Case Report
Volume 3 Issue 6 - 2016
Endodontic Prosthodontic Rehabilitation of an Over Erupted and Protruded Anterior Tooth
Nagy Abdul Samee Abdul Hameed*
Professor and Head of Dental Biomaterials, School of Dentistry, Badr University in Cairo, Egypt
*Corresponding Author: Nagy Abdul Samee Abdul Hameed, Professor and Head of Dental Biomaterials, School of Dentistry, Badr University in Cairo, Egypt.
Received: November 15, 2015; Published: February 29, 2016
Citation: Nagy Abdul Samee Abdul Hameed. “Endodontic Prosthodontic Rehabilitation of an Over Erupted and Protruded Anterior Tooth”. EC Dental Science 3.6 (2016): 642-648.
Abstract
Background: Recent trends put esthetic rehabilitation as a demanding treatment in order to correct malpositioned anterior dentition. This is enhanced by the patient’s background, especially careers that require prime appearance for the public. Esthetic and functional rehabilitation can be done successfully on such case by various treatment approaches. Orthodontic therapy is the most conservative treatment option for such cases but the patient rejected it due to various reasons like long treatment time, financial constraints, and appearance during the therapy, and relapse after the treatment. Alternatively, endodontic approach combined with the prosthodontics provides a quick, reliable and economic treatment option with no chances of relapse.
Purpose: To describe that even though there are many treatment alternatives and procedures, esthetic rehabilitation on overerupted and protruded anterior dentition using endodontic treatment, cast posts and all ceramic crowns, can improve patient’s appearance.
Case: This article presents a case report on esthetic rehabilitation of over erupted and protruded anterior tooth #11. Treatment was done due to patient’s refusal in receiving orthodontic treatment. The patient requested esthetic rehabilitation as an expectation for faster and instant esthetic result.
Case management: Endodontic treatment was done to the involved dentition prior to the final restoration. Cast posts and porcelain fused to metal crown was used as final restoration to correct the overerupted and protruded anterior tooth.
Conclusion: Esthetic rehabilitation can be done successfully on overerupted and protruded anterior dentition. Instant result could be achieved by this treatment. This is supported by the fact that dentists should be aware of not only choosing the right treatment and materials but also patient’s expectations and conditions.
Keywords: Single visit obturation; Protruded tooth; Over erupted tooth; Post with angled core and porcelain fused to metal restoration
Introduction
Aesthetics and pain are the main causes of letting the patient to seek treatment. The increasing demand for esthetics has encouraged the practitioners to develop new methods and techniques [1]. Orthodontic therapy is the most conservative treatment option for overerupted and protruded anterior teeth. However, it may be rejected by the patient because of longer treatment time, financial constraints and appearance during the therapy and relapse after the treatment [2,3].
Alternatively, endodontic approach combined with the prosthodontics provides a quick, reliable and economic treatment option with no chances of relapse [4,5]. Such treatment modality involves endodontic treatment followed by crowns with regard that endodontic treatment has high success rate [6,7]. In some cases, in order to correct malpositioned teeth to be in the right alignment requires decapitation of partial or all of tooth crown and restore it with indirect post, core and crown restoration. Regarding this, endodontic treatments are needed to be performed over the involved dentition, although these teeth are normally intact and in vital condition. Therefore, several important considerations in determining the post-endodontic restorations are needed and based on the protection and conservation of the remaining tooth structure to reduce pressure over teeth in restorative aspect, esthetic condition, inclination, and to achieve the natural tooth morphology [6]. Aesthetic post and core, and all ceramic crowns are indicated in the anterior teeth for better esthetics [8]. However, for financial reasons, metal cast post and core, and porcelain fused to metal crowns can be done. Considering esthetic, the best material of choice taking into consideration the cost factor for matching the natural state of a complex human dentition as in indirect anterior restoration is porcelain fused to metal crown for the highly desirable properties in color stability, translucency, light transmission, and biocompatibility [9-11].
The primary purpose of a post is to retain a core in a tooth with extensive loss of coronal tooth structure. If an endodontically treated anterior tooth is to receive a crown, a post often is indicated [12]. When the angle of the core must be changed in relation to the post, prefabricated posts should not be bent; therefore the custom cast post best fulfills this requirement [13].
Since there are many different philosophies and technologies that can be applied to esthetic rehabilitation cases, dentists must enrich themselves with thorough understanding about recent technologies and materials, and with that would come a greater ease in providing esthetic services with satisfactory results for the patients [14].
This case report describes the aesthetic rehabilitation of maxillary anterior overerupted and protruded teeth in no time using the combined endodontic prosthodontics approach.
Materials and Methods
A female patient 45 years old referred from the screening clinic, complaining from inability to incise, aesthetic, and psychological problems resulting from severely protruded and over erupted tooth # 11. During the treatment planning session, she rejected the orthodontic treatment since she wanted an immediate treatment. Hence, the alternative plane included endodontic treatment of tooth # 11 Figure 1 (labial view) & Figure 2 (mirror image for the palatal view)], followed by post and core along with full crown coverage. An informed consent of the patient was obtained before beginning of the procedure for the treatment. Endodontic treatment using single visit obturation technique was done to the tooth in question. Posthole preparation was performed following the standard procedures. An old head strome file (Union Broach) was fitted into the root canal so that it extended to the full depth of the prepared canal. The file was removed from the canal, and the canal was lightly lubricated with separating medium (Duralay, Relience Dental Manufacturing Co.). After posthole preparation, the injection technique was used to rapidly generate direct post and core patterns with cold cure acrylic resin. Cold cure resin (Duralay resin, Relience Dental Manufacturing Co) was mixed to a low-viscosity consistency. The acrylic resin was loaded into a needle tube that was inserted into Mark Speed Slot Syringe (Centrix). The acrylic resin was injected into the canal; beginning at the apical end of the canal and moving incisally as the resin was extruded from the syringe. The fitted file as wetted with monomer liquid and inserted into the acrylic resin in the canal and the remaining resin in the needle tube was extruded from the syringe to form the core portion of the pattern. The core portion was shaped with a plastic instrument while it was still in the doughy stage. The acrylic resin was not allowed to fully polymerize within the canal. The resin pattern was loosened and reseated several times while it was still elastic (rubber like) but was not removed entirely from the canal.
As the resin had polymerized, the pattern had been removed and examined for undercuts, voids, accuracy and stability. The core can be roughly shaped in the hand with green stones and coarse garnet discs. The preparation for the final restoration is completed with the dowel-core pattern in place. It is desirable to complete reduction and contouring in resin, because it is both difficult and time-consuming to shape the metal after the dowel core has been cast. The finished post core pattern was smoothed with fine sandpaper discs and a Burlew wheel (JF Jelenko, Armonk, NY) while still on the tooth (Figure 3). The resulting post pattern with angled core (Figure 4) was sprued, invested, and cast following the standard procedures and cemented in place (Figure 5). Porcelain fused to metal crown was constructed, cemented in place, correcting the protrusion [Figure 6 (labial view) and Figure 7 (mirror image for the palatal view)], and all complaints of the patient has been eliminated in a very short time. Follow up was performed every 6 months for two years after correcting the problem and the patient was very happy and very satisfied with his appearance without any complications.

Figure 1: Protruded & overerupted tooth #11 (Labial view).

Figure 2: Protruded & overerupted tooth #11 (mirror image for Palatal view).

Figure 3: Finished post core pattern on tooth # 11 (labial view).

Figure 4: Post with angled core pattern.

Figure 5: Cemented cast post and core (labial view).

Figure 6: Porcelain fused to metal crown cemented in place on tooth # 11 (labial view).

Figure 7: Porcelain fused to metal crown cemented in place on tooth #11 (mirror image for the palatal view).

Figure 8: X-ray of the finished case.

Discussion
Endodontists have been treating patients in one-appointment visits for some time. At one time, reported that nonsurgical one-visit treatment was part of their program [15]. Single visit root canal obturation was performed to the protruded tooth in order to reduce clinic time especially the tooth was vital. In the current work this protocol was used to shorten the time for correcting the tooth in question.
The quick fabrication and exact fitting of custom-made posts is the aim of fixed prosthodontic clinicians. Fabricating the resin pattern in vivo by the bead-brush technique [16] may lose time and effort for the dentist. The injection technique, instead of the bead-brush technique, was used to make pattern for the post and core because it is not time consuming [17,18].
Also the bead-brush technique is numerous setting reactions of the acrylic resin that occurring simultaneously. As a result, different portions of the post and core pattern are in slurry, stringy, doughy, and rubbery stages of polymerization process. Patterns may be locked into undetected undercuts because the coronal portion appears to be elastic, while the apical portion has passed the elastic stage of polymerization process. The injection technique eliminated the problems associated with the multiple setting reactions of the bead-brush technique because the resin was mixed, loaded into a needle tube and syringe, and injected to form the post and the core portion of the pattern. The preparation for the final restoration is completed with the dowel-core resin pattern in place. It is desirable to complete reduction and contouring in resin, because it is both difficult and time-consuming to shape the metal after the dowel core has been cast [19].
During abutment preparation, gross labial reduction was performed to allow the crown to be fabricated in proper alignment. The core portion was done with palatal angulation to correct the protrusion and still expecting favorable stresses to the tooth in question. This could be supported on the basis of the observations, of a three dimensional Finite Element Analysis (FEA) to access stress pattern in different implant abutment angulations. In this FEA it is concluded that though the compressive and tensile stresses generated through axial and oblique loading increase as the abutment angulation increases yet they are within the tolerance limits of the bone. However, care should be taken while planning a restoration so as to minimize the oblique component of force [20]. The treated tooth was followed up for two years and remained in the correct relationship with its neighboring and opposing teeth. The patient was highly satisfied with the results obtained.
Conclusion
A simple, quick and alternative method to orthodontic treatment for correcting over erupted and protruded tooth was presented. Prosthodontists and event general practitioners can utilize this technique to manage cases with similar malocclusions.
Bibliography
  1. Sadowski SJ. “An overview of treatment considerations for esthetic restorations: A review of the literature”. Journal of Prosthetic Dentistry 96.6 (2006): 433-442.
  2. Suha T and Kivanc U. “Esthetic rehabilitation of crowded maxillary anterior teeth utilizing ceramic veneers: a case report”. Cases journal 2.1 (2009): 8329.
  3. Javaheri D. “Considerations for planning esthetic treatment Assoc with veneers involving no or minimal preparation”. The Journal of the American Dental Association 138.3 (2007): 331-337.
  4. Kim J., et al. “Restorative space management: treatment planning and clinical considerations for insufficient space”. Practical procedures & aesthetic dentistry 17.1 (2005): 19-25.
  5. Toh CG., et al. “Indirect dental laminate veneers- an overview”. Journal of Dentistry 15.3 (1987): 117-124.
  6. Summitt JB., et al. “Fundamentals of operative dentistry: a contemporary approach”. 3rd edn. Chic ago: Quintessence Publishing (2006): 571-584.
  7. Shabahang S. “State of the art and science of endodontics”. The Journal of the American Dental Association 136.1 (2005): 41-52.
  8. Prasetyo EP. “Esthetic management for anterior teeth: a case report”. Jakarta: APDC Publishing (2007): 123.
  9. Roulet JF. “Indirect aesthetic restorations”. Journal of Advances in Aesthetic and Restorative Dentistry 5 (2003): 15-19.
  10. Shillingburg HT., et al. “Fundamentals of fixed prosthodontics”. 3rd edn. Chicago: Quintessence publishing (2006): 433-466.
  11. Schwartz RS and Robbins JW. “Post Placement and Restoration of Endodontically Treated Teeth: A Literature Review”. Journal of Endodontics 30.5 (2004): 289-301.
  12. Robbins JW. “Guidelines for the restoration of endodontically treated teeth”. The Journal of the American Dental Association 120.5 (1990): 558-562.
  13. Lunardhi GJ and Prasetyo EP. “Esthetic rehabilitation of crowded and protruded anterior dentition”. Dental Journal 42.1 (2009).
  14. Landers RR and Calhoun RL. “One-appointment endodontic therapy: an opinion survey”. JOE6.10 (1980): 799.
  15. Rosenstiel SF., et al. “Contemporary fixed prosthodontics”. 4th edn. St. Louis, Mosby (2006): 340-365.
  16. Awad MA and Abdulghaffar HS. “Custom-Made Post and Core - Part I: Technique to Fabricate Direct Custom-Made Post with Resin Pattern”. Journal of Dental Health, Oral Disorders & Therapy 1.3 (2014): 00013.
  17. Awad MA. “Custom-Made Post and Core - Part II: Fabrication of Direct Resin Core Using Special Mold”. Journal of Dental Health, Oral Disorders & Therapy 1.3 (2014): 00014.
  18. Shillingburg Jr., et al. “Fundamentals of Fixed Prosthodontics”. 3rd edn. Quintessence Publishing (1997): 204.
  19. Bahuguna R., et al. “Evaluation of stress patterns in bone around dental implant for different abutment angulations under axial and oblique loading: A finite element analysis”. National Journal of Maxillofacial Surgery 4.1 (2013): 46-51.
Copyright: © 2016 Nagy Abdul Samee Abdul Hameed. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PubMed Indexed Article


EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005


EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777


EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347


EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478


EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253


EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033


EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992


EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505


EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793


EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211


EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047


EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560


EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318


EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819


EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840


EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344


EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476


EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658


EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489


EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278


EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108


EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571


EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333


EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883


EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001


EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937


EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723


EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726


EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603


EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646


EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616


EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290


EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226


EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812


EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268


News and Events


November Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the November issue of respective journals and can be viewed in the current issue pages.

Submission Deadline for January Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the January issue of respective journals. Submissions are accepted on/before December 03, 2020.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to editor@ecronicon.uk