Core build up
Management of grossly destructed tooth structure requires post placement and core build up. This case discusses various options available for the core build up. Pre operative image shows the grossly destructed tooth structure with gingival inflammation on the palatal and interdental area. This is the common occurrence for most of the grossly destructed tooth structure.
The materials of choice available for the operator are composite, amalgam and cast metal. Resin composites have proven to be the stable and durable material for core build up especially the chemically activated resin or dual activated resin. This is because of the more polymerization that can take place than the light cure material. However, if the gingival inflammation is present, then resin composites can be used only after the gingivectomy or appropriate periodontal therapy. This case was managed with gingivectomy successfully and with composite core build up material. Amalgam can be used as the core material only if there are undercuts from the pulp chamber and the retention will be sufficiently provided by the remaining walls. Secondary retention can be achieved by the use of amalgam bonding agents. Cast metal post with core can be the choice of material if the isolation for the composite cannot be achieved and if the remaining tooth structure cannot provide adequate retention for amalgam. It should be remembered that conventional retreatment is not feasible for cast metal post core and if it is necessary, only option is to do surgical intervention or extraction. Post operative image shows composite core done after gingivectomy.