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    • Dr.Ozaibi د.العزيبي
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    OziDent

    Case: DT17 – Save the Crown

    0
    By Prof. Ashraf Samir Refai on February 2, 2018 Dental Cases

    In this dental case, Dr. Ashraf Samir Refai provides a step-by-step guide showing how he saved a fractured palatal cusp on upper 2nd premolar.

    Visit 1: Patient Profile & Diagnosis

    A 70-year-old female patient came with a palatal cusp fracture of an old amalgam filling on tooth upper 2nd premolar( #4 ), which I had placed 20 years ago. The amalgam filling persisted.

    Occlusal View of the fractured palatal cusp
    Close up of the fractured palatal cusp

    A temporary GI filling is placed and gave her an appointment for definitive treatment.

    Visit 2: The Definitive Treatment:

    The Temporary Filling

    On the second visit, the treatment plan is as following:

    • Isolation Via Rubber Dam
    • Remove both the temporary filling and amalgam filling and Inlay Preparation.
    • Tissue retraction using cord and Teflon.
    • Digital impression.
    • Restoration Construction in Cerec (cad/cam) emax.

    1. Rubber Dam Placement

    Split Dam Application

    2. Old Restoration Removal & Inlay Preparation.

    The buccal cusp was thick at the base above 2mm and it isn’t the functional cusp. In Respect to the patient’s age (over 75 years old)  and wishes ( she didn’t want to go through a root canal, post and core and crown). If it was treated for a crown and I had reduced the buccal cusp there would be no retention at all, thus an Inlay was the preferred treatment.

    After removal of the temp filling

    removal of the amalgam fragments – a
    removal of the amalgam fragments – b

    3. Tissue retraction

    Before tissue retraction
    Occlusal view of retracted tissues

    Palatal placement of Teflon for better retraction

    4. Digital impression

    Optispray is a powder used to spray on the teeth before taking a digital impression, which helps prevent light reflection for better details and accuracy.

    Optispray is placed on prepared tooth for proper image scanning

    5. Digital Designing of the Inlay

    Design using Cerec software – Margin Outline
    Design using Cerec software – Different views of the inlay with and without occlusion
    Design using Cerec software – Position of restoration in the C14 Emax block

    6. Milling of the Inlay

    The Inlay after milling and before finish and polish
    The Inlay: After Finishing / Polish

    Visit 3: Restoration Placement & Cementation:

    1. Tooth Isolation:

    Rubber dam isolation

    The use of rubber dam to offer proper isolation of the tooth surface before surface treatment.

    2. Inlay Surface Treatment

    The inlay fitting surface is etched via hydrofluoric acid etched, Silanation is done and finally bonding placement and light cured.

    Fitting Surface: hydrofluoric Acid Etch
    Fitting Surface: After etching
    Fitting Surface: Silanation

    Silanation: at the inner surface help promotes contact between resin cement and ceramic.*

    Fitting Surface: Bonding agent placement
    Fitting Surface: Curing

    3. Tooth surface treatment

    The Tooth surface is etched and then bonding is placed, then light cured.

    Tooth surface: After Etching
    Tooth surface: Light Curing of the bonding agent

    4. Inlay Placement & Curing

    A dual cure resin cement (G-Cem) is placed than cured.

    Dual Cure resin cement is placed – View A
    Dual Cure resin cement is placed – View B
    Curing of the Dual Cure resin cement – View A
    Curing of the Dual Cure resin cement – View B

    5. Finishing

    After the cement is placed and cured, it’s important to make sure the there is no excess cement ( especially in the proximal areas). Polishing is performed.

    Removal of excess cement – View A
    Removal of excess cement – View B1
    Removal of excess cement – View B2
    After removal of excess cement
    After Polishing

    6. Final View

    The final restoration after finishing and polishing

    Final Results

    Special thanks to Dr. Ashraf Samir Refai for allowing us to post and publish his case.
    Disclaimer: The patient had no objection to publishing this case as long as it didn’t identify her.


    Sources:

    • Case By Dr. Ashraf Samir Refai, Egypt
    • DR. Julia Nemes. link here (*)
    • Video on YouTube, Link Here
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    Prof. Ashraf Samir Refai
    • Website

    An endodontic specialist and an Associate Professor of Endodontics. Proud to be lecturing full time at the Department of Endodontics at Al-Azhar University and have Lectured part-time in many other universities.

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