CASE 2
Three-wall defect on an upper lateral incisor (aesthetic pre-endodontic build-up)
In this case, a 31 year-old female was referred for RCT of the four upper incisors. Fig. 24 is a photo of the initial situation in the condition in which she entered the referring dentist’s office. After the calculus removal and polishing, she came to our clinic for the endodontic treatment. The second right lateral incisor was the second in the treatment plan. Also, the radiograph revealed a huge carious lesion that involved the root canal system (Fig. 25). The first stage was to clean all the decayed hard tissues, but after the cleaning I had to perform a pre-endodontic build-up so that the patient could walk out of our clinic with a functional, and most of all aesthetic, tooth. All of the decayed tissue was removed, which left only half of the buccal wall and a few millimeters from the lingual (Figs. 26 & 27). A gutta-percha point was placed in the root canal to prevent the composite from entering the canal and obstructing the access (Fig. 28). The build-up was done using a flexible plastic matrix, flowable composite resin G-aenial A2, and composite G-aenial A2 and AE (Figs. 29 & 30). After building the proximal contacts, the gutta-percha point was removed in order to build a smooth palatal surface. The build-up was finished and polished (Figs. 31 & 32), and after cleaning, shaping, and one week medication with Ca(OH)2, the canal was obturated with MTA due to its large apical diameter (Fig. 33).
Figure 24. Preoperative photo of the initial clinical s…
Figure 25. Preoperative radiograph of tooth 1.2 (#7).
Figure 26. The tooth after removing the decayed tissues…
Figure 27. The tooth after removing the decayed tissues…
Figure 28. The positioned plastic matrix and a wedge. A…
Figure 29. Building of the palatal wall.
Figure 30. Building of the approximal contact points.
Figure 31. The finished pre-endodontic build up-buccal …
Figure 32. The finished pre-endodontic build up-palatal…
Figure 33. Postoperative radiograph of tooth 1.2 (#7)
CASE 3
Two-wall defect on a lower central incisor (aesthetic pre-endodontic build-up)
This patient was complaining from pain on percussion on tooth 31. The clinical examination showed a large decay on the distal side (Fig. 34) and the radiograph revealed that the decay had engaged the root canal system (Fig. 35). After cleaning the decayed tissues, a large disto-buccal defect was present (Fig. 36). A flexible plastic matrix was placed to form the distal contact point and a gutta-percha point was placed in the root canal so that the canal could be easily found during the access preparation (Fig. 37). A Total-etch procedure was performed (Fig. 38) and a single-bottle of self-priming bond was applied (XP Bond, Dentsply DeTrey). The material of choice for the pre-endodontic build-up was G-aenial Flo A2 (GC, Japan). The build-up was then polished and the patient was scheduled for endodontic treatment.
Figure 34. Preoperative photo of the initial clinical s…
Figure 35. A preoperative radiograph of tooth 3.1 (#24)…
Figure 36. The prapared cavity.
Figure 37. The positioned plastic matrix and a wedge. A…
Figure 38. The etching procedure.
Figure 39. During the build up.
Figure 40. The finished pre-endodontic build up
SUMMARY
The pre-endodontic build-up is a technique that is a very useful adjunct to endodontic treatment. The steps needed to do it are relatively easy and the build-up facilitates the rubber dam placement and the temporization of the tooth between visits. To summarize, the key points I adhere to for this treatment are as follows:
The materials of choice for the pre-endodontic build-up are flowable composite, composite resin (preferably bleach white or a shade that has a high contrast compared to the natural tooth), or a glass-ionomer cement.
If the tooth is going to be prepared for a crown, the build-up is ground from the inside. The purpose is to leave 0.5 — 0.7 mm to serve as a matrix for the final build-up. Then, during the crown preparation the build-up leftovers are removed.
The bonding procedure followed is always the Total-etch procedure with selective enamel etching for 30 sec., then applying the bonding agent, which can be a two-bottle system or a self-priming single bottle system.
The orifices of the root canal system should be blocked in order to prevent the composite resin or the bonding agent from penetrating the canal. This can be done using gutta-percha points, LC Block-Out resin (Ultradent Products, Inc.), or even a cotton pellet.
The contact points between adjacent teeth should be respected when possible.
The pre-endodontic build-up on frontal teeth should be made using the appropriate shades for the tooth so that the build-up will be as aesthetic as possible.