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The gold standard Restoring an endodontically treated abutment tooth with a pin-retained ¾ gold crown
A patient presented needing endodontic treatment on the maxillary right second molar, which was the distal abutment for a zirconia bridge. The tooth had been restored with an inlay on the mesial third. The bridge had been in function for more than three years when irreversible pulpitis developed on this distal abutment. We needed to find a material that could protect the cusps and prevent the inlay bridge retainer from being displaced. Because esthetics was not a concern for a second molar, we decided on a pin-retained gold inlay for several reasons, including minimal occlusal preparation and the ability to use a small pin preparation. Here is the case.
Conventional access preparation involved a small portion of the inlay. 1. The access preparation was initiated with SS White Piranha round diamonds (801-014), which scored the porcelain without crazing or fracture. 2. The SS White Great White #2 bur was then used to create the access preparation (Fig. 1). The preparation was enlarged with the Great White bur and the Piranha pencil diamond (858-014). Gentle cutting pressure on the porcelain frame prevented fracture. Given the location of the inlay preparation and endodontic access, the maxillary second molar would most likely fracture, compromising the tooth and bridge. A restoration that covered the abutment tooth would create a positive anchor into the remaining inlay preparation, prevent fracture of the buccal and/or lingual cusps, and prevent the bridge from being displaced mesially. This restoration would have the pin placed into the occlusal portion of the bridge to help secure it into position. (cont. below)
1. An alginate impression was taken to serve as a matrix for provisionals. 2. Excess alginate was removed and the tray was re-seated to confirm proper orientation. 3. The impression was wrapped in moist toweling and set aside.
1. The access preparation was cleaned and prepared for bonding. 2. A titanium pre-formed post was cemented into the lingual canal, extending into the clinical crown to link it to the root base. 3. To restore the access preparation, CoreX core material was placed in increments (Fig. 2) around the post and then cured. 4. The tooth was then prepared for the gold onlay.
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