Canine bridge abutment
Jon Richards DDS MS
Maxillary canine teeth can be very long, and this was no exception.
Tooth #6 is serving as the distal abutment of a long-span FPD from teeth 6-11. With so much riding on this foundation, it is critical to get a good result that preserves the structural integrity of the tooth.
Remarkably, the patient’s only complaint was slight palpation tenderness. I find this to be the case often when the apex of the tooth lies outside of the cortical plate. I suspect the inflammation resulting from the periapical condition has a little more “room” when it is not contained in the confines of the rigid bone. This was the case in this scenario based on the data gained from the CBCT volume. Anyway, just a theory.
Access was made conservatively through the incisal edge, just short of the facial surface. Care should always be taken to preserve the dentin cervica to the cingulum, as this is a critical area for resistance to future fracture. After 3 weeks of Ca(OH)2, her symptoms resolved and the tooth was obturated with warm gutta percha.
Restoration was completed immediately after the radicular endodontics were completed. A bonded fiber post will help repair the strength that was lost due to the endodontic access, will serve to “lock in” the crown, and also provide some resistance to fracture at the stress-concentration center of the cervical dentin.