It is a widely accepted practice that an endodontically treated tooth with substantial loss of tooth structure should undergo restoration with a post and core before the final crown is prepared and placed. The post and core play a crucial role in restoring the missing tooth structure, thereby enhancing the overall strength of the tooth and ensuring optimal resistance and retention for the final crown. Traditionally, the post was primarily seen as providing retention for the final core material. However, with advancements in adhesive dentistry, it is now recognized that a post can be effectively bonded to the root structure, offering adhesive benefits to both the core and the final crown.
This approach offers several advantages: it saves time, preserves sound tooth structure, exhibits high reliability when executed correctly, and is cost-effective. When restoring endodontically treated teeth with a post and core, we aim for three main things:
- A reliable dental adhesive that can set both chemically and by light.
- A strong post that does not have any voids or fractures.
- A unique composite resin material that can dual cure. This material should set like a natural tooth, allowing for precise shaping with rotary tools.
In this case presentation, we will discuss how the combined use of LuxaBond Universal, LuxaPost, and LuxaCore Z Dual helped save a fractured endodontically treated UR5.
**Case Discussion**
A middle-aged oncology patient presented with a fractured crown on the endodontically treated 15. The patient was about to undergo chemotherapy and radiotherapy for ongoing cancer treatment but required a fix for the recently broken, asymptomatic tooth. The patient did not have the luxury of multiple visits due to ongoing medical care but fortunately had the broken crown at hand.
Fig.1
Fractured tooth 15. We can see some residual buccal porcelain that had remained attached to the tooth.
Fig.2
Upon removing the residual porcelain fragment, we observed the remaining tooth tissue.
Fig.3
Another more buccal angle to show the fractured 15.
Fig.4
The porcelain crown was used to make a silicone index, which would be used later to remake a temporary crown.
Fig.5
Isolation was achieved using a heavy rubber dam.
Fig.6
Caries were removed, and the GIC plug was taken out to access the guttapercha.
Fig.7
The length of the LuxaPost drill (Black, 0.125) was measured using the LuxaPost ruler.
Fig.8
The Gutta Percha was removed to the desired length.
Fig.9
Placing the rubber stop before drilling is extremely important to avoid over-preparation. In this case, we prepared to a depth of 8 mm.
Fig.10
Once the desired amount of excess guttapercha is removed, the cavity and tooth are cleaned with Aquacare.
Fig.11
You can observe the effects of cleaning using Aquacare. The image on the left shows the condition before Aquacare use, while the image on the right displays the condition after Aquacare use.
Fig.12
The entire prepared tooth is etched with phosphoric acid for 20 seconds and then thoroughly rinsed with an air/water spray. The post space is further dried using paper points.
Fig.13
The tooth is now ready to receive the fibre post.
Fig.14
One or two drops of LuxaBond Universal A and one or two drops of LuxaBond B were placed onto the mixing pad. The two drops were thoroughly mixed, ensuring a 1:1 ratio of solution A to solution B.
Fig.15
The included mixing pad has individual mixing wells where a drop of LuxaBond Universal A and LuxaBond Universal B can be applied if more bond is needed. This is to avoid cross-contamination. If additional amounts of these solutions are required, they can be further added to the pad.
Fig.16
The special endo-brush, white (included in the LuxaBond Universal pack), is utilized to apply the mixed LuxaBond Universal. This larger-sized brush is suitable for applying the bond to the wider cervical part of the tooth.
Fig.17
The LuxaBond Universal pack also includes a finer micro brush (Black Special endo-brush), which can be used to apply LuxaBond Universal into narrower spaces or canals. Utilizing this brush ensures the spread of LuxaBond Universal to all the desired areas of the tooth for bonding. Since LuxaBond Universal is dual-cure (chemical and light setting), there’s no need for light curing at this stage.
Fig.18
Using the LuxaCore Z Dual tips (included in the LuxaCore Z Dual pack), LuxaCore Z Dual is dispensed into the root and coronal space.
Fig.19
In the LuxaPost Kit, each drill post has its corresponding fiber post included, making it an easy system to follow and use.
Fig.20
The LuxaPost is placed into the canal. Another advantage of the LuxaPost is that they are pre-silanized, simplifying the procedure.
Fig.21
The LuxaPost and LuxaCore Z Dual are now in place with no visible voids, ready to be light-cured.
Fig.22
Light curing is performed using the Eighteeth Curing Pen.
Fig.23
Additionally, LuxaCore Z Dual material is added to build up the core.
Fig.24
The post-core is now ready to prepare the tooth for a temporary crown.
Fig.25
Preparation of the tooth using a diamond bur.
Fig.26
With LuxaCore Z Dual, you can precisely control the bur so that no difference is felt, especially at the transitions between dentin and LuxaCore Z Dual. This tactile stability allows for groove-free preparations without any undercuts, presenting ideal conditions for precise work.
Fig.27
The prepared tooth with a precise and well defined core.
Fig.28
The silicone index is filled with Luxatemp Star and placed over the newly built tooth 15, and we wait for it to set.
Fig.29
Once the Luxatemp Star has set, it is removed from the silicone index and trimmed and refined using a Soflex disc.
Fig.30
The rubber dam is removed, and it is normal to observe some bleeding from the gingiva due to the release of pressure. This bleeding typically stops within a couple of minutes.
Fig.31
The Luxatemp Star crown is placed over the newly prepared tooth, and occlusion is checked using articulating paper. Any occlusal high spots are then adjusted accordingly.
Fig.32
The final outcome showcases a variety of different views to demonstrate the fit of the crown and the beautiful finish achieved by using Luxatemp Star as a temporary crown material.
Conclusions
By employing a method that maximizes the benefits of a dual-cure composite resin, efficient placement of a post and core material can be achieved, establishing a strong foundation for the final crown and ensuring a durable restoration that will benefit the patient for years to come. The harmonized system incorporating LuxaCore Z Dual, LuxaBond Universal, and LuxaPost offers several advantages. LuxaCore Z Dual provides dentin-like cuttability, allowing for controlled substance removal and precise preparation margins. It offers optimal bur guidance control and seamless integration at the transition between dentin and the material. Additionally, LuxaCore Z Dual boasts excellent flow properties, enabling optimal adaptation to cavity walls and posts while serving as a single material for both post cementation and core build-up.
LuxaBond Universal, a true universal bond compatible with any etching mode, provides exceptional bond strength for long-lasting restorations. It includes special endo-brushes for optimal application within the root canal and features a controlled adhesive protocol, particularly beneficial in root canal procedures.
LuxaPost, a pre-silanized post, is designed for cementation within the root canal using LuxaCore Z Dual, further enhancing the overall effectiveness and longevity of the restoration. An easy-to-follow system as outlined above allows the clinician to provide predictable and durable long-term solutions. Simplicity, as famously quoted by Leonardo Da Vinci, is the ultimate sophistication.
