the patient presented to the clinic suffering from slight pain on biting and that food gets impacted between her teeth on that side, after meticulous examination, taking photos and X-rays. We explained to her that we will need to do an RCT-retreatment for #45 & #47, while the molar #46 couldn’t be saved but we will replace it via a dental implant.
Started removing the old core material then the metal posts holding them, caries detector dye ( seek red ) was used to remove all the infected dentin then sandblasting with aquacare 29 microns to start the pre endodontic build-up, then we initiated the Re-RCT, removed all the old GP, injected Ca-OH for two weeks, then obdurated using bio ceramic sealer ( Endoseal MTA from Maruchi) .
The #47 was C-shaped whilst the #45 was only one canal, we used fiber post from Glassix plus to reinforce the #45 and both #45 and #47 received core build-up using SDR, Shofu X-flow 03 and packable composite form dentsply sirona neospectra LV.
Then we minimally prepared both #45 & #47 to receive PMMA crowns till we start the implant surgery on #46 and then retake the final scan after 3 months from the surgery due after the gingival and bone healing.
#45, #46 and #47 received final zirconia crowns, quadrant status was stable after checking on the patient and following her up for 18 months where we initially followed her weekly for the first month after zirconia crowns fabrication and then monthly for the past 18 months.
Pre-operative situation clinically
Pre-operative situation radiographically
old core material removal, metal posts removal, using Caried detector dye to remove all the infected dentin then using sandblasting to initiate the pre endodontic build up.
all endodontic retreatments were completed. fiber post has been used to reinforce tooth #45 and Ever - X posterior for tooth #47, then build up completed using SDR, show X-flow 03 and packable composite from neospectra.
teeth minimally prepared with horizontal preparation technique ( light chamfer ) to receive PMMA crowns.
here is retraction cord size 1 from ultrapak E to retract the sulcus horizontally.
all endodontic retreatments were completed. fiber post has been used to reinforce tooth #45 and Ever - X posterior for tooth #47, then build up completed using SDR, show X-flow 03 and packable composite from neospectra.
teeth minimally prepared with horizontal preparation technique ( light chamfer ) to receive PMMA crowns.
here is retraction cord size 000 from Cerkamed to retract the sulcus vertically.
steps from pre-operative situation till the minimal preparations for PMMA fabrication
obturation X-rays for #45 and #47
#46 extraction for immediate implant.
day of the final scan after 3 months from the implant placement.
screwmented zirconia crown for #46 over implant, and two zirconia crowns with only polished margins without glaze for #45 and #47 to enhance the gingival growth, attachment and stability around the crowns.
temporization for crowns on #45 and #47. screwing the #46 crown with filling the whole with teflon and composite till the follow up date.
nice gingival healing in the follow up visit. we got that view after 1 month from inserting the zirconia crowns temporarily.
Final cementation, look at the seamless margins.
18 months follow-up after final cementation.
final X-rays .
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