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Medical Forum / General / Dentistry / January 2006Post Crowns
Does anyone know of any websites that show the clinical steps for preparing post crowns? I am a dental student cheers >Does anyone know of any websites that show the clinical steps for preparing >post crowns? > >I am a dental student > >cheers Do you mean a post is incorporated into the crown casting ? Or are you referring to a cast post ? In what school are you a dental student ? / -- Whamatus wubbabubbazG@RBAGEyahoo.com >>Does anyone know of any websites that show the clinical steps for >>preparing [quoted text clipped - 13 lines] > Whamatus > wubbabubbazG@RBAGEyahoo.com Cast post and cores. Direct method eg parapost Or building a resin core from duralay which is given to the lab to invest and burnt out. I am at a UK dental School Forget the posts once you graduate. If the crown was going to fall off without it, the tooth is doomed anyway. You may need to perform the P&C during school to impress the instructors. I personally, like making the core part of the onlay or partial crown, but no post.  Signature/ Amatus / > >>>Does anyone know of any websites that show the clinical steps for [quoted text clipped - 21 lines] > > I am at a UK dental School > Forget the posts once you graduate. If the crown was going to fall off > without it, the tooth is doomed anyway. You may need to perform the P&C > during school to impress the instructors. I personally, like making the > core part of the onlay or partial crown, but no post. I did my first one last week using the parapost system. We did the theory over a year ago. I was really scared of causing a root fracture whilst trying to enlarge the canal with the parapost burs, so I went really slow. The prep took an hour. The tooth was LL5. The mesial aspect was subgingival. I placed a 1.2mm shoulder buccally and 0.5mm chamfer palatally. In the end, the ferrule I created was wafer thin. My instructor told me it was a loose loose situation (through no fault of my own) as if I had left those wafer thin walls in place it would have fractured during the casting process. Without a ferrule you increase the incidence of root fracture or post crown failure. In the end he told me to make sure that the post and core was made from a non precious metal, so that it can be sandblasted and etched for bonding with Panavia. I want to try different techniques such as the indirect-direct technique (the building up with duralay) >>Forget the posts once you graduate. If the crown was going to fall off >>without it, the tooth is doomed anyway. You may need to perform the P&C [quoted text clipped - 24 lines] > I want to try different techniques such as the indirect-direct technique > (the building up with duralay) You're unlikely to fracture a root by preping it. Never force the drill. One thing you may do (I have): you may enlarge a canal in a curved root and cause a perforation even if you aren't off line. This is most likely to happen on the distal aspect of mesial roots of lower molars and palatal aspect of buccal roots of upper molars, as well as premolars. I have not totally abandoned posts myself, though I certainly am more circumspect about their use than I used to be. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >>>Forget the posts once you graduate. If the crown was going to fall off >>>without it, the tooth is doomed anyway. You may need to perform the P&C [quoted text clipped - 35 lines] > > Steve Thanks steve, The roots were pretty straight, and I made sure that I was going paralell to the root at all times. I used an up and down motion, but didnt want to put too much downward pressure. I was initially getting very frustrated as I meassured 8mm from the post obturation radiograph. Trying to get a no.4 gates glidden to this mark was very laborious. I was going to use peezo reamers, but they had run out. I looked on coltene whaledent website about how to get the most from the parapost system, but there is nothing there. I find this hard to beleive that manufactures give so little support for their product and expect you to splash out and pay $$$$$$$. That is really unfair! The instructions would be great for novices like myself. > Thanks Steve, The roots were pretty straight, and I made sure that I was > going parallel to the root at all times. I used an up and down motion, but > didn't want to put too much downward pressure. > I was initially getting very frustrated as I measured 8mm from the post > obturation radiograph. Trying to get a no.4 gates glidden to this mark was > very laborious. I was going to use peezo reamers, but they had run out. Removing the gutta percha with Gates Glidden burs normally takes about 2 minutes at the most. You just need more practice and confidence. Peezo Reamers are easier to perforate the sides of the root with. Signature/ Amatus / > >>>>Forget the posts once you graduate. If the crown was going to fall off [quoted text clipped - 50 lines] > > The instructions would be great for novices like myself. >> Thanks Steve, The roots were pretty straight, and I made sure that I was >> going parallel to the root at all times. I used an up and down motion, but [quoted text clipped - 6 lines] >minutes at the most. You just need more practice and confidence. Peezo >Reamers are easier to perforate the sides of the root with. The Dentatus reamers that come with the kit work well and haven't perfed one, yet. -- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > > Thanks Steve, The roots were pretty straight, and I made sure that I was > > going parallel to the root at all times. I used an up and down motion, but [quoted text clipped - 6 lines] > minutes at the most. You just need more practice and confidence. Peezo > Reamers are easier to perforate the sides of the root with. Try the Brassler equivalent of the old GPX reamer. It is essentially a very smooth rotary file, used to remove GP safely. I like 'em. SP SignatureTake out the TRAASH to reply A #3 Gates will usually get you down the root easier than a #4. In practice, I probably do a post prep in just a few minutes. #3 GG, #4 GG, and then the post drill. As AC says, perforation is much more likely than fracture. The GG's follow the canal pretty well and remove the gutta-percha and slightly enlarge the canal. Then the post drill has an easier path to follow is less likely to be forced off line. One thing to watch for in school: I've seen more than one student work for an hour turning a 'B' prep into a 'C' prep (or worse). JME, Dartos > Thanks steve, The roots were pretty straight, and I made sure that I was > going paralell to the root at all times. I used an up and down motion, but [quoted text clipped - 9 lines] > > The instructions would be great for novices like myself. > As AC says, perforation is much more likely than fracture. The fracture comes about 2 years later (if the patient has parafunction). Signature/ Amatus / >A #3 Gates will usually get you down the root easier than a #4. In > practice, I probably do a post prep in just a few minutes. #3 GG, #4 GG, [quoted text clipped - 23 lines] >> >> The instructions would be great for novices like myself. In my early years, I did quite a few post build ups. Amazingly, I still see lots of them still functioning (and some are in some rather hostile environments!). Sure, I've extracted some failures also, but very few root fractures. JME, Dartos >> As AC says, perforation is much more likely than fracture. > > The fracture comes about 2 years later (if the patient has parafunction). Would you agree that the post did not extend the life of the tooth at all? That if the tooth survived, it never needed the post in the first place? Signature/ Amatus / > > In my early years, I did quite a few post build ups. Amazingly, [quoted text clipped - 8 lines] >> >> The fracture comes about 2 years later (if the patient has parafunction). For the majority, probably. For some, I don't think they would have worked for 6 months. Gordo has even come out with a pro-post/pin stance as of late. I do think that most teeth that require a post to rebuild are 'temporary', but that term is relative. I don't think it's all cut and dried right now. You're putting posts (of a sort) in some of your Cerec endo teeth. <G> Later, Dartos > Would you agree that the post did not extend the life of the tooth at all? > That if the tooth survived, it never needed the post in the first place? Gordo does not count. He has never run a "real" practice. Ever read his articles in the JADA ? My endo-crowns have an attached core, minimal if anything into the root canal space. Sometimes, I will go 2-3 mm into the root canal space if I want more surface area to bond to. Signature/ Amatus / > For the majority, probably. For some, I don't think they would > have worked for 6 months. [quoted text clipped - 13 lines] >> all? That if the tooth survived, it never needed the post in the first >> place? > Gordo does not count. He has never run a "real" practice. Ever read his > articles in the JADA ? > > My endo-crowns have an attached core, minimal if anything into the root > canal space. Sometimes, I will go 2-3 mm into the root canal space if I > want more surface area to bond to. I, for one, see no reason why this principal cannot be applied to those of us who have not (at least as yet) a CEREC machine. I'd like to know if these principals are published anywhere. Thanks SP SignatureTake out the TRAASH to reply >A #3 Gates will usually get you down the root easier than a #4. In >practice, I probably do a post prep in just a few minutes. #3 GG, #4 >GG, and then the post drill. As AC says, perforation is much more >likely than fracture. The GG's follow the canal pretty well and remove >the gutta-percha and slightly enlarge the canal. Then the post drill >has an easier path to follow is less likely to be forced off line. A nice thing about GG's for this is if you've used the GG during the endo TX. >One thing to watch for in school: I've seen more than one student work >for an hour turning a 'B' prep into a 'C' prep (or worse). No doubt. >JME, >Dartos [quoted text clipped - 12 lines] >> >> The instructions would be great for novices like myself. -- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>>>Forget the posts once you graduate. If the crown was going to fall off >>>>without it, the tooth is doomed anyway. You may need to perform the P&C [quoted text clipped - 49 lines] > > The instructions would be great for novices like myself. A #4 gates glidden is pretty big. I use a smaller one--maybe a 2 or 3 as a pilot drill only. As you know, they are not end-cutting, so they will follow the gutta percha pretty well. Using an in and out motion is a good idea to get the feel, but if you use a light touch you will soon be able to go right in. They are safer than peesos of the same size, esp. in curved canals. They do break at the shank, so you should have some needle clamp or silver point clamp (boy am I showing my age) handy to retrieve it if it breaks. Then you can go in with the appropriate size parapost drill. You don't want to force those in. Good luck, Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > A #4 gates glidden is pretty big. I use a smaller one--maybe a 2 or 3 >as a pilot drill only. As you know, they are not end-cutting, so they [quoted text clipped - 4 lines] >some needle clamp or silver point clamp (boy am I showing my age) handy >to retrieve it if it breaks. A 90 degree Steglitz works quite well. >Then you can go in with the appropriate >size parapost drill. You don't want to force those in. > >Good luck, >Steve -- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > A #4 gates glidden is pretty big. I use a smaller one--maybe a 2 or 3 > as a pilot drill only. As you know, they are not end-cutting, so they > will follow the gutta percha pretty well. Using an in and out motion is > a good idea to get the feel, but if you use a light touch you will soon > be able to go right in. They are safer than peesos of the same size, > esp. in curved canals. However.... finishing with a peeso will give you the legal limit in length you need to perform a reasonable prep. If you put the peeso up against the P/A, and eyeball the amount of root apical to the prep, it should be six mm. If it is less, you should tell the patient that there is already some evidence that conditions are not optimal, and opt for a pre-fab vs cast. That's why I start with those GPX rotary GP removers (Brassler has taken them over, and I can never remember what they call them now) and THEN, I finish with the Peezo just to give me what I need in terms of canal length. This is the same whether it is cast or pre-fab. SP SignatureTake out the TRAASH to reply > If you put the peeso up > against the P/A, and eyeball the amount of root apical to the prep, it > should be six mm. If I do that, the bur will be about as long as 1-2 mm on the PAx. Signature/ Amatus / > >> A #4 gates glidden is pretty big. I use a smaller one--maybe a 2 [quoted text clipped - 16 lines] > pre-fab. > SP > > If you put the peeso up > > against the P/A, and eyeball the amount of root apical to the prep, it > > should be six mm. > > If I do that, the bur will be about as long as 1-2 mm on the PAx. Sorry, I wasn't clear: I meant the working part of the bur ONLY. SP SignatureTake out the TRAASH to reply I was pointing out that holding a bur up against a radiograph on a computer monitor does not tell me anything about length. The image on the screen is typically magnified at leapt 15 times. Signature/ Amatus / > >> > If you put the peeso up [quoted text clipped - 5 lines] > Sorry, I wasn't clear: I meant the working part of the bur ONLY. > SP > I was pointing out that holding a bur up against a radiograph on a computer > monitor does not tell me anything about length. The image on the screen is > typically magnified at leapt 15 times. Oh, yes, I forgot that you're informatized. Then if you wanted to guage that length, you'd either take a photo with the peezo in the canal, take a standardized photo of a peezo by itself and measure it to use as a guage, or use your measuring tool to tell you these lengths. But even then, you have to use _something_ to standardize your measuring tool. The point I was trying to make is that if you use a small-ish peezo to be sure not to perf the root, and you dig down from the _canal_ entrance (as opposed to the _tooth_ entrance) till the working part is just buried in the canal but no more, you're supposed to end up with a (cast) post space of sufficient length for most if not all PM's and molars. That's what the Peezo was designed for, as I understand it. If by doing this you'd not be able to leave at least six mm of apical seal, you're supposed to forget using a cast post and go with the pre-fabs, because you have to cheat and make a shorter canal prep. The patient is supposed to be duly informed of this compromise. (I use Fiber Posts as do yourself). After reading this, I know you're going to say that the Pipe is as far into the patatoe patch as he can get, but that's what I was told by the Prostho up our way, and I'm pretty sure I didn't misunderstand. I'd be interested to hear what this sounds like to an (often) anti-posting, pulp-space-core-promoting CEREC monger such as yourself. Thanks SP SignatureTake out the TRAASH to reply My software includes a measurement tool. As long as the PAx was taken using the "parallel" technique, you can get very accurate measurements off the screen. When I compare these measurements to endo-measurement images, I find they are right on. (give or take .5 mm). So, I can determine the length of a root from a good PAx in seconds and decide how far into the canal space I want to work. I just sent W_B an image of an endo re-Tx I did yesterday. My measurement for the endo fill was done totally off the software. No measurement image exposed. Remind me later and I can send a copy to you if you like. Honestly, I do not see much reason for routinely placing posts anymore. The occasional fibre-post when you are playing the role of hero and the patient knows to only expect a year or three from the tooth. Cast P&C's are no longer done by me at all. I just sold my casting arm and burn out oven yesterday, as a matter of fact. If you are restoring a molar which has had RCT, you can get much more retention and strength from the inside of the pulp chamber than you will from a post. It is the occasional pre-molar or anterior which will challenge you. Amatus Cremona .. >> I was pointing out that holding a bur up against a radiograph on a >> computer [quoted text clipped - 29 lines] > Thanks > SP > If you are restoring a molar which has had RCT, you can get much more > retention and strength from the inside of the pulp chamber than you will > from a post. It is the occasional pre-molar or anterior which will > challenge you. Quite fully agree, except for Canines. I try ANYTHING to save 'em. SP SignatureTake out the TRAASH to reply > I just sent W_B an image of an endo re-Tx I did > yesterday. My measurement for the endo fill was done totally off the > software. No measurement image exposed. Remind me later and I can send a > copy to you if you like. I would, thank you, but it is not pressing (obviously). In the New Year, I will have a few questions for Amatus/Whamatus twins (sad, about your other sister, choking to death while laughing at a SWNMNBM post...) re Endo (sigh.... yes, again...). The re-TX you mention makes them all the more relevant. BTW: you really should take a few minutes and see the RealWorldEndo site. Thier rotary files/paper points/GP system is really great, IMO. Cheers SP SignatureTake out the TRAASH to reply >I'd be interested to hear what this sounds like to an (often) >anti-posting, pulp-space-core-promoting CEREC monger such as yourself. > >Thanks >SP CEREC monger, I like that ! Does he smell like fish ? -- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > >I'd be interested to hear what this sounds like to an (often) > >anti-posting, pulp-space-core-promoting CEREC monger such as yourself. [quoted text clipped - 5 lines] > > Does he smell like fish ? Your garden variety pulp-space-core-promoting CEREC monger doesn't smell like fish... He doesn't run around RattleSnake Buttes Montana with a little push cart with an unbrella on it yelling _fresh CERECS!!! Get 'em while 'ere HOT!!!_ He does occasionally smell of bruning Ceramic Stuff. Just so youse don't get the wrong idea, a pulp-space-core-promoting CEREC monger can also be a wo_man... Hope youse all had a Happy New Year. I spent mine down the Lower St Lawerence way eating _Cipaille_ ... Nothing can beat home cooking. Cheers SP SignatureTake out the TRAASH to reply > They do break at the shank, so you should have > some needle clamp or silver point clamp (boy am I showing my age) handy > to retrieve it if it breaks. Hey, I still have some silver point pliers too! I remember using them to retrieve a silver point for a re-treat case back in the nineties. I'll bet I can find them if I rummage around in the back of the drawer somewhere. Handy little item, you can get a good grip on the point with them. But there aren't any silver points to grip any more . . . - dentaldoc I had one last month. Jut used the same instrument on Thursday. I use to remove old Para-Post type posts. AC >> They do break at the shank, so you should have >> some needle clamp or silver point clamp (boy am I showing my age) handy [quoted text clipped - 9 lines] > > - dentaldoc > > They do break at the shank, so you should have > > some needle clamp or silver point clamp (boy am I showing my age) handy [quoted text clipped - 9 lines] > > - dentaldoc Ohhhh yessss there are: I have a couple-a older cases with crowns on 'em, and I'm just waiting for 'em to flare up... Seasons' Greetin's to you, Bill! SP SignatureTake out the TRAASH to reply > You're unlikely to fracture a root by prepping it. Never force the drill. > One thing you may do (I have): you may enlarge a canal in a curved root [quoted text clipped - 3 lines] > I have not totally abandoned posts myself, though I certainly am more > circumspect about their use than I used to be. I will occasionally place a fibre-post in an anterior tooth or a pre-molar that is very narrow. I doubt I insert 10 a year. If I place a post, I will remove the gutta percha, and then only smoothen the canal walls, not enlarge them. With bonded luting agents, you don't need the close fit you needed with Tenacin. In my office, a post is done for "Hero-Dontics". To try to get a few more years out of a very badly broken down tooth. The fibre-post will break before the root does, so you don't lose bone when the restoration fails. An important aspect of dentistry which is often overlooked, is what options will there be when the restoration you are placing fails? Failure of metal posts will often lead to extraction. Failure of FGC's will often break the tooth off at the gingival crest, or leave you with a half pound of mush under the crown. Always think ahead to what will be the options next time the tooth must be treated. Signature/ Amatus / > >>>Forget the posts once you graduate. If the crown was going to fall off [quoted text clipped - 36 lines] > > Steve >>You're unlikely to fracture a root by prepping it. Never force the drill. >>One thing you may do (I have): you may enlarge a canal in a curved root [quoted text clipped - 19 lines] > under the crown. Always think ahead to what will be the options next time > the tooth must be treated. My surgeon is thinking of those options while the caries is still in enamel. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > as if I had left those wafer thin walls in place it would have fractured > during the casting process. > Without a ferrule you increase the incidence of root fracture or post > crown failure. Come back here and remind me after you graduate. I will explain why many ferrules increase the likelihood of fracturing the tooth rather than decrease it. Until graduation, you will need to regurgitate back to the instructors whatever they believe. Signature/ Amatus / > >> Forget the posts once you graduate. If the crown was going to fall off [quoted text clipped - 26 lines] > I want to try different techniques such as the indirect-direct technique > (the building up with duralay) > Does anyone know of any websites that show the clinical steps for preparing > post crowns? > > I am a dental student > > cheers Here's an interesting hybrid technique, combining direct post with indirect core: http://www.dentistry.vcu.edu/prosth/clinic_info/post.html Here is an article advocating direct Duralay resin patterns for indirect post/cores: http://ordredesdentistesduquebec.qc.ca/publications/images/pdf/Prosthodontie_200 2_04_En.pdf This really should be routine stuff covered in any prosthodontic textbook. Steve >> Does anyone know of any websites that show the clinical steps for preparing >> post crowns? [quoted text clipped - 16 lines] > >Steve That would be fixed prosthodontics right ? I had a cat that was fixed once. -- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > >> Does anyone know of any websites that show the clinical steps for preparing > >> post crowns? [quoted text clipped - 25 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com I had a cat that was fixed twice. ...Once before and once after having kittens. .......The kittens were afflicted with an iatrogenic disorder... ............They were all born sterile. ....................Veterinary medicine is not a perfect science. ..........................But I might add,,, none of them were stinky -Sue > That would be fixed prosthodontics right ? > > I had a cat that was fixed once. > -- Was he fixed by a Prosthodontist? SP SignatureTake out the TRAASH to reply Hearsay and "what works for me" is not necessarily without value...but be careful, be very careful. If you think all endo teeth need a post you're wrong. If you think none of them do you're also wrong. You want a good, practical consensus based on such evidence as there is for restoring endo teeth read: Guidelines for the Restoration of Endodontically Treated Teeth. Robbins, J.W. JADA 120:558-566, 1990 All you guys don't like the ferrule: yeah, that's great, but where's your data? Somebody got a problem with instructors? I teach part-time in a postdoc general dentistry program. I don't abide BS theories, and no department chair tell me what to think or teach. Nobody has seen more endo/restorative failures than I have - gotta love those postdoc residents. Biggest reason is little/no ferrule. Sometimes you need a post. Often you don't. My Prostho residency instructors were anal about cast posts. They were full of s--- and didn't know it. 22 years later I know it, but I still make a cast post once in a while, mostly an artistic choice. To the dudes that like the post/crown cast together: how do you make a casting that fits both the margin and the canal? I'm a pretty handy C & B tech and I can't do it. Bottom line on posts: -Only function is for retention of the restoration. You got no coronal tooth structure to speak of, put in a post, man! Don't need it to retain the core or crown? Then don't bother. -Weakens the tooth if you remove tooth structure to fit it. -And posts should fit good. Sometimes you gotta make a casting to do this without reaming the crap outta the canal. -Jury is out on "best material", choice of luting agent and whether one should bond it in. -Anti-rotation, post length/width, optimum range of ferrule height all pretty well established. Don't agree? Hey man, do your best James Dean and be a rebel. Just don't expect to impress anyone. > Here's an interesting hybrid technique, combining direct post with > indirect core: > > http://www.dentistry.vcu.edu/prosth/clinic_info/post.html You know; it's not the same thing, but it reminds me of what Amatus does with the inserted Fiber Post becoming part of the core of his Onlays. Merci for the link and Happy Holidays to you and yours. SP SignatureTake out the TRAASH to reply >> Here's an interesting hybrid technique, combining direct post with >> indirect core: >> >> http://www.dentistry.vcu.edu/prosth/clinic_info/post.html That site is a horrible example of dentistry. That pre-molar will be lost in less than 2 years, taking a very expensive FPD with it. That tooth needs to come out and two (or three) implants placed. The root is probably only 6-8 mm long. The core alone is that long. Add a couple of mm for the height of the crown, and you have a fabulous lever arm. Fulcrum will be half-way point on the post with greatest force exerted at the tip of the post as the crown-lever tries to rotate the entire thing. Bang ! the root will crack in half in very short time. AC > >> Here's an interesting hybrid technique, combining direct post with > >> indirect core: [quoted text clipped - 5 lines] > > AC I was too chicken to say something similar, and I wouldn't have tried it, owing to my limited skills. If the patient wanted a tree trunk post like that, I'd have shipped it to the specialist. Thanks for cutting the issue down to the essential: Don't do it. SP SignatureTake out the TRAASH to reply >>> Here's an interesting hybrid technique, combining direct post with >>> indirect core: [quoted text clipped - 11 lines] > >AC While I highly value your analysis there are a few points that debatable. My observations: According to the second picture (if to scale) the perio probe indicates ~11mm of root length in bone. It also appears that not only is the first bicuspid missing, but the first molar is missing as well. The central and lateral are PFM's (PVC if you prefer). (probably all anteriors) (picture 6) The clinical crown of the cuspid is *very* short. Overprepped IMO. Agree that the post(s) are way too long, if the anterior PFM's are any indication of the parafuntional habits, then an NTI is definitely indicated. There seem to be some attached gingiva issues; maybe it's the photography. As an aside why anyone would try to finalize the core prep without cementing the core is beyond me. Most anyone cannot hold a core in place while a prep is being made on gold and tooth at the same time. This also invites swallowing, or worse, aspiration of the cast post. The assistant's right hand is ungloved, that's just plain bad form. %%%%%%%%%%%%%%%%%%% My treatment plan for this case. (at first glance) NTI #11 PFM NTI #13 short post/core #13 PFM NTI #12 implant NTI #12 PFM/implant restoration. Oh yeah, did I mention NTI ? I wouldn't use #13 as an FPD abutment, Unless double abutted to #15. Pipe-man, if this is the stuff they teach ya'll, it's at least 20 years behind the restorative curve, and very likely 30+ years. Old school concepts that ultimately fail catastrophically. -- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > I wouldn't use #13 as an FPD abutment, > Unless double abutted to #15. [quoted text clipped - 3 lines] > 30+ years. > Old school concepts that ultimately fail catastrophically. I don't know... we were taught to take canal impressions with Impregum (poly-ether) and adjust and cement the resulting cast post; but as I already said, the length of the post means there is insufficient apical seal in the Endo (need 5-6 mm) for the case to fly predictibly. I would have said much the same,and if the patient wanted the tooth saved, it would have been a Fiber Post and composite core/crown, and I would have left it awhile to see if the post/core was strong enough to not pull away from the finish line. If so, it would have been a standard PFM crown. I would not have tried to use this tooth as an abuttttttttttmenet for a bridge. NTI would be mandatory, and I would have started with that, and gottent the initial reticence/adapatation period outta the way and then attacked the tooth. The patient would have signed off if s/he didn't want the NTI. I _think_ what they _maybe_ are doing here is what the para-profs are teaching: prep for the final impression, take it in polysiloxane with no Williams rod or anything in the canal, and have the post and crown delivered together. You assemble it all in the tooth to see that everything fits, and then cement it all together (one-shot, with you injecting cement into the canal while holding the already-filled crown in your non-dominant hand. Once the post is in, you slap the crown on and put pressure on it to keep everything seated while the _expanding_ cement sets). So, maybe they needed to adjust the post and so they wanted to send the post back with the final impression of the finish line so the crown is waxed up on it and so it is all done at the same time....?...... Maybe..... <The Pipe sits back, grunts, and eats celery....> SP SignatureTake out the TRAASH to reply > Pipe-man, if this is the stuff they teach ya'll, it's at least > 20 years behind the restorative curve, and very likely > 30+ years. > Old school concepts that ultimately fail catastrophically. So, you would whip it out and plant some implants? Thanks SP SignatureTake out the TRAASH to reply > While I highly value your analysis there are a few points that > debatable. Thank Youse.... <titter, titter> > My observations: > > According to the second picture (if to scale) the perio probe > indicates ~11mm of root length in bone. Which means youse get only about 5mm of post/core/crown space... seems to me it'll be short and fat and ugly-like... > It also appears that not only is the first bicuspid missing, > but the first molar is missing as well. So one would gather from observing the bone density and quality on either side of that lone wolf PM tooth. > The central and lateral are PFM's (PVC if you prefer). > (probably all anteriors) [quoted text clipped - 15 lines] > at the same time. This also invites swallowing, or worse, > aspiration of the cast post. As I said in the other post, I think they had seating problems and were going to modify the post and then cement the post and crown together. > The assistant's right hand is ungloved, that's just plain bad form. After the damn dam is in place, so do most Endo's work un-gloved. At least, that's what I saw when we went to the Endo's place. > My treatment plan for this case. > (at first glance) [quoted text clipped - 8 lines] > NTI > #12 PFM/implant restoration. What about the missing molar (#14)? > Oh yeah, did I mention NTI ? NTI....?.... Vas ist das? > I wouldn't use #13 as an FPD abutment, > Unless double abutted to #15. What do youse mean here? Bridge from 11-X-13-X-15....? > Pipe-man, if this is the stuff they teach ya'll, it's at least > 20 years behind the restorative curve, and very likely > 30+ years. > Old school concepts that ultimately fail catastrophically. I do believe they are still teaching cast post and core, yes. And I for one will still think long and hard before I recommend other solutions to it (tho I have not forgotten what Amatus has said 'way back in that veneer case I was doing on Endo treated teeth... the one where I posted the teeth/diastema close-ups). So, whott-a does dis a-mean? Youse are now _always_ against cast posts in _any_ situation? Thanks SP SignatureTake out the TRAASH to reply Steve wrote: Here is an article advocating direct Duralay resin patterns for indirect post/cores: http://ordredesdentistesduquebec.qc.ca/publications/images/pdf/Prosth... This really should be routine stuff covered in any prosthodontic textbook. Steve ________________________________ That pdf page shows three basic applications for Duralay resin. Simple and effective. The article is dated 2002, but we were using Duralay for all three of those applications back in dental school over 35 years ago. It still works, though there are lots of other ways to gain the desired ends now. The main difference between now and in those years B.G. (before gloves) is that the resin doesn't get stuck all over the fingers anymore. - dentaldoc > That pdf page shows three basic applications for Duralay resin. Simple > and effective. [quoted text clipped - 8 lines] > > - dentaldoc Yeah--no "wet fingered" dentists anymore! Merry Christmas! Steve |
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