Case Presentation: Direct Composite + Post for Endo-Treated Discolored Anterior
Direct Composite + Post for Endo-Treated Discolored Anterior
Figure 1—Preoperative images, including full smile and retracted views, show undesirable discoloration on tooth No. 9
Primarily to add strength, I further enhance esthetics by placing a nonmetallic post (FibreKor, Pentron) because a substantial amount of discolored dentin was excavated and replaced by composite. Because the post is not metal, it does not afect the final shade.
An 18-year-old male patient, in routine care in my practice, was referred to me by an endodontist for evaluation and treatment. He presented with the chief complaint of darkening of his maxillary central incisor, tooth No. 9. He explained that after a traumatic skateboarding injury, he required a root canal, which subsequently resulted in this unwanted discoloration.
We discussed both the indirect and direct restorative options, and the patient was happy to try the less invasive, direct approach.
Treatment: First Visit
Palatal aspect: Without administering local anesthesia, I removed the hemosiderin-stained dentin from the palatal aspect. I cemented (GC FujiCEM2, GC America) a fiber post into place and removed the excess length. Next, I placed composite using a dentin shade (G-ænial Universal Flo, GC America) as a core into the post access opening. Because neighboring teeth desiccate during placement of the post, a second visit was scheduled to capture the true shade.
Figure 2—Palatal view of placed fiber post after excavation of hemosiderin stained dentin
Figure 3—View of cemented post with excess length removed
Figure 4—Dentin shade composite placed into post access opening
Facial aspect: To reveal the dentin-shade core, I prepped the facial aspect to enhance retention of the composite. In addition to sandblasting the existing composite core and the unprepped enamel (Microetcher, Zest Dental Solutions), I created intracoronal subgingival troughing. I placed veneering composites (G-ænial Sculpt, GC America) in increments that were each light-cured after placement—first, flowable (bleach white shade) to effectively mask the still-stained dentin remaining in the root; next, a layer of dentin opaque; and finally, a layer of enamel body. Final finishing and polishing created a lifelike and undetectable restoration. The patient was pleased.
Figure 5A and 5B—Facial (left) and incisal (right) views of tooth revealing core of dentin shade composite, including internal subgingival troughing
Figure 6—Bleach white shade of fl owable composite masks the discoloration optically transmitted into the clinical crown by the hemosiderin-stained dentin residing in the root of the tooth
Figure 7—Placement of dentin (opaque) shade of composite
Figure 8—Placement of enamel (body) shade of composite
Figure 9—Finished and polished restoration, close-up and full-smile views
Tags: G-aenial Universal Flo, GC FujiCEM 2, MicroEtcher II Intraoral Sandblaster, Pentron Clinical, Fibrekor Post System- Kit - Fibrekor Post System- Kit, Zest Dental Solutions, G-aenial Sculpt, Lab Miscellaneous, Cement glass ionomer luting, Pins & Posts (Restorative), Flowable, Universal Composite, GC America