An Alternative Technique for Cementation of Cast Post and Core Restoration

Bhushan Satish Gaikwad; Mayura S Badgujar

doi:10.4103/2277-4696.167570

CASE REPORT

Year : 2015 | Volume : 4 | Issue : 1 | Page : 44-46

An Alternative Technique for Cementation of Cast Post and Core Restoration

Bhushan Satish Gaikwad¹, Mayura S Badgujar²
¹ Department of Prosthodontics, Sinhgad Dental College and Hospital, Pune, Maharashtra, India
² Senior Associate Dentist, Clove Dental, Amar Colony, New Delhi, India

Date of Web Publication

19-Oct-2015

Correspondence Address:
Bhushan Satish Gaikwad
E/602 Nancy Lake Homes, Opposite Bharati Vidhyapeth, Katraj, Pune - 411 046, Maharashtra
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/2277-4696.167570

Abstract

Cementation of cast post and core restoration involves the application of luting cement in the prepared post space which is intra radicular. Commonly an endodontic instrument, lentulo spiral, and rotary hand piece at slow speed is used. Occasionally, the luting cement does not reach the base or is not uniformly spread on to the walls of the prepared post space. The inefficiency of the luting cement to cover all the surfaces of the prepared post space results in a compromised post and core treatment. An alternate procedure using a disposable syringe and needle has been described to achieve better results.

Keywords: Cementation procedure, luting cement, post and core, post space, and root canal

How to cite this article:
Gaikwad BS, Badgujar MS. An Alternative Technique for Cementation of Cast Post and Core Restoration. J Dent Allied Sci 2015;4:44-6

How to cite this URL:
Gaikwad BS, Badgujar MS. An Alternative Technique for Cementation of Cast Post and Core Restoration. J Dent Allied Sci [serial online] 2015 [cited 2023 Jun 6];4:44-6. Available from: https://www.jdas.in/text.asp?2015/4/1/44/167570

Introduction

Endodontic treatment is common in daily practice. After endodontic treatment, a tooth is expected to perform a normal function and also serves as a favorable abutment for fixed dental prosthesis or removable partial denture. ^[1] Invariably such teeth lack a substantial amount of tooth structure due to caries, previous restoration, or endodontic treatment making them susceptible to fracture. Compromised tooth structure is restored by prefabricated post, and the core is build up by light cure composite or a cast post and core is fabricated. The post and core system achieves retention from the prepared root canal in which they are cemented. It is difficult to achieve a uniform luting cement in the prepared post space, affecting retention. A study conducted by Goldstein et al. ^[2] compared four techniques for luting that is, lentulo spiral, endodontic explorer, paper point, and direct application of the post and determined the most uniform layer of cement and whether the retention of the post was affected by it. In the present case report, an alternative procedure for cementing cast post and core has been described aiming to achieve a more uniform luting potential by using a disposable syringe, and needle.

Case Report

A 55-year-old female patient visited the Department of Prosthodontics of Sinhgad Dental College and Hospital, Pune, seeking replacement for missing teeth. Patients' chief complaint was missing teeth in lower left back tooth region. On examination, it was found that 36, 37 were missing and 34, 35, 38 present. The 34, 35 teeth were endodontically treated and had inadequate occlusocervical height. Thus, a post and core restoration was decided to restore the compromised teeth, followed by appropriate restoration. In the present case report, an alternative method to cement cast post and core has been described.

Procedure

The root canal space was prepared to receive a cast post and core following which patterns were made by a direct technique using pattern resin (GC Pattern Resin, GC Corporation, Tokyo, Japan). The patterns were invested, casted, and finished. Before the cementation of cast post and core is commenced, the cast post and core should be evaluated. The prepared post space should be patent and free of residual temporary cement on the tooth structure. Complete seating of the post is confirmed by observing that the margins of tooth and post and core complex are flushed with no hindrance upon placing and removing action within the prepared root canal.

A syringe of 2 ml having a needle size of 0.55 mm × 25 mm/24 × 1 was used (Dispo Van, Hindustan Syringes and Medical Devices Ltd., India) [Figure 1].
The syringe was cut at 0.8 ml mark [Figure 2]. After cutting, the plastic bur was removed from the edge of the syringe to allow the smooth sliding of the plunger into the syringe.
The needle was inserted into the prepared post space ensuring the tip was contacting the base of the canal. The needle was curved allowing easy access to the site of delivery [Figure 2].
The root canal was dried thoroughly, and isolation of the site was done.
The needle was attached to the syringe and the plunger was removed from the modified syringe. Glass ionomer luting cement (GC Fuji I Glass Ionomer Luting Cement GC Corporation, Tokyo, Japan) was mixed as per the manufacturer's instructions and loaded into the syringe.
After the syringe is loaded with the luting cement, the plunger is replaced in the syringe.
The needle was inserted into the root canal ensuring that the tip is contacting base of the prepared post space [Figure 3].
To dispense the luting cement, a gentle pressure was applied to the plunger at the same time the needle was moved in a coronal direction.
The cast post and core were moved up and down with a pumping action in the canal, and excess luting cement is wiped off.
The cast post and core were again inserted into the prepared root canal and held with the help of finger pressure for a couple of minutes.
Excess luting cement was removed with the help of an explorer after the initial set of the cement was complete.

Figure 1: Two milliliter syringe having a needle size of 0.55 mm × 25 mm/24 × 1

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Figure 2: Syringe cut at 0.8 ml mark and needle was curved that allowed easy access to the site of delivery

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Figure 3: Needle placed at the base of the prepared root canal and luting cement dispensed gently

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Discussion

Endodontic treatment is necessary for treatment of teeth that have pathosis involving dental pulp. Teeth that have been endodontically treated fail due to the restoration failure rather than the endodontic treatment itself. ^[3] Restoring an endodontically treated tooth may require additional attention due to the loss of tooth structure which may not serve as a suitable foundation for prosthetic rehabilitation thus focusing on gaining additional retention from the root canal. The cast post and core have been the traditional and time-tested method of restoring endodontically treated teeth with inadequate coronal structure. ^[4] The factors that affect the post and core system may be post length, diameter, and design, luting agent and methods. The canal shape, preparation of the canal space, and tooth location in the dental arch also has an effect on the retention of the post and core system. ^[5] Luting methods such as placing the luting cement over the post and/or placing it in the post space with a lentulo spiral, paper point, or an endodontic explorer are known. Out of these methods, a widely practiced method is by dispensing the luting cement into the post space with a lentulo spiral and coating the post before insertion. A gentle pumping action allows the adequate venting of the luting cement coronally, preventing the hydraulic pressure build up. If the cement is applied only on to the post alone, a reduction in retention is observed due to the inadequacy of the luting cement in coating the root canal and the post. ^[2],[6]

There are five main groups of dental materials used to cement posts in situ; zinc phosphate, glass ionomers cement (GIC), polycarboxylate, resin-modified glass ionomers, and composite resins. GIC is more frequently used for the cementation of the prosthesis as well as post and core. GIC adheres to dentin through chemical and micromechanical retention. ^[7] The setting reaction of GIC has two distinct steps, ^[7] the first occurring when all the water present is consumed in their chemical composition and the second only when water is available from other sources, that is, from the dentin tubules. ^[8] The initial contraction was observed during the setting reaction, ^[9] followed by an increase in volume as a result of the hygroscopic expansion that takes place after material maturation. ^[10] Thus, an improved interaction between the cement and dentin is expected, leading to increased retention of the post. ^[10]

The procedure described involves filling the root canal space by injecting GIC luting cement with the help of a modified injection syringe. The method ensures complete filling of the post space and even coating of the walls. This is assured by inserting the tip of the needle to the bottom of the canal and moving it coronally as the cement is dispensed by compression of the syringe plunger. While placing the post in the prepared space, the technique allows uniform coating of luting cement on the post surface. The pumping action before complete seating of the post in the post space ensures the release of any air bubbles entrapped and displacement of excess cement coronally, thus minimizing the hydraulic pressure generated by the luting cement providing complete seating of the post and core over the tooth structure. The technique requires a quick hand as the luting cement needs to be manipulated, loaded into the syringe, dispensed in the post space and post and core placement. If the consistency of the luting cement is thick, it will prevent adequate flow through the needle when the plunger is pressed and may lead to deficient material or failure to fill the post space. A need to manipulate additional quantity of luting cement is required to fill the syringe and adequately fill the prepared post space.

Conclusion

In the present article, an alternative method for cementing cast post and core has been described. A modified syringe along with the needle was used to dispense the luting cement in the prepared post space to provide better clinical performance of the restoration. Various procedures are available for the cementation of post and core. Depending on the operators choice and evidence provided, the best method should be implicated to improve the clinical results.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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