Dentaltown January 2017 - 28

show your work
case study

Crowning a Winner

Retrofitting a crown on a compromised endodontic-treated tooth
by Dr. Isaias Íñiguez
Dr. Isaias Íñiguez graduated from La
Universidad Autónoma de Baja California
and went on to complete a postgraduate
program in aesthetic dentistry from Baylor
College of Dentistry in Dallas. Íñiguez was
the first Latin American dentist accredited
by The American Academy of Cosmetic Dentistry (AACD) in
1998; he continues to be the only accredited member of
the AACD with a practice in Mexico. Íñiguez is also an active
member of the American Dental Association, the California
Dental Association and the Association Dental Mexicana.

A note from the editor:
Last October we introduced a new department called "Show Your Work" that gives
Townies another opportunity to do just
that. Here, you'll find straightforward case
studies that your fellow dentists
take pride in.
Maybe they feel like they've finally mastered
a new technique they've been working on.
Perhaps they rose to the challenge of a
particularly tough patient case. Or it could
be that they just want bragging rights for
something that, in their eyes, approaches
perfection.

Introduction
A dislodged anterior crown with an
endodontic post needs immediate replacement.
Retrofitting and cementation of the existing
crown will save the patient time and money.
This case report demonstrates a precise method
for readapting an existing crown on a tooth
with an inadequate circumferential ferrule.

Case report
A 62-year-old male complained of tooth
mobility; a clinical examination revealed that
the crown on #6 became dislodged along
the fractured fiber post (Fig. 1). The X-ray
confirmed the root canal was intact and once
the crown was removed the remaining tooth
structure also appeared intact (Fig. 2). The
decision was made to rebond the crown.
I removed the remaining restorative
material and made an opening through the
lingual surface to facilitate the insertion of
the anatomic fiber post (Fig. 3)-a tapered
one (DT Light Illusion X-RO from Bisco1),
because parallel fiber posts require removal

of sound radicular dentine, which creates
sharper internal angles that may result in a
weakened root and a higher fracture risk.2
The post would be bonded through the
crown after it had been adhesively cemented.
After rubber dam isolation, no additional
dentin should be removed.3 I placed an
UltraPak retraction cord (Ultradent) and
cleaned the canal with alcohol, then 2%
chlorhexidine Cavity Cleanser (Bisco) before
trying on the crown for fit evaluation. I
sandblasted the remaining tooth structure
using MicroEtcher (Danville Materials),
then used Kerr's Take1 Light Body PVS
material to fill the endodontic access and
prevent residual restorative material from
entering. I applied Select HB Etch (Bisco), a
35% phosphoric acid solution, to the residual
structure for 15 seconds, then rinsed and
rewet with 2% chlorhexidine (Fig. 4) before
using Optibond FL etch-and-rinse adhesive
(Kerr). I applied multiple layers of primer
(Fig. 5, p. 30), followed by a thin layer of
adhesive agent and light curing (Fig. 6, p. 30).

Fig. 1

Fig. 3

Fig. 2

Fig. 4

If you've got a case you think might be a
great fit, shoot me an email:
sam@farranmedia.com. Be sure to include
a sentence that sums up why this case is so
special to you, to help us review and select
the best contenders for publication.
One last clarification: This opportunity is
available to registered Townies only! So be
sure to update your member information at
Dentaltown.com before giving us a shout.
Thank you!
Sam Mittelsteadt

28

Continued on p. 30

DECEMBER 2016 // dentaltown.com
http://www.Dentaltown.com http://www.dentaltown.com
Table of Contents for the Digital Edition of Dentaltown January 2017
