So I prepped a tooth for a crown, it had an existing large core build up, not placed by me. It was intact, no caries or anything. I prepared the tooth, packed my cord, impressed. Then as I was temporizing with a BisAcryl material, the build up came out with the temporary. In hindsight, I probably should have made the temp before I did my final impression or added more vaseline or lubicant over the core when I made the temp. But now I am wondering how I will make the core build up fit the crown that I just impressed for? Any ideas? Would I build it up with composite by eyeballing it and just adjust until I get a good marginal fit? or is there a way to somehow make a core build up using the crown? Any ideas would be appreciated.
clinical question: core build ups
- Thread starter zojirushi
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Personally, I'd bring the patient back. Redo the core build up (bill for the new build up) and re-impress. You'll waste more time trying to retrofit the crown to a new build up or trying to get the old one back in, then you will just redoing it. But that's just my opinion....
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Definitely bring the patient back for a new build up, prep and impression. In my opinion, "Eyeballing" or retrofitting a crown (especially when you know the impression is no good before sending it to the lab) is malpractice.
Use this as a learning experience. It's better it happened now then at delivery appt. Also, if the build up came off now it would have likely came off with the final crown as well. Either case, you would of had an unhappy patient. You are much better off explaining to the patient what happened and WHY it happened. The patient will appreciate that you took the time to do what's in their best interest.
A question to always ask yourself: what would you do if this was your mother/father/sister/brother? If you treat your patients the same way you treat your family, then you can never go wrong!
When I was in dental school, we were required to remove all previous restorative material and do a new build up before prepping for a crown. It was annoying but it saved my ass a number of times. There were plenty of times I found recurrent caries or realized that there was not enough tooth structure left and elective endo was needed.
Hup
Use this as a learning experience. It's better it happened now then at delivery appt. Also, if the build up came off now it would have likely came off with the final crown as well. Either case, you would of had an unhappy patient. You are much better off explaining to the patient what happened and WHY it happened. The patient will appreciate that you took the time to do what's in their best interest.
A question to always ask yourself: what would you do if this was your mother/father/sister/brother? If you treat your patients the same way you treat your family, then you can never go wrong!
When I was in dental school, we were required to remove all previous restorative material and do a new build up before prepping for a crown. It was annoying but it saved my ass a number of times. There were plenty of times I found recurrent caries or realized that there was not enough tooth structure left and elective endo was needed.
Hup
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I agree
Trying to match or create a similar buildup after crown was fabricated will simply hunt you down in the next couple of years.
Be honest you didn't do anything wrong and it happens. If I were you I would re do the buildup at a discounted fee, if tooth is endo treated I would definitely place a post.
Just explain to the pt the situation, he won't be happy but he'll appreciate it and rather than coming back after 2 yrs with an unrestorable tooth and blames you
Let us know how it went. Good luck
Trying to match or create a similar buildup after crown was fabricated will simply hunt you down in the next couple of years.
Be honest you didn't do anything wrong and it happens. If I were you I would re do the buildup at a discounted fee, if tooth is endo treated I would definitely place a post.
Just explain to the pt the situation, he won't be happy but he'll appreciate it and rather than coming back after 2 yrs with an unrestorable tooth and blames you
Let us know how it went. Good luck
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yeah, and it came off so easily. Definitely was not suitable as a long term core build-up. Prolly would have fallen off with the real crown.
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Look at your prep, add internal retention with a 35 cone bur or a 2 round bur. If your tooth is mostly core, you may want to consider endodontic retention but I wouldn't say "definitely place a post"... Posts in posterior teeth, if not done properly, can lead to problems.
Endo teeth are treated very well with removing ~2mm gutta percha from all the canals and to place composite plugs into the canals. In fact, amalgam cores that have internal retention and can engage the canals similar to the above are outstanding foundational restorations (along with RPD abutments, these are the only times I EVER place amalgam).
Remember, you are using a Bis-acryl material that has similar chemistry to composite resins and has a high potential to engage a resin core build-up. Furthermore, because you know it's a bis-acryl, you are probably not pumping the restoration (because you really don't have to) and therefore, if you have minimal taper to your restoration, it can become quite tight on the tooth, thus pulling the core. Use plenty of vaseline prior to using these provisional materials on resin cores.
BTW: re-do the impression, and don't charge for a re-do build-up... let the patient know what you did and how you want to make the crown fit great. Patient's get a little annoyed at having to get numb again, impression again, etc, but ultimately have more confidence in you that you are a good, caring dentist.
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If the buildup was tiny and didn't involve any area of the margin or within 3mm of it you might be able to retrofit. But, ideally you will bring them back and redo core buildup and reimpress.
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Hello all,
If the core comes off the see how big that piece is. If it is small, then the space will be filled with cement as long as you have four intact walls. The retention will not be affected. There is no need to re-impress. If a piece is big then I may re-impress without doing a build up because I will incorporate the missing piece into the crown and that will increase the retention as well as resistance to rotation. Now if it is really big then you have to redo the build up then re-impress. With few exceptions, trying to grind inside the crown to adapt to the new build up will do nothing but end up wasting time. DP
If the core comes off the see how big that piece is. If it is small, then the space will be filled with cement as long as you have four intact walls. The retention will not be affected. There is no need to re-impress. If a piece is big then I may re-impress without doing a build up because I will incorporate the missing piece into the crown and that will increase the retention as well as resistance to rotation. Now if it is really big then you have to redo the build up then re-impress. With few exceptions, trying to grind inside the crown to adapt to the new build up will do nothing but end up wasting time. DP
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If there is a ferrule effect all the way around to hold the crown, you're fine. If that was the case, I would finish the crown, use the final crown as a guide for a new composite build up under isolation which I would then adjust slightly after placement, then cement with a resin cement.
If there is no ferrule effect, then no build-up will help you and the tooth should have been prepped to have circumferential retention in the first place.
In the end, a tooth should always have a ferrule all the way around, using a "build up" to simply allow a somewhat uniform thickness of cement all around...which, by definition, is not a build-up. Interesting, huh?
If there is a ferrule effect, the crown will stay on and decay will not infiltrate, even if the build up were made out of sterilized dog poop...dry, of course. Save the patient an appointment. We are all cavalier about "redo it" but if there is proper retention, respect their time and cement/bond your beautiful crown.
If there is no ferrule effect, then no build-up will help you and the tooth should have been prepped to have circumferential retention in the first place.
In the end, a tooth should always have a ferrule all the way around, using a "build up" to simply allow a somewhat uniform thickness of cement all around...which, by definition, is not a build-up. Interesting, huh?
If there is a ferrule effect, the crown will stay on and decay will not infiltrate, even if the build up were made out of sterilized dog poop...dry, of course. Save the patient an appointment. We are all cavalier about "redo it" but if there is proper retention, respect their time and cement/bond your beautiful crown.
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DITTO, ... the above comment is coming from somebody who KNOWS what he (she) is talking about. Never, ... never do i personally ever trust a core build up from any dentist other than ME. Lesson learned....yes, ...? If one is going to build a house, ... do you start building a house on a foundation that was poured many years ago by somebody that you do not trust or even met?
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Great post. Here is a landmark article from 1996 that I saw recently. It is a great review of what to do and not to do. Read the summary at the end, as per the last post.
http://jada.ada.org/content/127/9/1397.full.pdf
http://jada.ada.org/content/127/9/1397.full.pdf
