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Medical Forum / General / Dentistry / August 2004LL3rd;gold crown???
Howdy troop: re: http://pages.globetrotter.net/stovepipe/page1.htm Don't worry: it'll load quickly, it's been chopped down. The Endo Guy just finnished this case. It had been done by me a few years ago, but the lesion never healed on the distal root. I asked him to re-do the case so as to be able to confidently put a post and crown on it. You can see that access is wide, and so I thought that doing a CEREC-style crown with pulp chamber post in gold (for resilience) would be the way to go. He has left me a post space, and so I'd put a fiber post in there and build up the floor with a good strong composite, like Filtek P-60. I'd then level the floor, sculpt the insides of the pulp chamber and cut down the outside of the tooth. I'd leave the whole thing supra-gingival, as there is no esthetic constraints here. The thing I'm wondering is whether or not there is an advantage here to doing a cast gold post: this would be difficult, due to the irregular and deep pulp chamber space. I'd have to destroy the whole wall of the pulp chamber to get a good line of draw. So, what I wanted to know, is whether there is any real advantage to doing that vs a fibre post and composite floor. Thanks SP  SignatureTo reply: take out the TRASH... > Howdy troop: > > re: http://pages.globetrotter.net/stovepipe/page1.htm > You can see that access is wide, and so I thought that doing a > CEREC-style crown with pulp chamber post in gold (for resilience) would [quoted text clipped - 3 lines] > chamber and cut down the outside of the tooth. I'd leave the whole thing > supra-gingival, as there is no esthetic constraints here. Just realized that this description is all screwed up: I wantd to do a fiber post in the distal root (Endo Guy left me the space) and then build up the floor in composite just enough to get a non retentive pulp chamber, and then do an all-gold crown with a pulp space post in it. Is that clearer? Is this feasable on a 3rd molar (forces+++)... ? > Thanks > SP SignatureTo reply: take out the TRASH... I do "Endo-Crowns" on third molars from time to time. If you reduce the occlusal enough to bet 3-4 mm of porcelain over every cuspal surface, plus the 10 mm of thickness in the pulp chamber, the porcelain holds up well and does not break. If it ever does break, the porcelain will chip rather than fracture the base of the tooth, so it can be repaired easily. >> Howdy troop: >> [quoted text clipped - 16 lines] >> Thanks >> SP > I do "Endo-Crowns" on third molars from time to time. If you reduce > the occlusal enough to bet 3-4 mm of porcelain over every cuspal > surface, plus the 10 mm of thickness in the pulp chamber, the > porcelain holds up well and does not break. If it ever does break, > the porcelain will chip rather than fracture the base of the tooth, so > it can be repaired easily. OK, but I don't think I have 10 mm intra pulpally, especially if I block the deepest part that is retentive. (If I don't the lingual wall will be and stat retetive. BTW: did you get to see that photo from the Endo Guy OK, or did it not load? Thanks SP SignatureTo reply: take out the TRASH... I got the photo just fine. If you measure from the floor of the pulp chamber to the top of finished restoration, you will have closeto 10mm. >> I do "Endo-Crowns" on third molars from time to time. If you reduce >> the occlusal enough to bet 3-4 mm of porcelain over every cuspal [quoted text clipped - 11 lines] >Thanks >SP > I got the photo just fine. If you measure from the floor of the pulp > chamber to the top of finished restoration, you will have closeto > 10mm. OK, but I know the lingual side of the prep (intra-pulpally) will be retentive; the tooth is basically shaped inside like a fish bowl. This is why I wanted to put a fiber post in, after covering the orifices to the other canals with GI, covering the whole floor with composite. If I wanted to do an Endo-Post, what would you recommend to block out those internal retentions? FWIW, I cement posts with 3M Unicem (composite/GI) after etching, SingleBond-ing and curing. Thanks SP SignatureTo reply: take out the TRASH... >> I got the photo just fine. If you measure from the floor of the pulp >> chamber to the top of finished restoration, you will have closeto [quoted text clipped - 9 lines] >Thanks >SP Fuji 9 -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > FWIW, I cement posts with 3M Unicem (composite/GI) > >after etching, SingleBond-ing and curing. [quoted text clipped - 5 lines] > -- > W_B Hmmm.... you know; we STILL have not gotten the Fuji 9 we ordered back in the ODQ congress days in May... Weird things, to say the least... Thanks SP SignatureTo reply: take out the TRASH... >> FWIW, I cement posts with 3M Unicem (composite/GI) >> >after etching, SingleBond-ing and curing. [quoted text clipped - 10 lines] >Thanks >SP Try Schein. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > >Hmmm.... you know; we STILL have not gotten the Fuji 9 we ordered back > >in the ODQ congress days in May... Weird things, to say the least... [quoted text clipped - 5 lines] > -- > W_B ....Things work a bit more dorky (I mean strangely) up here: the rep for Fugi supplies all the major houses(Shein, Patterson, Ash/Temple). She told us at the ODQ in May that things with the government should be OK in July. Well, here we are in August.... no F9... It's frustrating... All I have is Fugi II LC and Geristore... You'd think that if they want to block F9, they'd block Geristore too.... S....P SignatureTo reply: take out the TRASH... I don't block out anything. >> I got the photo just fine. If you measure from the floor of the pulp >> chamber to the top of finished restoration, you will have closeto [quoted text clipped - 9 lines] >Thanks >SP >I don't block out anything. I don't either. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > >I don't block out anything. > > I don't either. > > -- > W_B OK, thanks S----P SignatureTo reply: take out the TRASH... > I don't block out anything. OK, thanks S----P SignatureTo reply: take out the TRASH... >I got the photo just fine. If you measure from the floor of the pulp >chamber to the top of finished restoration, you will have closeto >10mm. Dudes ! lower first molar is rarely more than 19mm Range is from 16mm to 23mm Upper first MB, DB = 14 to 19 Palatal = 16-23mm Learn it, love it, live it. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE >OK, but I don't think Well you just said it all there. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > >OK, but I don't think > > Well you just said it all there. > > -- > W_B ???? Wahhhdddyyyaaaa mean by that? I'm thinking incorrectly or are you agreeing that I haven't the space I need??? Whot? SP SignatureTo reply: take out the TRASH... >> >OK, but I don't think >> [quoted text clipped - 7 lines] >Whot? >SP Was teasing you. Sorry, thought that you would get it. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > >???? Wahhhdddyyyaaaa mean by that? I'm thinking incorrectly or are you > >agreeing that I haven't the space I need??? [quoted text clipped - 7 lines] > -- > W_B No, you have to understand: Canadians ('Specially ones from Quebec) have no sense of humor. National Lampoon proved it in the late '70's. S----P SignatureTo reply: take out the TRASH... I have seen DrSteve do this and guarantee that he is 100% correct. >I do "Endo-Crowns" on third molars from time to time. If you reduce >the occlusal enough to bet 3-4 mm of porcelain over every cuspal [quoted text clipped - 23 lines] >>> Thanks >>> SP -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > I do "Endo-Crowns" on third molars from time to time. If you reduce > the occlusal enough to bet 3-4 mm of porcelain over every cuspal > surface, plus the 10 mm of thickness in the pulp chamber, the > porcelain holds up well and does not break. If it ever does break, > the porcelain will chip rather than fracture the base of the tooth, so > it can be repaired easily. OK: I've read over your and W_B's supporting statements, and I have to admit that if I can put in a crown that will split off rather than destroy the prep if it fails, that would be ideal. We'll cut the LL3M down on Monday and take an impression U/L. Will use a custom tray (already had it made) and will stay supra-gingival. Will have the lab pour it up, mount it, and return it for evaluation. (My assistant says she can pour up these cases using just a normal vibrating table, no vacuum mixer, w/o bubbles... we'll see...) . If I have the requesite 3-4mm, I'll do it. If not, I'll have to go with gold. I really don't want to push this thing under the gum line. BTW he is a snorer and a bruxer, and missing the 1M on the same side. I'm trying to convince him to wear an NTI to control both symtoms, but so far, he's leaning to the double arch things that protrude the sh#t out of you. This was recommended by the pneumologist where he got a sleep apnea evaluation (snoring lab here in Qc.... amazing: he dropped 1200$ on that evaluation...). Let youse know what happens... BTW, I asked about the photo b/cs I used a little-known Mac ftp client to post it to my web site. Works in a fraction of the time it took to upload it from my little web page maker. This is why I say that some of these photos can be posted to my site for others to see quite easily. They just can't stay there forever. Think about it. SignatureTo reply: take out the TRASH... Do the NTI for cost. >> I do "Endo-Crowns" on third molars from time to time. If you reduce >> the occlusal enough to bet 3-4 mm of porcelain over every cuspal [quoted text clipped - 30 lines] >others to see quite easily. They just can't stay there forever. Think >about it. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > Do the NTI for cost. That's more or less what I suggested to him, Thanks SP SignatureTo reply: take out the TRASH... >> Do the NTI for cost. > >That's more or less what I suggested to him, >Thanks >SP I figure $50US is adequate. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE Making an "Endo-Crown" in gold defeats the purpose. Only place a post when there is no other way to hold the restoration to the tooth. In the presence of parafunction, metal posts result in broken roots. >Howdy troop: > [quoted text clipped - 22 lines] >Thanks >SP > Making an "Endo-Crown" in gold defeats the purpose. Only place a post > when there is no other way to hold the restoration to the tooth. In > the presence of parafunction, metal posts result in broken roots. Well, it's that or a fiber post, raze the tooth and do a total build up in composite. I guess that's what I'll do... But tell me: why would doing an Endo-Crown in gold be defeating? It can be cemented well or even bonded, I think. Thanks SP SignatureTo reply: take out the TRASH... The endo-crown does not get the vertical external walls for retention form. The pulpal area will be slightly tapered. If your lab makes it, they will use block-out in this area as well. Gold will not bond as tightly, and will likely roll off the tooth. >> Making an "Endo-Crown" in gold defeats the purpose. Only place a post >> when there is no other way to hold the restoration to the tooth. In [quoted text clipped - 6 lines] >Thanks >SP >The endo-crown does not get the vertical external walls for retention >form. The pulpal area will be slightly tapered. If your lab makes it, >they will use block-out in this area as well. >Gold will not bond as >tightly, and will likely roll off the tooth. Disagree, if prepared correctly Au is the standard. Have seen your Cerec and believe it to be superior to anything currently available. It's just not worth 130K. >>> Making an "Endo-Crown" in gold defeats the purpose. Only place a post >>> when there is no other way to hold the restoration to the tooth. In [quoted text clipped - 6 lines] >>Thanks >>SP -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > >Gold will not bond as > >tightly, and will likely roll off the tooth. [quoted text clipped - 3 lines] > to anything currently available. > It's just not worth 130K. So, you would do an Endo-Post in Au and sand blast it to increase surface area, silane it and bond it with Fuji 9 ?? Thanks SP SignatureTo reply: take out the TRASH... >> >Gold will not bond as >> >tightly, and will likely roll off the tooth. [quoted text clipped - 8 lines] >Thanks >SP No. I only put Au on second molars and the occasional 3rd. It has to be a critical tooth for me to even deal with it. Otherwise I extract them. Harsh I know, but very practical. Patients appreciate truth. Saves them money too ! -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > No. > [quoted text clipped - 9 lines] > -- > W_B OK, but this guy is missing U/L 1M on that side. U/L 2M and 3M have quite good occluSION. I'm not sure about the occluDING, but the tooth doesn't show too much wear. I would like to save it and so will put a crown on it. It may turn out to be a dorky thing to do, but I've got a feeling.... A feeling deep inside, Oh No.... I've got a feeling... I think that ev'ry body knows,,, Oh Yeah... .... Everybody had a good year.... Everybody put their foot down... S----P SignatureTo reply: take out the TRASH... no >> >Gold will not bond as >> >tightly, and will likely roll off the tooth. [quoted text clipped - 8 lines] >Thanks >SP > no > >So, you would do an Endo-Post in Au and sand blast it to increase > >surface area, silane it and bond it with Fuji 9 ?? > >Thanks > >SP ... Then why'dja mention the Fuji 9 again? S____P SignatureTo reply: take out the TRASH... I do not use FUGI 9. >> no > [quoted text clipped - 5 lines] >... Then why'dja mention the Fuji 9 again? >S____P >I do not use FUGI 9. Foo-Geee? >>> no >> [quoted text clipped - 5 lines] >>... Then why'dja mention the Fuji 9 again? >>S____P >>I do not use FUGI 9. > >Foo-Geee? Fu-Bar ? -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > >I do not use FUGI 9. > > Foo-Geee? No... You're confusing this with the Fou Gees (sp?) R&B group.. dorksaysall sP SignatureTo reply: take out the TRASH... You need to. Excellent restorative material, easy to place. Bonds to tooth structure. Fluoride. Hard as Enamel. >I do not use FUGI 9. > [quoted text clipped - 7 lines] >>... Then why'dja mention the Fuji 9 again? >>S____P -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > You need to. Excellent restorative material, easy to place. > Bonds to tooth structure. Fluoride. Hard as Enamel. Hmmmm..... I'm seeing my guy tomorrow... I'm seriously considering re-appointing until I can get some of this blessed stuff for the build-up after the fiber post... dorkedagain SppppppppppppEEE SignatureTo reply: take out the TRASH... > I do not use FUGI 9. This does not surprise me, as you are a CEREC dentist. DodribbleththeDORK S.......................P eee SignatureTo reply: take out the TRASH... It is only $94K. It actually is only $1600/month. If your lab fee (for single units) is over this amount, the device is free from day one. I am saying gold will roll off the tooth if the preparation is done Cerec style,. >>The endo-crown does not get the vertical external walls for retention >>form. The pulpal area will be slightly tapered. If your lab makes it, [quoted text clipped - 18 lines] >>>Thanks >>>SP >It is only $94K. It actually is only $1600/month. If your lab fee >(for single units) is over this amount, the device is free from day >one. I am saying gold will roll off the tooth if the preparation is >done Cerec style,. I like you Mancuso, I just don't agree on this point. When are you going to come visit me ? -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE I have a trip to Vegas coming up to see my God-Son get married. After that, things settle down. Will look for a long weekend when the weather is better in DC than Detroit. >>It is only $94K. It actually is only $1600/month. If your lab fee >>(for single units) is over this amount, the device is free from day [quoted text clipped - 4 lines] > >When are you going to come visit me ? The timing is just perfect right now. >I have a trip to Vegas coming up to see my God-Son get married. After >that, things settle down. Will look for a long weekend when the [quoted text clipped - 8 lines] >> >>When are you going to come visit me ? -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > It is only $94K. It actually is only $1600/month. If your lab fee > (for single units) is over this amount, the device is free from day > one. I am saying gold will roll off the tooth if the preparation is > done Cerec style,. A-Ha.... that save a real dork move on my part. I will continue though. I'll do the fiberpost, build up and really go around carefully to get paralell walls. I'lll llleave the temp on for awhile to see how the forces treat it. Then I'll make the crown. The temp will guide me and I might even do the wax-up my self if the temp tells me what I want to know. Bam-Boom S----P SignatureTo reply: take out the TRASH... >raze the tooth and do a total build up >in composite. I guess that's what I'll do Fugi 9 -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > >raze the tooth and do a total build up > >in composite. I guess that's what I'll do [quoted text clipped - 3 lines] > -- > W_B ???? You'd do a build up in Fugi 9 as well????? Confused SP SignatureTo reply: take out the TRASH... >> >raze the tooth and do a total build up >> >in composite. I guess that's what I'll do [quoted text clipped - 7 lines] >Confused >SP Yep. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > >> Fugi 9 > >> [quoted text clipped - 6 lines] > > Yep. Holy dorkington... It's obvious that you think this stuff is the work horse of dentistry. Do the Canuks a favor and tell the Canadian Prime Minister to stop being such a dork and re-commence importing it for us. Thanks S,,,,P SignatureTo reply: take out the TRASH... Fill me in.............. why can't you get it in Canada? Does it contain a banned substance? Has it failed to meet testing standards? >> >> Fugi 9 >> >> [quoted text clipped - 12 lines] >Thanks >S,,,,P BTW Fugi 9 is great for that patient who can't afford a crown right away. IMO holds up better than composite. As Joel has said many times it's not the most esthetic material Good for posterior use, have even built cusps out of it. It sets so hard that you must use a diamond to trim it. Polish and finish in the usual manner. >Fill me in.............. why can't you get it in Canada? Does it >contain a banned substance? Has it failed to meet testing standards? [quoted text clipped - 15 lines] >>Thanks >>S,,,,P -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > BTW Fugi 9 is great for that patient who can't afford > a crown right away. IMO holds up better than composite. > As Joel has said many times it's not the most esthetic material > Good for posterior use, have even built cusps out of it. > It sets so hard that you must use a diamond to trim it. > Polish and finish in the usual manner. Now I understand (Finally...) why you use it as a core build-up material. I'm going to re-appoint my guy tomorrow, get some of the stuff, and put a fiber post in and build up the core in F9. I'll hollow out the tooth from inside the pulp chamber and then just fill it in. Then I'll cut the external of the tooth to recieve an crown. The only dilemma I have now is whether to go with my instincts (gold crown) or porcelain as you both have recommended.... but is there enough space for that....?... We'll see. BTW, I thought JME was more of a champion of Geristore... That, I COULD get, and have been putting it into proximal root caries in some of my elderly patients, where I can't guarantee a dry field for composite. They advertise that stuff as the 'Duct Tape of Dentistry'.... I haven't found that to be true to date, but it does have that use... Boooooooooooooooooooooo0000000M Splorf SignatureTo reply: take out the TRASH... > Fill me in.............. why can't you get it in Canada? Does it > contain a banned substance? Has it failed to meet testing standards? Re: Fugi 9: All I know is it was the FIRST ITEM on my list for the ODQ convention in late May. This was directly a result of W_B's preaching about what you can do with it. The second thing on my list was Contact Pro (and I didn't get that either, as I didn't do my homework enough to know it was marketed by Dentsply). I went to the Fugi kiosk, and they said that it had been blocked by Health Canada. HOLY SH*T!!!, I said out loud... and the guy took me aside and told me this (I've posted this b/4): They (Health Canada) don't like importing and using a material that was originally designed to be a permanent filling material for teeth in Third World countries. I know what that could mean: when I did a med/dent mission into the mountains in Honduras between 3rd and 4th years, I saw many people who could have benefited by the placement of a material that sticks to anything without the necessity of preps and bonding as we do in modern dentistry. You must realize that this is what Fugi 9 was originally designed to do. If we had had it, we would have extracted a lot less teeth. When I asked, Jeff Brucia confirmed this about F9, and added that it is a great sedative dressing as well: you place it, wait a few days at least, then grind it down to a base material in thickness, and composite over it. IOW don't remove all of it. It takes at least 24 hours to set properly... This is why you don't want to use it as a base. W_B, can you confirm that? This is why I use Fugi II LC as a base if I need one. I also put that in deep distal boxes before composite if isolation can be had. Then, the rep from Fugi in Montreal phoned and told us that F9 would be available in late July. That is the last I've heard. I admit I haven't pestered him too much about it, considering my explosion in front of all those people at the convention, but I will phone back tomorrow, and let y'all know what they say. Now you know all I do.... SPlorf SignatureTo reply: take out the TRASH... Weird reason for not importing it. Thanks for filling me in. >> Fill me in.............. why can't you get it in Canada? Does it >> contain a banned substance? Has it failed to meet testing standards? [quoted text clipped - 31 lines] >Now you know all I do.... >SPlorf >This is why you don't >>want to use it as a base. W_B, can you confirm that? Sets rock hard in 3.5 minutes. There is a light cure sealer that should be used over it. If its a final restoration I will use the LC covering. Otherwise in a endo tooth I do not. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com Absolutely true. Bonded porcelain is the key. I like the Calibra material. Dr. SMancuso should check into it. And so should the rest of you practitioners. >Making an "Endo-Crown" in gold defeats the purpose. Only place a post >when there is no other way to hold the restoration to the tooth. In [quoted text clipped - 26 lines] >>Thanks >>SP -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE |
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