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Cast post and core foundation for the badly broken down
molar tooth
EV Bass*
rolls and in some cases with the addition of suction present, look into the dowel preparation to ensure that
with a tongue guard. In the author’s opinion a rubber the GP root filling is in the middle of the dowel space.
dam would interfere with frequent checks for occlusal This is done with a front surface mirror. If GP is not in
clearance and alignment with adjacent teeth. Possible the middle you might be going sideways. If obstruction
damage to the surrounding gingiva by clamps may to the advancement of the reamer is felt, go to a depth
create a problem for finalizing the preparation and of no more than 6-8mm from the canal orifice.
impression taking at the same appointment. Depending on the size and shape of the canal either a
No 2 or No 3 PD reamer could now be used, with
T E C H N I QU E lateral pivoting movements so that the walls of the
The procedure described is for a lower molar. dowel preparation are shaved to conform to the cross-
Existing restorations are removed and the tooth is sectional shape of the root; in this case (distal root) it is
roughly prepared for a crown, with a chamfer at the oval in shape therefore a bucco-lingual movement is
gingival level. All unsupported/thin enamel and dentine used. At this stage ensure that the dowel space walls are
are removed using a horizontally approaching completely free of extraneous material, and smooth; it
diamond, so that sound residual tooth structure has a is not possible to achieve this result with a parallel-
minimum wall thickness of 1mm. With an ultrasonic sided post drill, which is not side-cutting. Now the
scaler and #6 round long shank bur the pulp chamber mesio-lingual canal is prepared using OP-PO (Optident,
is rendered free of luting cement, gutta percha (GP), West Yorkshire, England) drills consecutively from No 1
and temporary restorative material. The orifices of the (white) to No 3 (pink) to a depth of 4-5mm from the
canals are prepared with a #4 round long shank bur to orifice (in curved roots it can be shorter), again
a depth of 1-2mm. observing GP shavings as in the distal dowel
A dowel space is prepared in the distal canal using a preparation.
No 2 Produits Dentaires (PD) reamer with very light The preparations are now washed and dried.
pressure. GP shavings should be observed coming out The PD reamer with the shank cut off is placed in the
alongside the reamer. If there are no GP shavings distal canal dowel preparation (No 2 or No 3
Fig 1. Modified PD reamers (#2 and #3) are on the right with distance Fig 2. A modified s/s OPTE-03 temporary post at the bottom. It has
pieces removed, guiding tips cut off and depth indicating grooves been adjusted in length at its smooth end so that when in the dowel
marked at 10mm and 15mm. space it is clear of the opposing dentition.
58 Australian Dental Journal 2002;47:1.
Fig 3. Preparation of the mesial wall of the pulp chamber to be Fig 5. The shortened OPTE-03 s/s temporary post is in the mesio-
parallel with the distal dowel space. A PD reamer has been cut off at lingual dowel space and the #40 modified barbed broach (part of the
the shank and placed in the distal dowel space as a guild to ensure handle has been cut off and the shortened barbed broach has been
parallelism of the preparation. folded over) is in the distal dowel space. They are clear of each other
and clear of the opposing occlusion.
Fig 4. Distal dowel preparation is cleaned with EDTA on a cotton Fig 6. Dual arch impression for cast metal post/core. The s/s OPTE-
wisp wrapped around a #40 modified finger plugger; the bubbling 03 post has been reinserted into the impression until all three grooves
effect of the EDTA is clearly seen. are engaged.
Australian Dental Journal 2002;47:1. 59
Fig 7. The impression in Fig 6 sectioned mesio-distally. The #40 Fig 9. The cast gold post/core is checked for fit in the mouth. The
folded barbed broach supporting the impression of the distal dowel shortened sprue and the OPT-3 post have been notched with a
space and the OPTE-03 post in the mesio-lingual post hole are carborundum disk level with the occlusal surface of the core.
exposed.
Fig 10. The case gold post/core with OPT-3 post fitted through the
Fig 8. A titanium #3 serrated and sand-blasted OPT-3 post, is fitted core have been cemented and are ready for the final impression for a
through the cast gold core. crown.
60 Australian Dental Journal 2002;47:1.
Fig 11. A porcelain fused to metal crown has been issued. Fig 14. Root filled 46 and 47 ready for restoration. Nothing of the
clinical crowns remains.
Fig 15. Two cast gold post/cores with titanium posts sliding through
the cores. Note that the posts and the sprues have been notched level
with the occlusal table of the cores to facilitate breaking them off at
cementation.
Fig 12. Upper left 5, 6 and 7 after completion of RCT and removal
of weak and unsupported coronal tissue present a restorative
challenge.
CONCLUSION 6. State-of-art post and core use from global dental literature. CRA
Newsletter 1998;22:2.
In this article another technique is described for 7. Johnson JK, Schwartz NL, Blackwell RT. Evaluation and restora-
restoration of mandibular molars after endodontic tion of endodontically treated posterior teeth. J Am Dent Assoc
treatment, where very little is left of the clinical crown. 1976;93:597-605.
Preparation of two post holes in divergent roots using 8. Trabert RC, Cooney JP. The endodontically treated tooth.
specific slightly modified instruments has been Restorative concepts and technique. Dent Clin North Am
1984;28:923-951.
presented in this paper. A new impression technique for
9. Goldman M, De Vitre R, Tenca J. Cement distribution and bond
cast post and core restoration, for single unit and short strength in cemented posts. J Dent Res 1984;63:1392-1395.
span bridges as well as the preparation of the post holes 10. Bass EV, Kafalias MC. Dual-arch impressions. Aust Dent J
for cementation with a modern luting cement are also 1992;37:1-5.
described. 11. Bass EV, Kafalias MC. Dual-arch impressions. J Dent Assoc
South Africa 1992;47:428-431.
AC K N OW L E D G E M E N T S
The author would like to thank Mr Ian Burrell for his
excellent technical assistance. Dr S Dracopoulos and Dr
S Bender for their help in preparing this manuscript.
The administration staff of HCF Dental Centre,
Sydney, for encouragement and support in this project.
There was no commercial, government or any other
Address for correspondence/reprints:
grant offered for the work described in this paper.
Dr EV Bass
HCF Dental Centre
REFERENCES
Level 3, 403 George Street
1. Chiche G, Weaver C, Pinault A. Divergent post and tube and
screw systems for the short crown preparation. Quintessence Int Sydney, New South Wales 2000
1990;10:813-820. Email: sbender@hcf.com.au