Franz Sebastian Schwindling1, Akinori Tasaka2, Tim Hilgenfeld3, Peter Rammelsberg4, Andreas Zenthöfer4. 1. Department of Prosthetic Dentistry, Heidelberg University Hospital, Heidelberg, Germany. Electronic address: Sebastian.schwindling@med.uni-heidelberg.de. 2. Department of Removable Partial Prosthodontics, Tokyo Dental College, Tokyo, Japan. 3. Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany. 4. Department of Prosthetic Dentistry, Heidelberg University Hospital, Heidelberg, Germany.
Abstract
PATIENTS: This case report presents a novel method to remove glass fiber-reinforced composite root posts in a minimally invasive way while simultaneously shaping the canal for a new post-endodontic restoration. A multi-morbid, handicapped 62-year-old patient was referred with a horizontally fractured maxillary incisor presenting approximately 1 mm residual coronal tooth height. Endodontic revision was necessary, which required removal of a glass fiber-reinforced composite post. A cone-beam computed tomography (CBCT) scan was imported into conventional implant-planning software and matched to a stone cast of the intraoral situation. Position, length, and axis of the future post were planned virtually. Based on this planning, a tooth-supported splint was three-dimensionally (3D) printed. This splint allowed use of a 2.2-mm spiral drill for removal of the fractured post and shaping of the root canal for a new cast post-and-core. This metal post-and-core was adhesively cemented and prepared for a zirconia single crown veneered in the labial aspect. DISCUSSION: This method currently requires use of CBCT-based, ionizing 3D imaging. Additional refinements to this approach can be made regarding spiral drill design and coating as well as regarding the post-and-core workflow. CONCLUSIONS: 3D-guided post-endodontic management is feasible. More research is needed to balance higher radiation doses against therapeutic success.
PATIENTS: This case report presents a novel method to remove glass fiber-reinforced composite root posts in a minimally invasive way while simultaneously shaping the canal for a new post-endodontic restoration. A multi-morbid, handicapped 62-year-old patient was referred with a horizontally fractured maxillary incisor presenting approximately 1 mm residual coronal tooth height. Endodontic revision was necessary, which required removal of a glass fiber-reinforced composite post. A cone-beam computed tomography (CBCT) scan was imported into conventional implant-planning software and matched to a stone cast of the intraoral situation. Position, length, and axis of the future post were planned virtually. Based on this planning, a tooth-supported splint was three-dimensionally (3D) printed. This splint allowed use of a 2.2-mm spiral drill for removal of the fractured post and shaping of the root canal for a new cast post-and-core. This metal post-and-core was adhesively cemented and prepared for a zirconia single crown veneered in the labial aspect. DISCUSSION: This method currently requires use of CBCT-based, ionizing 3D imaging. Additional refinements to this approach can be made regarding spiral drill design and coating as well as regarding the post-and-core workflow. CONCLUSIONS: 3D-guided post-endodontic management is feasible. More research is needed to balance higher radiation doses against therapeutic success.
Authors: Thomas Held; Christopher Herpel; Franz Sebastian Schwindling; Leo Christ; Kristin Lang; Sebastian Regnery; Tanja Eichkorn; Adriane Hommertgen; Cornelia Jaekel; Johannes Krisam; Julius Moratin; Jan Mrosek; Karl Metzger; Karim Zaoui; Tracy Moutsis; Semi Harrabi; Klaus Herfarth; Christian Freudlsperger; Peter Rammelsberg; Jürgen Debus; Sebastian Adeberg Journal: Radiat Oncol Date: 2021-04-17 Impact factor: 3.481