Activa core and composite buildup #7

Posted on February 14 2017

#7 broke off near the gingiva. Ferrule for a crown would be limited. I felt the best chance for success would be a direct composite buildup. Activa is very strong, bonds well to tooth and composite, quick and easy to place and is bioactive. I believe these properities make it an excellent core material.

Before

Step 1

 

All caries removed and root canal completed

Step 2

Gutta Percha removed 7 mm into canal space

Ferrule practically nonexistent after all caries have been removed

Step 3

 

Greater curve "Wide" in place

Step 4

 

Greater Curve "wide" cut back for access

Step 5

Contact openings made mesial and distal. Retainer secured with Triad Gel to provide more stability for the setup.

Core sequence:

Step 6

Clean and Boost (Apex Dental)

Consepsis (Ultra Dent)

Prelude SE (Danville)

Ribbond stuffed longitudinally into the A3 Activa (Pulpdent)

Activa with its' Ribbond Core will be the restorative for the lingual 1/2 of the tooth.

Filtek Placement

Step 7

At the cervical 1/3 A3 Filtek Body (3M) is tapered toward the incisal. A2 Filtek Body covers the incisal 2/3rd's. Both Filtek's were placed using the snowplow technique.

Labial shaping

Step 8

Prior to band removal I do most of the labial shaping with the band left in place. This incisal view is critical for establishing proper labial contours and line angles.

Shaping interproximal contours

Step 9

#12 blade is excellent tool for shaping interproximal contours. 

Final restoration #10

Step 10

 

Incisal view

Step 11

An important final look before releasing patient.

Over the years I have had a lot of success with similar cases. However, I never fail to share with my patient an extensive CYA statement about long term prognosis.

6 comments

  • Dennis Brown, DDS: February 18, 2017

    dr al ciletti – Thanks. You made my day.

  • Dennis Brown, DDS: February 18, 2017

    vance wascom – I extend the Ribbond core 2/3rds up. Visualize incisally so you make certain the fibers are mid tooth before curing. I cure the first layer of Filtek composite and then snow plow the final layer. Trying to control and shape a large volume of 2 uncured layers is hard.

  • Dennis Brown, DDS: February 18, 2017

    Nathan mayo – The Ribbond stuffed vertically into the canal space and extending up through the core is a custom made post and core. The advantage of the Ribbond: It allows more flexibility. Flexibility simlar to dentin. The goal is to have everyting move like a tooth. Flexing forces are evenly distributed and not concentrated in one place. Fiber posts and metal posts are not good at distributing forces. They are too rigid.

  • nathan mayo: February 16, 2017

    Your restorative work is magnificent, but do you mean to tell us that you did not place a post of any kind in that canal? Did I miss something? I know bonding is a good thing, but I cannot imagine any bond strength good enough to do that. The prettiest restoration is of of no value if it comes out.

  • vance wascom: February 16, 2017

    I learn so much from your posts, been using greater band about 3 years now, how far did you extrude ribbons and did you cure a2 and a3 all at one time…..thanks

  • dr al ciletti: February 16, 2017

    Your cases never cease to amaze me! I’ve really learned more from your emails than from most of my CE courses – and I’ve been doing this for 36 years. I love your bands and now I do most of my anterior composites with them – mylar just doesn’t fulfill the contours and contact needs like your curved bands. Thanks again! Best,
    AL

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