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Dowel Core Techniques for Multi-rooted Teeth: Series of Three Cases

Ajay Jain and Ugrappa Sridevi*

AIMST Dental Institute, AIMST University, Semeling, Bedong 08100, Kedah, Malaysia

*Corresponding Author:
Ugrappa Sridevi
Faculty of Dentistry, AIMST Dental Institute
AIMST University, Semeling, Bedong 08100
Kedah, Malaysia, India
Tel: +60109454204
E-mail: [email protected]

Received May 09, 2016; Accepted May 15, 2016; Published May 25, 2016

Citation: Jain A, Sridevi U (2016) Dowel Core Techniques for Multi-rooted Teeth: Series of Three Cases. Dentistry 6:377. doi:10.4172/2161-1122.1000377

Copyright: © 2016 Jain A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

An endodontically treated tooth should have a good prognosis so that it can resume full function and serve satisfactorily as an abutment for a Fixed Dental Prosthesis (FDP) or a removable partial dental prosthesis. However, special techniques are needed to restore such a tooth. There are various dowel core techniques have been advocated in the literature. This case report presents the restoration of mutilated endodontically treated multi-rooted teeth by using three customized dowel core techniques.

Keywords

Dowel core; Multi-rooted teeth; Interlock dowel core; Split dowel core; Richmond crown

Introduction

Endodontically treated teeth are mutilated by caries and access requirements, present restorative problems. Frequently, only the root portion can offer the needed retention. Even if coronal retention is available, the remaining tooth tissue requires special treatment to prevent further destruction [1]. Special techniques for endodontically treated teeth are not new. Early efforts provided the Davis and Richmond crowns [2]. Later, precious-metal precision dowels fitted to reamed canals [3,4] and threaded posts [5] offered the needed retention. More recently, cast gold dowel-cores made from reinforced direct wax and direct acrylic resin patterns, as well as pin-retained amalgam cores, have been advocated [6-9]. The purpose of this article is to explore various techniques to rehabilitate multi-rooted teeth with custom dowel-core.

Endodontically treated teeth should have a good prognosis so that it can resume full function and serve satisfactorily as an abutment for a Fixed Dental Prosthesis (FDP) or a removable partial dental prosthesis. However, special techniques are needed to restore such a tooth. The loss of tooth structure makes retention of subsequent restorations more problematic and increases the likelihood of fracture during functional loading.10A number of different clinical techniques have been proposed to solve these problems, and opinions vary about the most appropriate one. This paper presents different techniques of dowel core for rehabilitation of endodontically treated multi-rooted teeth. All patients visited to private dental clinic, Delhi, India.

Case report 1

A 25 years old male patient visited to the department for the placement of crown at his upper right back region. Patient gave history of decay since 5 years. On clinical and radiographic examination, it was observed that tooth number 17 was endodontically treated and distal surface was at the gingival level. Treatment planned for this patient was to rehabilitate the crown with Richmond full metal crown.

Procedure: 1. Both the palatal canals of maxillary second molar are enlarged to one half to two third of the canal length till no. 4 peeso reamer (Mani, Inc., U.S.) (Figure 1).

Figure

Figure 1: Palatal canals of maxillary second molar.

2. Buccal canal also enlarged till no. 4 peeso reamer (Mani, Inc., U.S.) and extended 2-3 mm.

3. Unsupported enamel rods are removed.

4. Elastomeric impression of the post space is made by using 18 gauge stainless steel wire (Figure 2).

Figure

Figure 2: Elastomeric impression of the post space.

5. Cast is poured with type IV dental stone (Kalabhai, Mumbai, India).

6. Acrylic resin pattern of the buccal half of the preparation is made and a keyway is provided in occlusal surface of the buccal core that is parallel to the palatal canals (Figure 3).

Figure

Figure 3: Occlusal surface of the buccal core.

7. Acrylic resin pattern of the palatal half is made with key incorporated in the core and crown is attached to it (Figure 4).

Figure

Figure 4: Acrylic resin pattern of the palatal half.

8. Both the patterns are separated, invested and casted.

9. Cementation of the buccal half followed by cementation of palatal half with crown integrated to it (Figures 5 and 6).

Figure

Figure 5: Cementation of the buccal half.

Figure

Figure 6: Cementation of palatal half with crown.

Case report 2

A 44 years old male patient visited to the department for the placement of crown at his lower right back region. Patient gave history of decay since 3 years. On clinical and radiographic examination, it was seen that tooth number 46 was endodontically treated with minimal tooth structure remaining. Treatment planned for this patient was to rehabilitate with interlocking dowel core [10,11] for improved retention of the prosthesis.

Procedure: 1. Preoperative view of grossly destructed endodontically treated mandibular right first molar (Figure 7).

Figure

Figure 7: Destructed endodontically treated mandibular right first molar.

2. Enlarge the mesial and distal canals to the one half to two-third of the canals till number 3 peeso reamer (Mani, Inc., U.S.) (Figure 8).

Figure

Figure 8: Mesial and distal canals.

3. Select one of the canals as primary and prepare the internal walls of the tooth parallel to the line of draw of that canal.

4. Remove all unsupported enamel.

5. Develop the post and the coronal portion of the post using a plastic toothpick and self-cure pattern acrylic resin (GC Pattern resin LS, America Inc.) (Figure 9).

Figure

Figure 9: GC pattern resin LS.

9. While the acrylic resin is still plastic but almost set, lift the toothpick to remove the pattern in order to check for undercuts in the canal and to verify the path of insertion of the pattern.

10. Trim the borders of the acrylic resin pattern to the desired shape using diamond bur.

11. Obtain access to the remaining canal through the acrylic resin pattern using carbide bur (SS White, Xemax surgical products, Inc.) (Figure 10).

Figure

Figure 10: Access to canal through the acrylic resin pattern.

12. Enlarge the canal access opening and prepare a dovetail in the acrylic resin pattern to obtain an interlock.

13. Flow inlay wax (Shiva products, India) over the blades of a latch-type steel bur and up into the shaft. While the wax is soft, carry the bur to place into the canal. With finger pressure adapt the soft wax into the interlock in the acrylic resin pattern (Figure 11).

Figure

Figure 11: Soft wax in the acrylic resin pattern.

14. Carve and finish the wax pattern with warm carvers after the wax has cooled.

15. Remove the wax pattern from the canal and the interlock using the end of the bur, invest and cast it.

16. Cementation of dowel core with interlock in the mesial canal (Figure 12).

Figure

Figure 12: Cementation of dowel core with interlock.

Case report 3

A 53 years old male patient visited to the department for the placement of crown at his upper right back region. Patient gave history of decay since 1 year. On clinical and radiographic examination, it was seen that tooth number 17 was endodontically treated. Treatment planned was to rehabilitate with split dowel core.

Procedure: 1. Both the palatal canals of maxillary first molar are enlarged to one half to two third of the canal length till no. 4 peeso reamer (Mani, Inc., U.S.) (Figure 13).

Figure

Figure 13: Palatal canals of maxillary first molar.

2. Buccal canal also enlarged till no. 4 peeso reamer and extended 2-3 mm.

3. Unsupported enamel rods are removed.

4. Elastomeric impression of the post space is made by using 18 gauge stainless steel wire (Figure 14).

Figure

Figure 14: Elastomeric impression of the post space.

5. Cast is poured with type IV dental stone (Kalabhai, Mumbai, India).

6. Acrylic resin pattern (GC Pattern resin LS, America Inc.) of the buccal half of the preparation is made and a keyway is provided in occlusal surface of the buccal core that is parallel to the palatal canals (Figure 15).

Figure

Figure 15: Occlusal surface of the buccal core.

7. Acrylic resin pattern of the palatal half is made with key incorporated in the core (Figure 16).

Figure

Figure 16: Acrylic resin pattern of the palatal half is made with key.

8. Both the patterns are separated, invested and casted.

9. Cementation of buccal half followed by cementation of palatal half of the dowel core (Figures 17 and 18).

Figure

Figure 17: Cementation of buccal half.

Figure

Figure 18: Cementation of palatal half.

10. Fit in of the full metal crown prosthesis (Figure 19).

Figure

Figure 19: Full metal crown prosthesis.

Discussion

Various techniques [12-15] have been mentioned in the literature to rehabilitate multi-rooted teeth by using custom dowel core. Since, custom dowel core systems are more retentive, rigid and precise when compare to prefabricated metal or fiber reinforced dowel core system for posterior teeth, where there is less esthetic demand. This case report utilizes different techniques for custom dowel core for rehabilitation of grossly decayed multi-rooted posterior teeth. All three cases mentioned in this case report have its own advantages and disadvantages. Richmond crown has its own uniqueness for saving patient extra visit and cost. Since, crown portion is attached to the cast custom dowel core, it may be the disadvantage in case of crown dislodgement at later stage, and dowel gets also dislodged along with. Interlock dowel core system is technique sensitive, one should be good enough to manipulate the materials in the oral cavity and this technique gives better retention of the core as well as crown. Split core dowel core system engages the canal in such a way that all forces of mastication transfers directly to the apical portion of the tooth and then to the alveolar bone and mainly indicated in grossly decayed tooth to reinforce the remaining tooth structure. Since, the development of fiber dowel core system, these custom cast technique still can be used where fiber dowel system is not indicated.

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Review summary

  1. Lester
    Posted on Aug 19 2016 at 6:28 pm
    The article deals with case report on restoration of mutilated endodontically treated multi-rooted teeth by using three different techniques. Authors have reported all the related advantages and disadvantages of this techniques. The article provides useful information and will help in the improving the treatment practices in persons with special needs.
 

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