Customized resin matrix
Jon Richards DDS MS
The restorative approach on this case is the reason I chose to share it online.
There is a FPD planned from tooth #12 to #15, with #13 to serve as a pier abutment. Although both #12 and #13 have been through a lot, the patient has no interest in an implant and was informed of the questionable nature of the teeth selected to support the bridge. After informed consent, we do the best we can with what we have to work with.
Treatment had been previously initiated and CaOH was in the canals of #13. Knowing that the temp FPD would not be a good fit, I took a pre-treatment VPS impression so I could remake the temporary after the new post and core for #13.
The temp was removed and quite a bit of caries was present. After cleaning it up, 2 canals were treated. I normally would have elected to treat this in 2 visits of my own, but had concerns about maintaining isolation in a temp with this much loss of coronal tooth structure. A single visit approach was the best way to maximize the chance of a positive outcome.
You will notice that the rubber dam was never removed. This is a very important point. Why work so hard to isolate the case, only to flood it with the oral flora during the restorative? It just doesn’t make a lot of sense to do that. Instead, the rubber dam stayed on and I made a custom “resin matrix” to serve as the scaffold for 2 posts and a composite core. The crown prep was completed, also while isolated. I virtually never remove the dam to restore a tooth- that’s the value of immediate restoration.
After removal of the rubber dam, I refabricated a new FPD. The patient will return in a few days for #12.