Case 39 | Prosthodontic Award 2015 | Mexico
Dr. René Rodriguez Romero
A thirty two years old female patient that came into the dental office with the chief complain “I want you to do some surgery to change the color of my gum and change the Crown”.
The following dental history was identified: She had lost her tooth at the age of 12, a root canal treatment was performed, followed by a post and core; and porcelain fused to metal crown. She changed the PFM two more times at the ages of 16 and 26; both were PFM.
At the time she arrived to our office, she refered having a thin periodonto and gum inflamation because the overconture of the Crown. When PFM crown was removed, a metalic nail was found used as post; it was removed with an ultrasonic instrument.The pigmentation caused by the nail was not only in the core, it was also all inside the root. The root canal treatment seems good. We cleaned the canal and sealed with flowable composite; an internal and external bleaching protocol was improved. Expressed 35% hydrogen peroxide inside the root and the chamber and placed a tinny cotton pellet in gel. Then the provisional restoration were placed and leaved for 3 days, this procedure was repeated 3 more times. Then after 3 weeks a new fiber post was placed.(Parapost-Fiberlux, Coltene).
The final impression was taken with regular and light material using a one step technique, with double retraction cord (00 and 000). A color map and photos of the colorimeter were deliver to the laboratory, the main complex was the fluorosis and texture of the teeth. A lithium disilicate with makeup technique was fabricated (e-max, Ivoclar Vivadent). Two different porcelain test were placed then, the patient was very satisfied with the result so we decided to cement.
The lithium disilicate crown was etched with 9% hydrofluoric acid (Porcelain Etch; Ultradent Products, Inc) for 20 seconds then rinsed for 20 seconds. The prothesis was subjected to postetching cleaning using phosphoric acid (Ultra-Etch; Ultradent Products, Inc) with a brushing motion for 1 minute, followed by rinsing for 20 seconds, and then immersion in alcohol at 95% in an ultrasonic bath for 3 minutes. After thorough air drying, intaglio surfaces were silanated (Silane; Ultradent Products, Inc) and heat dried at 100oC for 5 minutes.
Dentin etching for 5 seconds with a 37.5% phosphoric acid (Ultra-Etch; Ultradent Products, Inc, South Jordan, Utah), abundant rinsing, careful air drying with no desiccating for 3 to 5 seconds. The next step was the application of the adhesive (Adhese, Ivoclar Vivadent) with a scrubing motion for 15 seconds, air drying for 3 seconds, and no polimerization. A resin cement A2 were used as luting agent (Relyx 200, 3M). All excess were removed after polimerization with a thin instrument and a scalpel.
The patient was clearly satisfied with the overall treatment, although she was very timid in expressing her satisfaction. The restorations integrated nicely and naturally with the rest of the dentition (colour and shape), and the soft tissues remained very healthy. Despite we could not eliminate the complete pigmentation of the tooth, the results seems very nice in a social distance.