Prosthetic rehabilitation of a mandibular root amputated molar using single crown

Transcription

1 Cse Report Prosthetic rehilittion of mndiulr root mputted molr using single crown Azm Sdt Mostfvi, Seyed Mehrn Flhchi Deprtment of Prosthodontics, Dentl Reserch Center, Fculty of Dentistry, Tehrn University of Medicl Sciences, Tehrn, Irn Astrct In teeth with furction involvement, root mputtion is one of the tretment choices. A chllenge which dentist my encounter with is the prosthetic tretment of such teeth when their djcent teeth re intct. According to the current gol of opertive dentistry sed on conservtive tretment, it would e desirle to do in mnner resulting in miniml dmge to the djcent sound teeth. In the following cse report, step y step conservtive tretment sequences of mndiulr molr with distl root mputtion which not involving surrounding teeth is descried. During 18 months follow up, the results were stisfctory. Keywords: Furction involvement, prosthetic rehilittion, root mputtion Address for correspondence: Dr. Seyed Mehrn Flhchi, Deprtment of Prosthodontics, Dentl Reserch Center, Fculty of Dentistry, Tehrn University of Medicl Sciences, Northern Kregr Street, Tehrn , Irn. E mil: mehrn.flhchi@gmil.com Received: 28 th April, 2017, Accepted: 14 th August, 2017 INTRODUCTION Root resection ws defined for the first time in Since tht time, reports nd studies out this tretment modlity hve een ccomplished. Decision mking out molr teeth with furction involvement is still chllenge for the clinicins. [1] There exist severl tretment options with different mounts of complexity to mintin such tooth which indeed require the collortion of periodontics, endodontic, nd restortive dentistry. Choosing the est tretment option is contingent on mny fctors. The most importnt fctor is the grde of furction involvement which is n effective fctor in the determintion of prognosis s well. [2] One of the mentioned tretment options is root resective therpy with the im of preservtion s much tooth structure s possile. There re different resection procedures including root mputtion, hemisection, isection, nd rdisection. [3] Severl cses out root resection hve een reported. In ll of such cse reports, fixed dentl prosthesis (FDP) ws chosen s the tretment of choice. Nowdys, the gol of opertive dentistry is to chieve the oth esthetic nd conservtive results. Therefore, in the cse of molr root resection, it would e desirle to void preprtion of the intct tooth djcent to edentulous spce resulted from root resection. In the following report, step y step tretment sequences of mndiulr molr with distl root mputtion which ws restored conservtively with single crown is reported nd the essentil considertions for using this tretment modlity is discussed s well. Access this rticle online Quick Response Code: Wesite: ips.org This is n open ccess rticle distriuted under the terms of the Cretive Commons Attriution NonCommercil ShreAlike 3.0 License, which llows others to remix, twek, nd uild upon the work non commercilly, s long s the uthor is credited nd the new cretions re licensed under the identicl terms. For reprints contct: reprints@medknow.com DOI: /jips.jips_121_17 How to cite this rticle: Mostfvi AS, Flhchi SM. Prosthetic rehilittion of mndiulr root mputted molr using single crown. J Indin Prosthodont Soc 2017;17: The Journl of Indin Prosthodontic Society Pulished y Wolters Kluwer - Medknow

2 CASE REPORT Mostfvi nd Flhchi: Rehilittion of mndiulr root mputted molr A 35 yer old mle ptient ws referred to the Prosthodontics Deprtment of Tehrn University of Medicl Sciences with mndiulr right first molr sujected to distl root mputtion [Figure 1]. The ptient s orl hygiene ws good, nd he insisted to keep his teeth intct. Root cnl therpy nd n extensive deficient mlgm restortion hd een done for the tooth. After consulttion with the endodontic deprtment, the ccurcy of existing endodontic tretment ws verified. The usul tretment option performed in mndiulr root resected teeth is FDP. It hs een used in ll relted cses reported. In this ptient, however, right second molr hd miniml composite restortion, nd the ptient did not tend to the preprtion of his sound tooth [Figure 2]. To these resons nd ccording to the im of the prosthetic rehilittion which is the preservtion of teeth structure, single crown restortion ws considered for him. In the first ppointment, dignostic csts were provided. The extensive mlgm restortion ws removed. Preprtion of the tooth nd root cnl ws performed. A 5 mm gutt perch ws reserved to picl sel mintennce. Postpttern (Pttern resin LS, GC Americ, Illinois, USA) ws formed [Figure 3] nd preprtion ws ccomplished. In the second ppointment, the cst post nd core ws tried in nd its seting ws verified y peripicl rdiogrph fter cementtion (GC Fuji II, GC Americ, Illinois, USA), refinement of the preprtion ws done, nd occlusl clernce ws checked [Figure 4]. The gingivl finishing line ws shllow chmfer nd little sugingivl to mke the pproprite estlishment of emergence profile. Retrction cord ws plced to expose the mrgin, nd complete rch putty wsh impression ws mde with poly ivinyl siloxne (Pnsil, Kettench, Hesse, Germny). The temporry restortion ws mde with fetures to e respected in the finl restortion (Vislys Temp, crylic composite mteril, Kettench, Hesse, Germny). The impressions were poured nd mounted on nonrcon semidjustle rticultor (Denttus rticultor ARH, Denttus, Spång, Sweden). The required specific fetures were determined for the technicin s follows: uccolingul dimension of the crown should e smller nd decresed towrd the distl prt (cntilevered portion should e smller); Wide nd strong proximl contct should e provided, prticulrly in distl prt; clernce of cntilevered portion from the ridge should e provided sufficient to llow the tip of explorer to cross the site; nd occlusl contct should not e estlished on cntilevered portion. Restortion should hve contct in Mximum Intercusption (MIC) position, not in eccentric movements. To e sure of considering these Figure 1: Buccl view of mndiulr right first molr with distl root mputtion Figure 2: Preopertive rdiogrph of mndiulr right first molr Figure 3: Fricted postpttern fetures, crown wx up ws checked [Figure 5]. In the third ppointment, seting of the cst frmework ws verified, nd mrgins were evluted in oth clinicl nd rdiogrphic exmintion [Figure 6]. Then, porcelin lyering ws ccomplished y technicin [Figure 7]. In the fourth clinicl ppointment, porcelin trying, checking the color nd contour nd occlusl djustment were performed sed on previous criteri descried. In the fifth ppointment, fter The Journl of Indin Prosthodontic Society Volume 17 Issue 4 Octoer-Decemer

3 [Downloded free from on Thursdy, Ferury 15, 2018, IP: ] Mostfvi nd Flhchi: Rehilittion of mndiulr root mputted molr Figure 4: Finl preprtion fter postcementtion Figure 6: Cst frmework try-in through () clinicl exmintion, nd () peripicl rdiogrph porcelin glzing, the crown ws cemented with temporry cement (Temp ond, Kerr, Cliforni, USA) [Figure 8]. Orl hygiene instructions were given to the ptient nd recll ppointments were scheduled. After 1 month, the restortion ws cemented permnently with glss ionomer luting gent (GC Fuji II, GC Americ, Illinois, USA). During 18 months follow up, there ws no prolem with esthetic, function, nd hygiene nd the ptient ws stisfied with his prosthesis [Figure 9]. DISCUSSION Current studies reveled tht one of the effective tretment options for molrs with furction involvement is root resective therpy.[4] It ws found tht it cn provide desirle long term prognosis, especilly when restortion with ccurte fit nd occlusion is fricted.[5] Bühler suggested tht efore extrction of ny molr, hemisection should e considered s possile tretment modlity.[6] There re mny studies out survivl rte nd success of root resected teeth. Some of them stted tht over 10 yers, 30% of molrs sujected to root resection filed.[7] Others suggested tht survivl rte of such teeth is more thn 90%.[8] Crnevle et l. found tht survivl rte of oth root resected tooth nd nonresected tooth in 10 yers of oservtion were 93% nd 99%, respectively.[4] 414 Figure 5: Designing frmework wx up. () Lterl view, () occlusl view Figure 7: Porcelin lyered restortion. () Occlusl view, () lterl view Some studies compred survivl rte of root resected teeth versus dentl implnts.[1] Zfiropoulos et l. found tht mjority of oth dentl implnts nd root resected teeth hd not ny compliction within t lest 4 yers mintennce cre. However, compliction of root resected mndiulr molrs ws more thn dentl implnts.[1] Fugzzotto stted tht cumultive success rtes of molrs sujected to root resection nd dentl implnts replcing the molr re 96.8% nd 97%, respectively, over 15 yers. They suggested tht functionl success of oth tretment options is high.[9] Choosing molr for root resective therpy is influenced y severl fctors including root morphology, ttchment of the remining root, the divergence of root nd loction of the furction.[10] Mesil root is more difficult to prepre ecuse its concvity is towrd the distl. Therefore, in The Journl of Indin Prosthodontic Society Volume 17 Issue 4 Octoer-Decemer 2017

4 Mostfvi nd Flhchi: Rehilittion of mndiulr root mputted molr Figure 9: Finl restortion fter 18 months. () Introrl view, () peripicl rdiogrph Figure 8: Finl restortion of mndiulr right first molr mndiulr molrs, the mesil root is often sujected to the resection nd it is preferred tht distl root is mintined. [10] However, occsionlly, distl root hs severe one loss nd it is condemned. In such condition, if the mesil root hs pproprite ntomy, it cn e mintined nd the distl root would e resected, similr to the current cse. There re mny cse reports out mndiulr root resected molrs. In ll of them, edentulous re resulted from root resection ws mnged using FDP. However, sometimes, dentists encounter with situtions in which the tooth djcent to the edentulous re is intct or with miniml restortion. In such condition, preprtion of sound tooth structure is so invsive nd is contrry to conservtive gols of opertive dentistry. Therefore, in descried ptient, single crown restortion ws preferred. Biomechnicl, endodontic, nd periodontl fctors re the min resons of filure in restortions of root resected teeth. In study of Lnger et l., filure resons of the root resected molrs were s follows: root frcture (75%), endodontic tretment filure (18.4%), dissolution of the cement (7.9%), nd periodontl prolems (26.3%). The most common reson resulting in root frcture is iomechnicl prolems. [11] Augereu et l. ssessed loction of stress nd its mgnitude y 3 D finite element in 4 conditions: (1) molr without root mputtion, (2) mesil root mputtion restored y single crown, (3) mesil root mputtion restored y FDP with two distl utments nd mesil cntilever, nd (4) mesil root mputtion restored y FDP with two utments (the distl root nd the second premolr). They found tht option 2 pplies more stresses on surrounding one nd the root. [12] According to this, lthough using single crown with cntilever splinted to the remining root hs iomechnicl risk, it cn meet conservtive gols which is so importnt in tody dentistry. Therefore, in such condition, certin considertions re required to void this prolem: Although suprgingivl mrgin is fvorle, [13] too provide sufficient retention nd proper emergence profile, mrgins should e plced sugingivl, ut not too much In the conventionl method, the smller size of the occlusl tle is determining fctor in the survivl of restortion in root resected tooth. [14] The uccolingul width of the occlusl tle should e decresed towrd the cntilevered portion (to the distl prt, in this cse) Another importnt fctor in root resected teeth is proper occlusl djustment [10] which is more importnt in such cses. There should e stle contct except in cntilevered portion in MIC. No occlusl contct should e exist in eccentric movements A rod nd strong proximl contct should e provided, prticulrly in cntilevered side Light contct of uccl hlf of the cntilevered portion with the ridge is importnt so tht super floss should e le to pss eneth of the pontic to etter orl hygiene. CONCLUSION Choosing the proper prosthesis type for the root mputted molr depends on severl fctors such s iomechnicl considertions nd condition of the djcent teeth. Therefore, proper cse selection is of utmost importnce in ny tretment pln. If the djcent teeth re sound or with miniml restortion, it is possile to restore the remining root in mnner which provides oth conservtive nd functionl gols. In such condition, single crown with cntilevered portion my e suitle option, if the descried importnt considertions re respected. Finncil support nd sponsorship Nil. Conflicts of interest There re no conflicts of interest. The Journl of Indin Prosthodontic Society Volume 17 Issue 4 Octoer-Decemer

5 Mostfvi nd Flhchi: Rehilittion of mndiulr root mputted molr REFERENCES 1. Zfiropoulos GG, Hoffmnn O, Ksj A, Willershusen B, Deli G, Ttkis DN, et l. Mndiulr molr root resection versus implnt therpy: A retrospective nonrndomized study. J Orl Implntol 2009;35: Svärdström G, Wennström JL. Periodontl tretment decisions for molrs: An nlysis of influencing fctors nd long term outcome. J Periodontol 2000;71: Prmr G, Vshi P. Hemisection: A cse report nd review. Endodontology 2003;15: Crnevle G, Pontoriero R, di Feo G. Long term effects of root resective therpy in furction involved molrs. A 10 yer longitudinl study. J Clin Periodontol 1998;25: Ydv P, Thir M, Kumr MV, Ro H. Prosthetic rehilittion of hemisected mxillry molr: A rre entity. J Indin Prosthodont Soc 2013;13: Bühler H. Survivl rtes of hemisected teeth: An ttempt to compre them with survivl rtes of lloplstic implnts. Int J Periodontics Restortive Dent 1994;14: Crnevle G, Di Feo G, Tonelli MP, Mrin C, Fuzzi M. A retrospective nlysis of the periodontl prosthetic tretment of molrs with interrdiculr lesions. Int J Periodontics Restortive Dent 1991;11: Blomlöf L, Jnsson L, Appelgren R, Ehnevid H, Lindskog S. Prognosis nd mortlity of root resected molrs. Int J Periodontics Restortive Dent 1997;17: Fugzzotto PA. A comprison of the success of root resected molrs nd molr position implnts in function in privte prctice: Results of up to 15 plus yers. J Periodontol 2001;72: Schmitt SM, Brown FH. The hemisected mndiulr molr: A strtegic utment. J Prosthet Dent 1987;58: Lnger B, Stein SD, Wgenerg B. An evlution of root resections. A ten yer study. J Periodontol 1981;52: Augereu D, Pierrisnrd L, Renult P, Brquins M. Prosthetic restortion fter coronordiculr resection: Mechnicl ehvior of the distl root remining nd surrounding one. J Prosthet Dent 1998;80: Svdi A, Rngrjn V, Svdi RC, Stheesh P. Biologic perspectives in restortive tretment. J Indin Prosthodont Soc 2011;11: Sd MN, Moreno J, Crwford C. Hemisection s n lterntive tretment for decyed multirooted terminl utment: A cse report. J Cn Dent Assoc 2009;75: The Journl of Indin Prosthodontic Society Volume 17 Issue 4 Octoer-Decemer 2017