Case Presentation: Direct Composite + Post for Endo-Treated Discolored Anterior

Published Date 01/10/2019
Figure 1—Preoperative images, including full smile and retracted views, show undesirable discoloration on tooth No. 9
The technique presented here is one I developed as an alternative to a lab-fabricated veneer when correcting discoloration caused by pulpal necrosis on an anterior tooth. By placing a direct composite “veneer,” I am able to manage the shade directly (i.e., at chairside), thereby eliminating the complexity of matching an indirect restoration. This process allows me to create an optically biomimetic internal aspect. With an indirect veneer, we use a more superficial opaquer, thus creating a clinical crown that is optically different than adjacent virgin teeth.

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
Treatment: Second Visit
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
This compactable, universal composite features high-density, uniform dispersion nano-filler technology for a resin that is easy to shape, sculpt, and polish for strong, esthetic restorations.
This 2nd-generation RMGI luting cement is powered by F2 Flex Fuse Technology, which incorporates high-elastic crosslinking monomers with a modified filler-surface treatment for increased strength.
Dr. Marus has a comprehensive cosmetic-focused general practice in Yardley, PA. He lectures internationally on smile design, and his smile makeover techniques have been published in numerous journals worldwide. In addition, he is a consultant and advisor to leading manufacturers of dental products and professional organizations.
GC FujiCEM 2
GC America
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