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Journal of Research and Advancement in Dentistry

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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: ashudent@yahoo.com

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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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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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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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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