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06/05/2022

Anatomized fiberglass posts: Step-by-step clinical routine

Authors: Dr. Raphael Monte Alto, Dr. Helena Klemba, Dr. Ariane Vaz Storrer, Dr. Francieli Suntak, Dr. Luany Halaiko, Jucimara Klemba and DP Miguel Abrão

INITIAL EVALUATION

After anamnesis, clinical and radiographic exams, the professionals noted the presence of a temporarily cemented total crown in acrylic composite. The endodontic treatment was adequate without painful symptoms neither periapical alteration. 

After the removal of the crown, due to the presence of little coronary remainder, the reconstruction was planned based on an anatomic fiberglass post and a future total crown in pure ceramic.

TREATMENT PERFORMED

The removal of the restoration in composite was done and the coronary remainder was evaluated. After odontometrics, using a number 2 Gates-Glidden drill, the gutta-percha was removed keeping 5mm in the apical region. With a prophylactic intra-canal brush, the cleaning of the canal was made for the removal of the remaining gutta-percha and endodontic cement. After cleaning, the DC 1 Whitepost System post was tried out. The choice for a post with a diameter narrower than the canal has as its purpose the anatomization of the post with composite. That procedure, besides allowing for a better frictional retention with the canal, allows for the positioning of the post in a very centralized manner in relation to the abutment in composite.

To prevent the composite from being retained in the canal, the canal was isolated with a water-based gel. The post was cleaned with gauze and alcohol and an adhesive was applied on its surface. With the dentin composite Vittra APS DA2 a cone was modeled, over the apical area of the fiberglass post, with dimensions compatible to the canal. The assembly was taken slowly so that the composite would copy the shape of the canal. After the total insertion of the post in its odontometrics, the cervical composite was slightly condensed for the perfect adaptation in the cervical area. With a photoactivating  equipment, a 5-second photoactivation was carried out, the  post was removed 2mm and then returned to the previous  position followed by another light activation for 5 seconds.  That procedure is done until the post comes out completely  polymerized.

Before the total removal of the post, a mark is made for the identification of the vestibular face. With the post and composite outside the mouth, a complementary polymerization is carried out. The canal was washed, the post was reinserted and the coronary portion was filled with the same composite.

With the assembly in position, the preparation for the total crown is done and right away, the assembly is removed with hemostatic pliers. For the final cementation, the canal was washed with abundant water and dried with paper cones and the post was cleaned with gauze and alcohol. The Ambar Universal APS adhesive was applied inside the canal and the Allcem Core cement was used for the final cementation. After the removal of the isolation, the preparation was finished and a molding was done. The mold was sent to the laboratory Singulares (TPD Miguel Abrão) where a disilicate crown was fabricated. The crown was cemented with Allcem Veneer APS and Ambar Universal APS.

STEP-BY-STEP

Fig. 1 Caso inicial - Coroa  provisória em resina acrílica

Fig. 1 Initial case – Temporary crown in acrylic composite.

Figs. 2 e 3 Remanescente coronário visão vestibular

Figs. 2 e 3 Remanescente coronário visão vestibular

Figs. 2 and 3 Vestibular view of the coronary remainder.

Fig. 4 Isolamento Absoluto realizado

Fig. 4 Absolute isolation made.

Fig. 5 Remoção da guta-percha com broca de largo mantendo 5 mm na região apical

Fig. 5 Removal of the gutta-percha with Gates-Glidden drill keeping 5mm in the apical region.

 Fig. 6 Remoção da guta-percha com broca de largo mantendo 5 mm na região apical

Fig. 6 Removal of the gutta-percha with Gates-Glidden drill, keeping 5mm in the apical region.

Fig. 7 Limpeza do conduto com escova intracanal

Fig. 7 Cleaning the canal with an intracanal brush.

Fig. 8 Conduto pronto para receber o pino

Fig. 8 Canal ready to receive the post.

 Fig. 9 Prova do pino 1. Nessa foto é possível observar a falta de adaptação do pino Whitepost System DC 1

Fig. 9 Fitting of the post 1. In this photo it is possible to note the failure in the fitting of the WhitePost DC post.

Fig. 10 Esse espaço permite que o pino seja posicionado adequadamente no núcleo através do reembasamento com resina composta

Fig. 10 That space allows for the post to be positioned adequately in the nucleus by means of relining with composite.

Fig. 11 Pino posicionado centralizado ao futuro núcleo coronário

Fig. 11 Post positioned in the center of the future coronary nucleus

Fig. 12 Isolamento do conduto com gel à base de água

Fig. 12 Isolation of the canal with water-based gel.

Fig. 13 Isolamento do conduto com gel à base de água

Fig. 13 Isolation of the canal with water-based gel.

Fig. 14 Após aplicação do adesivo e fotopolimerização por 20s, um cone de resina composta é realizado

Fig. 14 After the application of the adhesive and photopolymerization for 20 seconds. A composite cone is made.

Fig. 15 Pode ser observado o formato compatível com o conduto

Fig. 15 Note the shape compatible with the canal.

Figuras.016

Figuras.017

Figuras.018

Figs. 16 a 19 Inserção do conjunto no conduto

Figs. 16 to 19 Insertion of the assembly in the canal.

Fig. 20 Condensação cervical da  resina composta

Fig. 20 Cervical condensation of the composite.

Fig. 21 Fotopolimerização por 5s

Fig. 21 Photopolymerization for 5 seconds.

Fig. 22 Marcação da face vestibular  do pino e remoção do pino modelado

Fig. 22 Marking of the vestibular face of the post and removal of the molded post.

Fig. 23 Marcação da face vestibular  do pino e remoção do pino modelado

Fig. 23 Marking of the vestibular face of the post and removal of the molded post.

Fig. 24 Pino modelado. Caso nesse  momento exista alguma retenção  é possível remover com um disco  de lixa

Fig. 24 Molded post. At this moment, if there is any retention, it can be removed with sandpaper.

Fig. 25 Lavagem do conduto

Fig. 25 Washing of the canal.

Fig. 26 Reinserção do pino e aplicação de um adesivo na porção coronal

Fig. 26 Reinsertion of the post and application of the adhesive in the coronal portion

Fig. 27 Preenchimento com  resina composta

Fig. 27 Filling with composite.

Fig. 28 Preparo para coroa total concluído

Fig. 28 The preparation of the total crown is concluded.

Fig. 29 Remoção do pino modelado

Fig. 29 Removal of the molded post.

Fig. 30 Remoção do pino modelado

Fig. 30 Removal of the molded post modelado.

Fig. 31 Pino anatômico pronto

Fig. 31 Anatomic post ready.

Fig. 32 Lavagem e secagem do conduto com cones de papel

Fig. 32 Washing and drying of the canal with paper cones.

Fig. 33 Aplicação do Adesivo Ambar Universal APS

Fig. 33 Application of the Ambar APS Universal adhesive.

Preenchimento com cimento Dual Allcem Core

Preenchimento com cimento Dual Allcem Core

Fig. 34 a 36 Preenchimento com cimento Dual Allcem Core

Fig. 34 to 36 Filling with Dual Allcem Core cement.

Fig. 37 Após a inserção do pinos o excesso de  cimento é removido com um pincel

Fig. 37 After post placement, excess cement is removed with a brush.

Fig. 38 Após a inserção do pinos o excesso de  cimento é removido com um pincel

Fig. 38 After post placement, excess cement is removed with a brush.

Pino cimentado

Fig. 39 e 40 Pino cimentado

Fig. 39 and 40 Cemented post.

Fig. 41 Preparo concluído após remoção do  isolamento absoluto

Fig. 41 Preparation concluded after the removal of rubber dam isolation.

Fig. 42 Foto da cimentação fina

Fig. 42 Final cementation.