Another tough one to check out - #2 Endo no crown- By Thomas W. Mitchell, DDS, FAGD

Introduction: 

The patient is an aging Chinese national here with her very high tech and amazing daughter/professor at UW Computer Science. Not a lot of English gets spoken but she understands enough and her daughter helps her out. This started with big decay and fracture at #2. Because of all the cultural issues and the difficulty of treatment, this tooth will never get a crown.

Thomas W. Mitchell, DDS, FAGD
Big decay led her to my favorite Endodontist
Thomas W. Mitchell, DDS, FAGD
Thomas W. Mitchell, DDS, FAGD
One of my world class assistants placed this dam for me. That's a #2 winged clamp.
Thomas W. Mitchell, DDS, FAGD
We routinely bond in DT Fiberposts. My Endo's leave space for this when they can without removing a significant amount of dentin. This is bonded in with Clean and Boost, Surpass 1,2,3 and WO Anchor.
Thomas W. Mitchell, DDS, FAGD
Here I've shortened the post and placed a Getz Dixieland Band in a Tofflemeyer retainer. To get the band down over the gingival margin I had to narrow the other 2/3's of the band. There was no room for a wedge.
Thomas W. Mitchell, DDS, FAGD
I placed Surpass 1,2,3 again and co-cured WO Titan Flowable across the gingival margin and a little ways up the proximal walls.
Thomas W. Mitchell, DDS, FAGD
Then filled the prep about 2/3 full with Injectafil, let it gel and then cured for just a couple of secs. It's dual cure so we just need to get it started curing and it'll do the rest by itself. Letting it gel first releases all the shrinkage stress so as it shrinks it won't break the remaining tooth structure.
Thomas W. Mitchell, DDS, FAGD
Then an occlusal layer of Exquisite which is pulse cured.
Thomas W. Mitchell, DDS, FAGD
A little polishing with red Softflex discs and we're ready to check occlusion.
Thomas W. Mitchell, DDS, FAGD
It was a little high. Because we couldn't use a wedge the gingival margin had a little bulge but no overhang.
Thomas W. Mitchell, DDS, FAGD
From the lingual you can see how I smeared the WO Titan up the proximal wall and also across the gingival. I like to do that on these deep ones in case someone (not me!) has to go back in.
Thomas W. Mitchell, DDS, FAGD
This is the best x-ray we could take.

Conclusion: 

We all know that "all posterior endo'd teeth need crowns", but it can't always happen. This style of restoration, because the techniques and the products are so good, has the potential to last a long long time.

Case by: 

Thomas W. Mitchell, DDS, FAGD

Email: 

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