The patient presented for treatment with tooth No. 19 missing a previous crown with no sensitivity or discomfort. When questioned, the patient stated that the crown had been missing for several years. X-rays were taken and an endodontic evaluation was performed. The absence of a response to Endo-Ice (COLTENE) after 20-plus seconds led to the diagnosis of necrotic pulp tissue, and endodontic therapy was recommended.
Treatment
The patient consented to treatment to fully restore tooth No. 19, which included endodontic therapy and fitting for a new full-coverage crown. The patient was anesthetized with 4% Articadent with 1:200,000 epi that was buffered (Dentsply Sirona). Rubber dam isolation was performed and root canal therapy completed using the WaveOne Gold primary fi le (Dentsply Sirona Endodontics) and obturation completed using GuttaCore (Dentsply Sirona Endodontics).
On searing gutta-percha to the osseous crest, adhesive bonding was performed to best seal off the canal orifices. Prime&Bond Elect (Dentsply Sirona Restorative) was the adhesive chosen and SureFil SDR flow+ (Dentsply Sirona Restorative) was used to adapt to the cavity walls and seal the canal orifice chamber. A small amount of contrasting composite was used on top of SureFil SDR flow+ to complete the core buildup.
Crown Preparation and Placement
Crown preparation was commenced using the Midwest E Pro electric torque handpiece (Dentsply Sirona Restorative) and a single-use, sterile diamond from Microcopy. When a uniform reduction was completed and the prep analyzed, a digital impression was recorded using the 3M True Definition scanner (3M Oral Care). The information was emailed to DSG/GPS lab in Florida along with the prescription for a full-coverage zirconia crown.
Less than 2 weeks later, the patient returned for cementation. The prep was cleaned with Pumice Preppies (Whip Mix) and the final crown was tried in. The final crown was cemented with Ceramir Crown & Bridge cement (Doxa Dental).
Conclusion
Tooth No. 19 was easily and efficiently restored, deploying several key products along the way. What is important to note is that the restoration was discussed with the patient before the endodontic therapy. Having an end-in-mind mentality—thinking it through from root to crown—led to the successful preservation of this tooth. Both the patient and I are hopeful this tooth will make it to its 85th birthday.
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