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Journal of Research and Advancement in Dentistry
Vol.1 No. 3, July- Oct 2012 133
Custom made post & core used to correct malpositioned maxillary canine -
A case report
a1 2 3Ashish Kumar Srivastava , Ujjal Chatterjee , Madhu Ranjan
Abstract:Maxillary Canine plays a major role in the esthetic component of an individual. Loss of Caninenot only compromises esthetics, but also limits the Prosthodontics option to replace this
particular tooth. The presence of poor abutments mesial & distal to the Canine leaves us withthe option to use Implants or Removable Partial Denture. However Maxillary Canine whenmalpositioned can be corrected even if the patient disagrees with Orthodontic treatment due tothe time constrains & economic factors.
Introduction:
Malocclusion is a common problem in
today's population. However the degree of
severity varies from case to case.
O r t h o d o n t i c - P r o s t h o d o n t i c s
interrelationship is well documented. Certain
factors will always indicate either of the two.
The most common deciding factors amongothers are, the age of the patient, predictable
time period for Orthodontic treatment, Loss
of permanent tooth / teeth to make way for
space. Custom post & core gives us the
advantage to change the alignment of the
long axis of the tooth & bring it to an
acceptable position so as to give a pleasing
e s t h e t i c a p p e a r a n c e & m a x i m u m
preservation of natural tooth structure
aCorresponding author: [email protected]
1Reader, Department of Prosthodontics, Hazaribagh
College of Dental Sciences & Hospital, Hazaribagh2Professor & H.O.D. Department of Prosthodontics,
Hazaribagh College of Dental Sciences & Hospital,
Hazaribagh
3Reader, Department of Prosthodontics Hazaribagh
College of Dental Sciences & Hospital, Hazaribagh
Case report:
A 20 year old male reported with chief
complains of poor esthetics as one of the
upper front teeth was discolored, out of shape
and alignment. History revealed a prior
treatment of cheek laceration in left anterior
region due to malpositioned canine which
was treated by excessive coronal tooth
reduction (Fig.1). This led to the tooth being
non-vital. The patient wanted to correct his
appearance, but was reluctant to Orthodontic
treatment due to time factor. Co-relation of
radiographic & clinical examination
suggested endodontic treatment of 23.
Custom made post & core followed by metal
ceramic crown was planned.
After evaluation of endodontic
treatment, the tooth was prepared for post and
core. The coronal tooth structure was
modified with rotary instruments (Fig.2). For
post space preparation, entire length of the
obturated canal was measured & the apical 4-5 mm of gutta percha was left
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Journal of Research and Advancement in Dentistry
Vol.1 No. 3, July- Oct 2012 134
intact. The canal was prepared in an
elliptical shape so as to prevent rotation of
the Post. This was done by using rotatory
instruments, specific files, Pesso reamers,
or gates glidden drills, approximately the
size of no. 90 file. The coronal end of the
canal is funneled. Remaining coronal tooth
structure was prepared to produce ferrule
effect.
Direct technique was used for
making the pattern of the post and core. After
lubrication of post space with thin layer of
petrolatum jelly, impression was made using
prefabricated acrylic post by sprinkle
method. After checking the fit & lack of
undercut in the post, core was made by
adding some more acrylic on the coronal
portion, which was then modified to the level
of alignment required for correction of the
position of the canine (Fig.3).
The acrylic pattern was invested in
conventional way & the casting done. The
procured cast of post & core (Fig.4) was
finished, polished and then checked in the
mouth for fit, alignment, and any
discrepancy. It was then cemented using type
I glass ionomer cement. Using high speed
rotary hand piece, the core was prepared for
further alignment & smoothening (Fig.5). An
elastomeric impression was made of the
prepared tooth. Acrylic temporary crown
was placed. Metal trial on subsequent visit
was done & shade selected. The fabricated
Metal ceramic crown was cemented using
luting Glass Ionomer Cement (Fig.6).
Discussion:
Prior to treatment an evaluation of
endodontic status, periodontal status,
1,2,3
restorability of the tooth must be made.
The reinforcement of tooth is essential when
selecting a post and core technique. The
procedure should not weaken the tooth or
risk of the loss of the endodontic seal.
Excessive canal enlargement or apical
extension that leaves less than 4-5 mm of
4,5apical gutta percha should be avoided. The
cast post and core maintains the integrity of
the tooth with a cervical collar exhibiting the
4,6,7,8,9ferrule effect. The preparation of the
tooth should extend 2 mm beyond the
cervical margin of the post and core. In direct
technique to develop the pattern of the canalacrylic, plastic, tooth pick, nails, paper clips
and so on have been reported. Careful
consideration of occlusion and load transfer
4,6,7,10,11,12,13has to be planned.
A cast post and core may be indicated
when a tooth is misaligned and the core must
be angled in relation to the post to achieve
proper alignment with the adjacent teeth.
Perhaps the biggest disadvantage for cast
post and cores is in areas that require an
esthetic temporary restoration. Satisfactory
result obtained both functionally &
esthetically bought to forefront the benefits
of cast post & core. It is a prolonged method
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Journal of Research and Advancement in Dentistry
Vol.1 No. 3, July- Oct 2012 135
Fig 1 Nonvital malpositioned 23 with
excessive coronal tooth structure loss
Fig 2 Gross Reduction of remaining
coronal tooth structure & root canal
preparation for post impression.
Fig 3 Acrylic post & core placed in
prepared root canal for final check of
alignment
Fig 4 Post & core obtained after
casting
Fig 5 Cast post & core cemented into
prepared root canal
Fig 6 Final restoration of PorcelainFused to Metal crown fixed on Canine.
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Journal of Research and Advancement in Dentistry
Vol.1 No. 3, July- Oct 2012 136
including additional laboratory & clinical4,8,12,13
steps.
Conclusion:
Conventional custom post & core technique
still is advantageous against newer materials
in case of altering the alignment of tooth. Its
disadvantages are high level of precision &
occurrences of casting failure. Rigidity of
metal & non parallel alignment to long axis
of tooth can lead to fracture provided
meticulous steps are taken to prevent
occurrences of traumatic forces.
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