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Restorative-Conservative Dentistry/ 12 January 2025/ |

Saving structurally compromised premolar

Author: Baqer hussain

Email: asdbaqer5@gmail.com

Nationality: Iraq

Branch: Restorative-Conservative Dentistry

Brand: Gold standard clearfil SE bond

Material: Ribbond, EVER X

Technique: DME, overlay

In such cases; Structurally compromised lower premolar,we depend on replacing the missing dentine with fiber and fiber reinforced composite

And replacing the enamel with indirect lithium disilicate restoration

In all these procedures we depending on modern adhesive dentistry

In this case, lower premolar ( 4) was treated previously with unsuccessful Endodontic treatment .

We isolate the tooth with rubber dam and Endodontic retreatment was done with Bioceramic sealer and single cone since it’s viable option for obturation

( Elizabeth A Chybowski, Gerald N Glickman, Yogesh Patel, Alex Fleury, Eric Solomon, Jianing He‏ , Journal of endodontics 44)

Then we elevate the margins (DME) by using gold standard bonds Se clearfill bond and composite Ap-x composite and resin coating with flowable composite for the remaining tooth structure

And replacing the dentine with ribbond and Ever X composite in order to strengthen the remaining tooth against fracture, Both fiber types improve fracture resistance and the fracture mode of structurally compromised teeth is equally efficient. Application technique deserves attention. Ribbond could be placed in a single layer at the cavity floor, whereas EverX Posterior should replace missing dentin in an anatomically shaped way.

We complete the Biobase by placing conventional composite on the fibers and preparing the tooth for indirect restoration

Additional silicone impression was taken and sent for lab

After 5 days we received the lab work

In the last visit we inserted the E max indirect restoration by doing the adhesive protocol for the E max and the tooth Biobase

Sandblasting, etching, saline ,bonding for the tooth Biobase

Hydrofluoric acid , acid etching, saline, bonding for E max indirect restoration

Then the treated E max bonded to tooth Biobase by heated composite (Ap-x composite)

After removing the composite excess

Then light cure for 1 minutes for each side

Removing excess debris and bond by sharp instrument from around the tooth

And finish the case and taking X ray to see fitted restoration

Follow up the case for more 1 year and still with good condition, aesthetic, functional and healthy

references:

1- Biomimetic restorative dentistry ( PASCAL MANGE)

2- Can Fiber-reinforced Composites Increase the Fracture Resistance of Direct Composite Restorations in Structurally Compromised Teeth? A Systematic Review and Meta-analysis of Laboratory Studies

https://doi.org/10.2341/24-032-LIT

3-Clinical outcome of non-surgical root canal treatment using a single-cone technique with endosequence bioceramic sealer: a retrospective analysis‏ (Elizabeth A Chybowski, Gerald N Glickman, Yogesh Patel, Alex Fleury, Eric Solomon, Jianing He‏

Journal of endodontics 44 (6), 941-945, 2018)

Dr. Baqer Hussain

general Dentist BDS from Iraq

graduated from Al-muthanna University 2017

certified in conservative dentistry ( direct, indirect restoration)

diploma in implant surgery.
Owner of dr.baqer clinics