Sorry,,, do u mean x-ray ??

It is ok :)

i will take x-ray in the next visit and show it :)

http://www.youtube.com/watch?v=cqozh2pH_u4

this video somehow look like the case. he used laser as a closed flap laser crown lengthening .

I had this problem some times ago either. The problem is not the PFM bridge, it is still ok, but the leverage of this construction and the tooth preparation.

The bite force on the pontic leeds to enormous leverage to the mesial tooth ( this one is root treated, which is not a good survival prognosis in this situation). The preparation design of the root treated tooth does not include a sufficently dimensioned Ferrule-Desin to stabilize the root, both tooth stump are very short. In future I only use bridges with distal pontics if I can have a sufficient Ferrule-Design and sufficient stump high to all preparated teeth.

I suggest that next time you cut the bridge. Do not use extractors for crowns. I recommend you determine what caused the fracture of porcelain (Interference horizontal / vertical, inadequate design of the metal). If a root canal is in good condition (clinical and radiographic examination) may need clinical crown lengthening. I suggest using a metal post as long as possible (leaving at least 4 mm apical sealing). The flag design is not suitable for this case, it is better to design with posterior.Pero anterior pillar and has worked several years if I do not see the downside. Check occlusion and visit your dental technician.

Ih the upper left first is not fractured:

- crown lenghtjening (if necessary)

- new endodontic treatment

- reconstruction with a fiber post and composite

- two single crown

it would be wonderful if an X Ray could be added here but clinically evaluating this picture,the cause here could be the distal pontic of the cantilever there.cantilevers exert an enormous force on the mesial tooth/teeth and the chances of overload are more with distal than with mesial cantilevers.in my opinion,your clinical evaluation could comprise of these steps:

-take an xray and rule out fracture of the tooth in question.if fractured,extract it....its history!!!

-evaluate if the endo treatment is worthwhile,or else get it redone.

-evaluate the crown root ratio on the xray and if more than 1:2, then you can plan for an orthodontic extrusion as they are far more favourable prognostically compared to crown lengthening.

-once you are able to extrude the tooth so as to place a 3mm ferrule, reflect a flap and do osteoplasty to ensure harmony of gingival zenith to the adjacent teeth.

-place a fibre post with a composite core and ensure it is silanated.

-prepare the tooth and restore the crowns individually thereby ensuring gingival health and patient maintenance and comfort.

-and for heavens sake.........Avoid the cantilever !!!!!!........dentistry has evolved from being a mere art like magic to a sound science with plenty of evidence based data showing you what is good and what is not.........Believe!!!!

The X-ray will not show evidence of root fracture if the fracture is too small or in the mesial distal direction. Thus, the absence of a crack in the X-ray image is not the key for a predictable prognosis (I'm not saying that you don't need a X-ray, you sure need it for perio and endo analysis). Tomography images also have limitations, since its resolution is around 0.2-0.3 mm, so a crack smaller than this won't "appear" in the image.

The main evidence of root fracture is clinical. By inserting an instrument (e.g. probe) and executing gentle movements that provide a soft torque to the root, one can observe the patient reactions. If there is any sign of pain it would means that there is an actual root fracture.

I also agree with the cantilever problems. Specially in cases where the abutments have post and core and mainly distal extensions they should be avoided.

I advise you to follow this protocole

fisrt do a xray to determinate the long of crown to see if the ratio root /crown is benefit for the treatment.

If the the ratio root crowm is benfit remove 2/3 of the obturation material and leave 1/3 near of the apex.

Third do a tenon with tenon and a aboudment

Umesh Pai

thanks for your answer , it is really so interested

i would like to ask about fiber post. if i have anterior remaining root, so i ave to put fiber post then composite core. but, i think in R.R. i have to limited to casted post and core as one unit then crown to reduce the percentage of future fracture of fixed-prosthesis.... give me your opinion please

thanks

Creo que al perderse estructura dentaria en una pieza con poste y ccorona, generalmente, queda una raiz muy subgingival y da trabajo adaptar alli una nueva corona sin pasar por un alargue de corona previo, lo que no garantiza que no vaya a haber iflamacion e invasion del surco gingival. Por lo que seria una pieza descartada, o si se intentara salvar, probaria con un provisional para ver como responden los tejidos, siempre y cuando , haya buena higiene bucal yque haya armonia oclusal

Dear Hanan;

I agree with Hugo so my advice would be a careful examination of the first premolar (the one with the post) since it's common in this situations (mesial pilar of a cantillever structure with endodontic treatment and intra-canal post) that there is a vertical fracture of the root. Given these fractures are really hard / near impposible to detect on X rays, I would advice to do a periodontal screening of the sextant. Try to find any shallow, deep pocket in the premolar (common sign of fracture) and also study the probing depths of the adyacent tooth in order to discard periodontal desease as cause of that shallow deep pocket. If posible use magnifying glasses and tinction to search for the fracture and try to mobilize the fragments as Hugo already suggested.

If the root is okay then i'ld try to rehabilitate but not with the same cantillever structure. Maybe try a unitary crown in the first premolar (after endodontic retreatment and use of a resin post), a unitary crown in the second premolar and evaluate implant possibility for the molar.

Good luck with the case!