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Hey everyone, I have done this before, but my friend, Dr. Bob Lowe, who is Ross Nash’s partner, taught me these, just thought I’d share one today. This is another reason why I love our lasers. Normally, send off to the periodontist, wait 8 weeks, get em back, do restoration. Today this patient came in, had sheared off a crown that was on this tooth which was an abutment for her lower partial denture. It had been previously treated endodontically, and the endo was fine. Notice the tissue growing over the tooth. I used a T-4 tip with .5w 11%air and 7%water, troughed around and exposed the root area, then used a hemostat to remove an old stainless post. I enlarged the canal space with a batt cone burr, and took the impression for the post. Here is the preop photo.
Here is the post op photo.
Ok, now I removed approximately 1mm of bone circumfrentially, and have a biological width of 2-3 mm. I would like some constructive criticism. What would you others do here? What type of post? Build up? Teach me some new tricks! Please! I love how the laser really gives us such lattitude to do things well. I got an excellent impression, and oh, of course, the patient felt nothing, I used no anesthetic, and she was happy, she said she was on a diet, and was happy to lose the ounce she shed once I removed the tissue, isn’t that hillarious? Thanks everyone.
MarkMark,
Nice job on the post removal and laser prep.
I’d go with cast post and core, cutting a keyway in the post prep, so the new post/ core can’t rotate when the RPD is placed back on the new crown. Could it be the rotational forces are what caused the core to fail around the old post?
Seems like with the tapping force of the laser there should be a way to use that to break up cement around a post and vibrate it out. Maybe put an intermediate material on top the post and laser tap it? I don’t know just typing out loud
The biologic width sounds good , how much tooth (ferule?)do you have to place the crown on? I think I remember hearing or reading 2mm minimum or you increase chance of fracture. I can tell you the ones I’ve done with less than that have failed (those times patients and I didn’t want to have the periodontist do crown lengthening,prelaser era).
Its hard to tell from the picture but 1 1/2 -2 mm biologic width plus 2mm minimum ferule and I’d think you’d be good to go.
Ok Gang..My turn..8o y/o with hopeless tooth that wouldnt hold out till implant work was done…this tooth will be added as pontic to implant prosthesis… the tooth fractured under old crown. So we bust out our laser, soft tissue crown lenghtening, preped tooth with laser creating a depression where post would be( canal was calcified and didnt want to spend money on hopeless tooth). I undercut internal aspect for that depression ,etched, tenure corepaste and cemented crown back on… Note on secong photo I frosted tissue and prep , creating my “Laser Band Aid” of frost on the tissue
