8 This technique works best if there is 2 to 3 mm of remaining sound tooth structure above the margins. The tooth structure can guide the refining of the core buildup as well as provide adequate retention and resistance. REFERENCES Fig. 5. Core ready to receive temporary cement.
core buildup material to polymerize under pressure (Fig. 3). 6. Remove FPD by gently tapping with a Morrell Crown Remover (Franklin Dental Supply Inc, Valley Stream, N.Y.). Trim excess material by hand instruments such as a scaler (Hu-Friedy Mfg Co, Chicago, Ill.) and 5850 diamond bur (Brasseler USA, Savanna, Ga.). Refine core to desired form and existing tooth margins (Figs. 4 and 5). 7. Cement FPD core with temporary cement (Temp Bond; Kerr Manufacturing Co, Romulus, Mich.). Use resin-modified glass ionomer cement if additional retention is desired.
SUMMARY The advantages of this technique are simplicity and timeliness. A single thickness of the PTFE averages 50 m, which creates a built-in relief thickness of more than 50 m. The PTFE tape can be adapted onto the internal surfaces to allow for some overlapping of the tape. Such relief assists the clinician if the path of draw of multiple abutments is tighter than ideal (3 to 5 degrees 92
1. Walton TR. A 10-year longitudinal study of fixed prosthodontics: clinical characteristics and outcome of single-unit metal-ceramic crowns. Int J Prosthodont 1999;12:519-26. 2. Brady WF. Restoration of a tooth to accommodate a preexisting cast crown. J Prosthet Dent 1982;48:268-70. 3. Heilman ME VI. A simplified pattern for a cast metal post. J Am Dent Assoc 1998;129:223. 4. Portera JJ, Thomson JA. Reuse of existing crown after tooth fracture at the gingival margin. J Prosthet Dent 1983;50:195-7. 5. Sabbak SA. Simplified technique for refabrication of cast posts and cores. J Prosthet Dent 2000;83:686-7. 6. Rosen H. Dissolution of cement, root caries, fracture, and retrofit of post and cores. J Prosthet Dent 1998;80:511-3. 7. Wilson AH Jr, Chan DC. The relationship between preparation convergence and retention of extracoronal retainers. J Prosthodont 1994;3:74-8. 8. Walshaw PR, McComb D. Clinical considerations for optimal dentinal bonding. Quintessence Int 1996;27:619-25. Reprint requests to: DR DANIEL C. N. CHAN ASSOCIATE PROFESSOR AND DIRECTOR DIVISION OF OPERATIVE DENTISTRY DEPARTMENT OF ORAL REHABILITATION MEDICAL COLLEGE OF GEORGIA AUGUSTA, GA 30912-1260 FAX: (706)721-8349 E-MAIL: [email protected] Copyright © 2003 by The Editorial Council of The Journal of Prosthetic Dentistry. 0022-3913/2003/$30.00 ⫹ 0 doi:10.1067/mpr.2003.65
VOLUME 89 NUMBER 1
R
etreatment of previously crowned abutment teeth because of fracture is common.1 Tooth fracture accounts for 56% of retreatments, whereas caries and loss of retention account for only 24% of retreatments. Various techniques have been reported to fabricate or replace cast post and core.2-6 One method uses the original die or its replica, a vinyl polysiloxane matrix, and autopolymerizing resin (Duralay; Reliance Dental Manufacturing, Worth, Ill.). This article describes a simple procedure in which polytetrafluoroethylene (PTFE) is used as a matrix and separating medium to repair multiple fractured or broken-down abutment teeth under existing crowns. After the core buildup is completed, conventional techniques2-6 can be used to restore the dentition.
TECHNIQUE 1. A 6-unit fixed partial denture (FPD) was dislodged because of fracture of the maxillary right canine abutment and carious maxillary left canine abutment. It should be noted that 2 to 3 mm of sound tooth structure remains above the gingival margin of the maxillary right canine (Fig. 1). 2. Clean individual crowns with high-speed carbide round burs (GW6R or GWSL6R; SS White Bur Inc, Lakewood, N.J.), followed by air-abrasion and pressure steaming (remove all remnants of tooth substance and luting cement inside crowns). 3. Lightly coat internal and external aspect of crown with petroleum jelly (Fougera; E. Fougera and Co, Melville, N.Y.) and adapt PTFE tape (TFE Threaded Seal Tape; Oatey, Cleveland, Ohio). Petroleum jelly will help the PTFE adhere to the crown and further protect the exposed surface from excess material sticking (Fig. 2). 4. Remove carious and soft dentin on abutments with a slow-speed No. 6 or No. 8 large round bur (SS White Bur Inc). Prepare tooth substrate surface for bonding by proper etching, priming, and application of adhesive. a
Associate Professor and Director, Division of Operative Dentistry, Department of Oral Rehabilitation.
JANUARY 2003
Fig. 1. Remaining tooth structure on maxillary right canine after crown/tooth fracture. Similar situation exists in maxillary left canine.
Fig. 2. Crown adapted with PTFE tape inside. Note tape material covering margins. Excess material will not adhere to crown and can be removed easily with hand instruments and bur.
5. Add autopolymerizing composite resin for core buildup (Encore with fluoride; Centrix Inc, Shelton, Conn.) to the cavity in the abutment crowns as well as onto the tooth surfaces. Seat the FPD in place under light digital pressure to ensure proper fitting. Allow THE JOURNAL OF PROSTHETIC DENTISTRY 91
THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 3. Crown seated in place. Core buildup material allowed to set under finger pressure.
CHAN
Fig. 4. Six-unit FPD removed with minimal trauma. Excess material trimmed with coarse diamond bur and refined to tooth margins.
of convergence).7 This technique will also work in the fabrication of provisional multiple crowns with a slightly different path of draw. The PTFE also serves as a barrier for petroleum jelly so that the polymerized composite surface will not be contaminated by the petroleum jelly, resulting in a better surface for subsequent bonding.8 This technique works best if there is 2 to 3 mm of remaining sound tooth structure above the margins. The tooth structure can guide the refining of the core buildup as well as provide adequate retention and resistance. REFERENCES Fig. 5. Core ready to receive temporary cement.
core buildup material to polymerize under pressure (Fig. 3). 6. Remove FPD by gently tapping with a Morrell Crown Remover (Franklin Dental Supply Inc, Valley Stream, N.Y.). Trim excess material by hand instruments such as a scaler (Hu-Friedy Mfg Co, Chicago, Ill.) and 5850 diamond bur (Brasseler USA, Savanna, Ga.). Refine core to desired form and existing tooth margins (Figs. 4 and 5). 7. Cement FPD core with temporary cement (Temp Bond; Kerr Manufacturing Co, Romulus, Mich.). Use resin-modified glass ionomer cement if additional retention is desired.
SUMMARY The advantages of this technique are simplicity and timeliness. A single thickness of the PTFE averages 50 m, which creates a built-in relief thickness of more than 50 m. The PTFE tape can be adapted onto the internal surfaces to allow for some overlapping of the tape. Such relief assists the clinician if the path of draw of multiple abutments is tighter than ideal (3 to 5 degrees 92
1. Walton TR. A 10-year longitudinal study of fixed prosthodontics: clinical characteristics and outcome of single-unit metal-ceramic crowns. Int J Prosthodont 1999;12:519-26. 2. Brady WF. Restoration of a tooth to accommodate a preexisting cast crown. J Prosthet Dent 1982;48:268-70. 3. Heilman ME VI. A simplified pattern for a cast metal post. J Am Dent Assoc 1998;129:223. 4. Portera JJ, Thomson JA. Reuse of existing crown after tooth fracture at the gingival margin. J Prosthet Dent 1983;50:195-7. 5. Sabbak SA. Simplified technique for refabrication of cast posts and cores. J Prosthet Dent 2000;83:686-7. 6. Rosen H. Dissolution of cement, root caries, fracture, and retrofit of post and cores. J Prosthet Dent 1998;80:511-3. 7. Wilson AH Jr, Chan DC. The relationship between preparation convergence and retention of extracoronal retainers. J Prosthodont 1994;3:74-8. 8. Walshaw PR, McComb D. Clinical considerations for optimal dentinal bonding. Quintessence Int 1996;27:619-25. Reprint requests to: DR DANIEL C. N. CHAN ASSOCIATE PROFESSOR AND DIRECTOR DIVISION OF OPERATIVE DENTISTRY DEPARTMENT OF ORAL REHABILITATION MEDICAL COLLEGE OF GEORGIA AUGUSTA, GA 30912-1260 FAX: (706)721-8349 E-MAIL: [email protected] Copyright © 2003 by The Editorial Council of The Journal of Prosthetic Dentistry. 0022-3913/2003/$30.00 ⫹ 0 doi:10.1067/mpr.2003.65
VOLUME 89 NUMBER 1