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Medical Forum / General / Dentistry / January 2005For Stovie
Stovie, You might be interested in the work of a swedish dentist named Sverker Toreskog, who started doing onlay-type crowns and endo-crowns (core+crown in one piece) during the late eighties. He published a book in 1993 showing how to do these stepo by step. I havent followed his work personally, but heard about him in a discussion group. Unfortunately, I don't have any more details. British dentists in that group said they have been doing this for about a decade, so there must be some labs who know what to do. If I'm not mistaken, you should have labs in Canada that can undertake this type of work; I don't think it's an impossibly difficult job for a witty technician. Hell, you can always make a cast, prep it and send it to them to see what they'll give you. George > Stovie, > You might be interested in the work of a swedish dentist named Sverker [quoted text clipped - 11 lines] > > George Excellent, George, thanks loads. Through S. Toreskog, I can probably Google to find his writings and through the Science Citation Index, I can find those who have cited his work since his publications. This is assuming the SCI still exists. FWIW, if you're young enough to make the initial investment, I think that getting a CEREC 3D and developing a patient base that is willing and able to support you is proabably the way to go. It would be the simplest, and you would have much support behind you. At my age, other solutions impose themselves, and I'll check out what you've sent me. I refuse to believe that there is only one way to skin a cat. Thanks again! ;-) SP  SignatureNot a real Addy, yet George Chatzipetros <chpet...@hotmail.com> wrote: > Stovie, > You might be interested in the work of a swedish dentist named Sverker [quoted text clipped - 9 lines] > always make a cast, prep it and send it to them to see what they'll > give you. > George The core & crown one-piece casting was common back in the 1950's and before, so I would think that labs would still be able to make them. When I was in dental school in the sixties, the prosthodontists had generally switched to doing cores and crowns in two separate procedures. I have no doubt that it's possible to get a good fit in one piece, bit I find it easier to control with two separate castings. - dentaldoc > The core & crown one-piece casting was common back in the 1950's and > before, so I would think that labs would still be able to make them. [quoted text clipped - 4 lines] > piece, bit I find it easier to control with two separate castings. > - dentaldoc Good, Bill. I have two questions: 1) Is what you're describing related to the Richmond crown? 2) Let's say you've done the Endo on a lower second molar that has an extensive MO lesion on it. Knowing what you do, do you still believe that cutting the tooth down, doing a post and a crown is best in that instance? I have to admit that the Dr S way of thinking, in that you sculpt and replace only what is missing in the pulp and on the outside (while leaving the vulnerable cervical area intact) makes sense. The big thing would be to see a comparative study. Thanks SP SignatureNot a real Addy, yet > > The core & crown one-piece casting was common back in the 1950's and > > before, so I would think that labs would still be able to make them. [quoted text clipped - 20 lines] > Thanks > SP As a general rule, I try to retain as much sound tooth structure as possible. In the case of the lower second molar, I generally build up with composite and use the pulp chamber itself for retention. What you write makes great sense: ( . . . you sculpt and > replace only what is missing in the pulp and on the outside (while > leaving the vulnerable cervical area intact) This was advocated many years ago, long before bonded composites were available. In many cases, amalgam bases could be constructed with adequate retention from the remaining tooth structure -- sometimes adding a preformed post in the canal for even more retention of the amalgam core. I tried this years ago and it worked. It preserved a lot of sound tooth structure in many cases. When composites were developed, I switched to bonded composite as the core, and it works well, in my experience. I've never been fond of the approach of razing a tooth and replacing everything you've just ground off with a post and large core, unless it's absolutely necessary (and there are such cases). To my way of thinking, it's preferable to retain as much healthy structure as sound principles allow. Regards, dentaldoc Hi Bill, Do you still prepare the outer walls of the tooth to create the "ferrule" effect? Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >> > The core & crown one-piece casting was common back in the 1950's [quoted text clipped - 53 lines] > Regards, > dentaldoc Hi, Steve -- I try to get a "ferrule effect" when the final restoration is a full crown, and where the main retention and resistance is from the post & core. When I envision the use of a ferrule, I think of a tooth which has lost so much tooth structure that the post & core is just about the only thing left supragingivally. In that case, the ferrule provides that the final crown margins are on tooth structure, even where the vast majority of that crown interior will be contacting core material. It's a different matter when full crowns are not used. A bonded onlay, whether Cerec or traditional, would protect endo-treated molars with full coverage of the cusps, without requiring a finish line in the cervical region. So I don't attempt to get a "ferrule" when placing an onlay. For non-metallic onlays, a shoulder margin works better anyway. I usually try to preserve remaining tooth structure with the use of an onlay, instead of going to a full crown. When I use an inlay or an onlay, the concept of a ferrule doesn't enter the picture. Best regards, Bill Hi Bill, Do you still prepare the outer walls of the tooth to create the "ferrule" effect? -- ~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... - Hide quoted text - - Show quoted text - > StovePipe wrote: >> Bill <dental...@hotmail.com> wrote: >> > The core & crown one-piece casting was common back in the 1950's > and >> > before, so I would think that labs would still be able to make > them. >> > When I was in dental school in the sixties, the prosthodontists had >> > generally switched to doing cores and crowns in two separate >> > procedures. I have no doubt that it's possible to get a good fit in > one >> > piece, bit I find it easier to control with two separate castings. >> > - dentaldoc >> Good, Bill. I have two questions: 1) Is what you're describing > related >> to the Richmond crown? >> 2) Let's say you've done the Endo on a lower second molar that has an >> extensive MO lesion on it. Knowing what you do, do you still believe >> that cutting the tooth down, doing a post and a crown is best in that >> instance? >> I have to admit that the Dr S way of thinking, in that you sculpt and >> replace only what is missing in the pulp and on the outside (while >> leaving the vulnerable cervical area intact) makes sense. The big > thing >> would be to see a comparative study. >> Thanks >> SP > As a general rule, I try to retain as much sound tooth structure as > possible. In the case of the lower second molar, I generally build up > with composite and use the pulp chamber itself for retention. > What you write makes great sense: ( . . . you sculpt and >> replace only what is missing in the pulp and on the outside (while >> leaving the vulnerable cervical area intact) > This was advocated many years ago, long before bonded composites were > available. In many cases, amalgam bases could be constructed with > adequate retention from the remaining tooth structure -- sometimes > adding a preformed post in the canal for even more retention of the > amalgam core. > I tried this years ago and it worked. It preserved a lot of sound tooth > structure in many cases. When composites were developed, I switched to > bonded composite as the core, and it works well, in my experience. > I've never been fond of the approach of razing a tooth and replacing > everything you've just ground off with a post and large core, unless > it's absolutely necessary (and there are such cases). To my way of > thinking, it's preferable to retain as much healthy structure as sound > principles allow. > Regards, > dentaldoc My two cents (for what it is worth). If the residual tooth is thin and you make a ferrule, there is fairly good chance of breaking to tooth off at the base of core. If the tooth is plenty thick, you don't need a ferrule. Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > Hi, Steve -- > [quoted text clipped - 120 lines] >> Regards, >> dentaldoc > My two cents (for what it is worth). If the residual tooth is thin and you > make a ferrule, there is fairly good chance of breaking to tooth off at the > base of core. If the tooth is plenty thick, you don't need a ferrule. Yes, that IS worth something.... Thanks SP SignatureNot a real Addy, yet >My two cents (for what it is worth). If the residual tooth is thin and you >make a ferrule, there is fairly good chance of breaking to tooth off at the >base of core. If the tooth is plenty thick, you don't need a ferrule. Gee I disagree. Joel I don't mind if we disagree. Want to discuss it or just leave it there? Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >>My two cents (for what it is worth). If the residual tooth is thin and [quoted text clipped - 6 lines] > > Joel >I don't mind if we disagree. Want to discuss it or just leave it there? We had probably best just leave it there. By the way, I do agree with your concept of eliminating posts with the CEREC technique. Posts can be nasty things. This discussion centers around a tooth that is broken off flush with the gum line. Current therapy might include extraction and implant so it is no biggie anymore. Years ago, developing methods for restoring these and using them as bridge abutments was important. That included ferrules. It kept many folks away from dentures! Joel Unfortunately, those posts retaining the abutment crown would often work loose or break taking the other abutment with it. Implants are so much more predictable. Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >>I don't mind if we disagree. Want to discuss it or just leave it there? [quoted text clipped - 14 lines] > > Joel >Unfortunately, those posts retaining the abutment crown would often work >loose or break taking the other abutment with it. > >Implants are so much more predictable. I suppose if there is a choice, the implant is more predictable at this point in time. If the patient is going to yank the tooth and not go for the implant, then we have trouble a-brewin'. Joel > I tried this years ago and it worked. It preserved a lot of sound tooth > structure in many cases. When composites were developed, I switched to > bonded composite as the core, and it works well, in my experience. So, if I understand this, you shovel in composite into the pulp chamber and completely seal it. So, in effect, you re-create the tooth as it was b/4 opening it up for Endo. BUT: What then? You still reduce it like as if it was a vital tooth getting crowned, no??? > I've never been fond of the approach of razing a tooth and replacing > everything you've just ground off with a post and large core, unless > it's absolutely necessary (and there are such cases). To my way of > thinking, it's preferable to retain as much healthy structure as sound > principles allow. I would say the same: I do so little C&B that I must really think about what I am doing and agonize over: IS THIS REALLY THE RIGHT THING TO DO FOR THIS CASE????. I just hate the idea of removing sound tooth structure as well. If you know of any other references besides Sverker Toreskog's book (Which I haven't gotten hold of yet, but I'm looking), I'd appreciate it. If nothing else, the CEREC craze may just revive this way of doing C&B. Thanks loads for the input, Bill! SP SignatureNot a real Addy, yet Bill <dental...@hotmail.com> wrote: > I tried this years ago and it worked. It preserved a lot of sound tooth > structure in many cases. When composites were developed, I switched to > bonded composite as the core, and it works well, in my experience. So, if I understand this, you shovel in composite into the pulp chamber and completely seal it. So, in effect, you re-create the tooth as it was b/4 opening it up for Endo. BUT: What then? You still reduce it like as if it was a vital tooth getting crowned, no??? Bill replies: Yep! Once the interior is filled with well-retained hard stuff (and assuming we don't have any paper-thin enamel walls anywhere) then I treat the tooth with a more-ideal onlay or crown prep. As long as the cusps are adequately prepped and covered, that seems to satisfy the need to prevent cusp fracture in endo-treated teeth. At least, that's my current thinking on the subject. > I've never been fond of the approach of razing a tooth and replacing > everything you've just ground off with a post and large core, unless > it's absolutely necessary (and there are such cases). To my way of > thinking, it's preferable to retain as much healthy structure as sound > principles allow. I would say the same: I do so little C&B that I must really think about what I am doing and agonize over: IS THIS REALLY THE RIGHT THING TO DO FOR THIS CASE????. I just hate the idea of removing sound tooth structure as well. If you know of any other references besides Sverker Toreskog's book (Which I haven't gotten hold of yet, but I'm looking), I'd appreciate it. If nothing else, the CEREC craze may just revive this way of doing C&B. Bill replies: I agree with you 100%. The key is to retain SOUND tooth structure. Why grind it away? Thanks loads for the input, Bill! SP SignatureNot a real Addy, yet Good talking with you, - Bill > Bill replies: > I agree with you 100%. The key is to retain SOUND tooth structure. Why > grind it away? Thanks for the input, yet again, Bill! SP SignatureNot a real Addy, yet |
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