Use of Bioactive Liner for Crown Preparation

Sam Simos, DDS
Author: Sam Simos, DDS
Date: 07/29/2013 03:49pm
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A 35-year-old female patient presented with hot/cold sensitivity and pain associated with chewing on tooth No. 30. The patient's complaint was that the pain was worse in the morning, was present all day, and lasted for 10 to 15 minutes after stimulation. The pain was present for about 2 months and had stayed about the same. She avoided chewing on this side.

The patient's radiographs revealed some decay beneath the restoration. The restoration was also very close to the mesial pulp horn. A very strong possible diagnosis was cracked tooth syndrome. I also suggested to the patient that irreversible pulpal damage was possibly present.

After reviewing the digital photographs and digital radiographs, the patient and I discussed cracked tooth syndrome. For treatment options, we discussed the option of a crown and buildup. We also discussed that the patient might need a root canal.

The patient chose the crown and restoration because she wanted to resolve the chewing issue she was experiencing. She understood that a root canal would be necessary if complete resolution was not achieved in the temporary phase.

I removed the patient's existing filling and completed a crown preparation on tooth No. 30. The challenge I encountered during treatment was an issue with the patient's lingual cusps. Both lingual cusps fractured off during removal of the existing filling, confirming cracked tooth syndrome, which made the preparation more difficult. Prior to this issue, I took a digital photograph to show her that both lingual cusps showed evidence of a fracture line.

After the crown preparation procedure, I checked the patient’s bite and dismissed her with postoperative instructions. Her 24-hour postoperative exam revealed no sensitivity to hot or cold and no chewing sensitivity. Her 2-week evaluation revealed normal chewing activity with no sensitivity. The final IPS e.max restoration was bonded in place, I checked her bite, and I dismissed the patient. After 6 months, the patient did not report any further problems with this tooth.

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Category TagsEsthetic Dentistry, Restorative Dentistry, Bonding Agents, Composites (Universal), Crown and Bridge

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