2017 New Grad Edition - 31

Teeth #2-5 all have profound recurrent decay. In my experience, the only restorations to have
any sort of longevity in this type of mouth are crowns.
I would fill all the teeth on this film (for the most part), and inform the patient that he or she
is going to have extensive treatment needs in the future, based on the fact that dental restorations
do not last forever.
I would probably do a conservative prep E.max or BruxZir crown on the RCT tooth. If a
large D.O. is placed, you may end up needing to RCT re-treat when the tooth gets profound
recurrent decay again (like it had on the original D.O. composite pre-RCT) ■

6/26/2017

You may have missed some of the info we've been posting about how easy, quick and successful you can be with these newer versions of bonding systems and composites. We've shown
multiyear recall successes of large and small composite restorations. The key is attention to
detail and, of course, isolation. In the case shown, even as mediocre as the restorations appear,
the problem is hygiene, which actually is the best predictor of success (or lack thereof). There
is no doubt in my mind that the endo tooth #5 can be successfully restored for many years in
composite. If it fails because of hygiene, guess what else would fail? ■

Tom Mitchell
Member Since: 02/16/04
Post: 37 of 86

6/27/2017

The problem in the OP's case is that the access is very discrete. Very nicely done. Such a
small access, it would be a shame to crown this tooth. It would be the kiss of death if it were
crowned.
A full-coverage crown will destroy all enamel and replace it with a porcelain shell, which will
be sitting on a very narrow root, because the crown prep takes the margin down to where the
diameter is much narrower. Just thinking about it makes me cringe.
With such a tiny access, all you really need is a D.O. composite. You did an amazing job at
conserving tooth structure with the endo. Why destroy your nice work with a crown?
And then there is the economic argument. You have a lot more chances of having problems with a crown than with a well-done composite. All elements are pointing you toward a
composite. ■

eeznogood
Member Since: 02/23/06
Post: 40 of 86

6/27/2017

I'll throw in my two cents: The decay on the mesial #4 and the distal #5 are a direct result
of the open contact. Taking those two teeth out of the equation, the existing restorations are
seemingly intact (excluding #2 M.O.) and there are a number of interproximal lesions that need
addressing.
I would place a well-bonded core as a direct restoration, take care of the general caries and
evaluate #4 at that point. Assuming that the restoration in #4 is well sealed and performing well,
I would inform the patient and let her decide what happens in her mouth. I tend to lean toward
crowning when there is a large MOD plus RCT. ■

DrMentch
Member Since: 09/14/09
Post: 41 of 86

6/27/2017

The hygiene is poor. The diet is poor. There is even the possibility of a chemical dependency
here. I cannot understand why anyone would want to stuff a mouthful of expensive crowns
into such a hostile environment. In my experience, reversing lousy hygiene and diet is limited
in success.
Direct composite is a more prudent economic choice than a mouth full of expensive crowns
until the patient demonstrates it's worth spending the money. Better to have recurrent decay on
the direct than under a crown.
This is a disease. Caries control is one of the basic tenets of treating dental disease. ■

John Kanca
Member Since: 06/21/03
Post: 42 of 86

6/27/2017

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