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24 ◊Page 22 RESTORATIVE Dental Tribune Middle East & Africa Edition | 4/2017 Fig. 17: Silver dies left hand side view Fig. 18: Coping and implant abutments right hand side view Fig. 19: Copings left hand side view Fig. 20: Completed bridge – anterior view Fig. 21: Completed bridge – left hand side view Fig. 22: Copings cemented in the mouth – phosphate cement Fig. 23: Bridge cemented over the copings with ‘soft cement’ Newburg RE Pameijer CH (1976). Retentive properties of post and core systems. J Prosth Dent 40: 538 Nyman S et al (1975). The role of occlusion for the stability of fixed bridges in patients with reduced periodontal tissue support. J Clin Peri- odont 2: 53 Nyman S, Lindhe J (1976). Prosthetic rehabili- tation of patients with advanced periodontal disease. J Clin Periodont 50: 163 Robertson G (1985). The role of copings in fixed bridgework. Rest Dent Oct: 160 ration is required (which may not al- ways be possible) and there are also two finish lines. Although advanta- geous in an aesthetic restoration (Fig. 12 to 23)., it may not always be possi- ble to keep both of these metal mar- gins sub-gingival. Should extra tooth preparation not be completed then an over-contoured bridge or one that shows excess opaque porcelain on the labial surface may result. Conclusions Gold copings can be an excellent long-term, or provisional restoration as the coping can protect the tooth from caries and cementation failure. Maintenance is made easier by the ability to remove the superstructure at will. Aesthetics can often be com- promised by the need for greater tooth reduction and often two vis- ible metal margins. Acknowledgements I would like to thank Martin Fletcher, Bradley Moore and John Wibberley for their technical help in these cases. References Amsterdam M (1974). Periodontal prosthesis – 25 years in retrospect. Alpha Omega 67: 9 Faucher R, Bryant R (1983). Bilateral fixed splints. Int J Perio Rest Dent 3: 9 Professor Paul Tipton BDS, MSc, DGDP RCS (UK) DENTAL SURGEON Visiting Professor of Restorative and Cosmetic Dentistry, City of London Dental School | www.colds.co.uk SPECIALIST IN PROSTHODONTICS | www.drpaultipton.co.uk T Clinic @ Manchester , London | www.tclinic.co.uk TIPTON TRAINING Ltd | www.tiptontraining.co.uk www.bard.uk.com President of the British Academy of Restorative Dentistry (BARD) Endodontic treatment, retreatment and permanent cementation of full ceramic CAD/CAM crown in one visit Clinical case By MUDr. Marek Šupler, MPH Introduction One visit dentistry is becoming more and more popular among patients nowadays. The reasons behind are various – lack of time due to work, unwillingness to come several times, parking issues, and many others. A rising demand for treatment that includes as few steps as possible is becoming a strong trend among pa- tients. In some cases, all that needs to be done is acquire more knowledge on endodontic treatments, a suit- able rinse protocol and usage of FRC pins. As far as the prosthetic work is concerned, modern chairside CAD/ CAM systems allow to achieve a very efficient and rapid post-endodontic completion and reinforcement of the tooth. This study reports how one visit treatment can cover endodontic, endodontic retreatment, through usage of FRC pin, and permanent cementation of full ceramic crown, using MyCrown. Patient first contact 32 years old woman came to our dental clinic with broken tooth no. 14 and asked for emergency treatment as the tooth is in the smile area and the patient stated she felt deficient and uncomfortable when working and speaking with people. (Fig. 1, Fig. 2) After taking an intraoral X-ray and status analysis, we suggested RCRT (root canal endodontic retreatment), followed by treatment with FRC (fiberglass-reinforced composite) post and reconstruction with ceram- ic crown, made by CAD/CAM system MyCrown. Endodontic treatment During the treatment with Zeiss Opmi Pico microscope, it was found, that the palatal root canal was not treated at all. Subsequently, the ves- tibular root canal retreatment and palatal root canal treatment were performed using a standard rinse protocol using 5% NaOCl, 0.2% CHX and EDTA. To fill the root canals M- Two system ISO 25/06% - gutta-per- cha and Bee-Fill system were used. (Fig. 3) Immediately after the endodontic treatment, the palatal part of the gin- giva was removed by electrotome. The FRC ENA post was placed in the palatal root canal. After remov- ing a portion of gutta-percha from the filled root canal, 6mm deep, the dentin was etched with orthophos- phoric acid for 30 seconds and then rinsed with water from syringe for 30 seconds. The ENA bond was mixed with the polymerization acti- vator in a 1:1 ratio and applied to the dentin with microbrush and also to the pre-silanised pin. Subsequently, ENA CEM - dual curing resin cement was applied to the duct and FRC post was introduced. Enlightenment with curing light 30 seconds. The crown part of the tooth was rebuilt by the same ENA CEM - dual curing cement. Thus, the tooth was ready for shoul- der preparation before the digital impression. (Fig. 4) Gingiva management After shoulder preparation and pres- ervation of all parameters for the next restoration, the tooth was pre- pared for digital impression. Firstly, it is most important to make the edge of the preparation as clear as possible. This is the most important thing in defining the future resto- ration. This has resulted in proper gingival management. In this case, a two-cord technique was used. (Fig. 5) A thinner fibre was first put into sul- cus without haemostasis solution. Subsequently, a fibre with thickness 3, impregnated with aluminium chloride, was put for faster and bet- ter haemostasis and retraction. After 5 minutes, the thicker fibre is drawn, the thinner one is left and the edge of the preparation is clearly visible. Treatment with MyCrown The scanning area must be dry be- fore every digital impression. For better access to the oral cavity we use OptraGate. By using DryTips, the sa- liva of gl. parotis is stopped. Lingua- Fix fixes the tongue while removing saliva with suction from the sublin- gual gland. (Fig. 6) After drying the area of interest and applying sufficient amount of HD FONA spray, scanning can begin. First, the area of restoration is scanned, then the opposite jaw, and finally a buccal scan to register the occlusion. After correlating the ÿPage 25 Fig. 1. Subgingival tooth fracture Fig. 2. First patient check Fig. 3. During endo with FRC endodontic posts. Fig. 4. After endodontic treatment Fig. 5. Two-cord technique