Fibre post segments in composite core build-ups

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Fig. 1a: Schematic diagram of a molar with conservative access opening, which when restored with a core only, will leave sufficient width and height of dentin to act as a ferrule resisting failure.

Fig. 1b: The same tooth with a widely divergent access opening, restored with Macrolock posts and composite core, when prepared for a full coverage restoration will not leave sufficient dentine (no ferrule).

Fig. 2: Schematic diagram of the molar in Figure 1a, but with Macrolock Fiber Post segments as inserts to decrease composite volume and increase polymerisation factors.

Fig. 3: Radiographic presentation of a patient with pain in the lower left second molar, which has been minimally restored.

Fig. 4: The clinical presentation of the second molar which would demonstrate sufficient tooth structure remaining after root canal treatment so that a fibre post and core is not required.

Fig. 5: Magnified view of the distal ridge of the second molar demonstrating a vertical crack.

Fig. 6: Completion of the debridement of the canals after rubber dam isolation with a better view of the extent of the distal crack line.

Fig. 7: The root canals have been obturated with gutta percha, a couple of mm below the level of the pulpal floor.

Fig. 8: After placement of the phosphoric acid (UltraEtch Ultradent) a microbrush is used to agitate the acid to clean the dentin, rinsed and lightly dried.

Fig. 9: MPa bonding agent is applied to a microbrush and agitated into the tubules, followed by evaporation of the solvent with an air-only line.

Fig. 10: The bonding agent is cured for 10 seconds with a Valo curing unit (Ultradent).

Fig. 11: Multiple MacroLock X-RO (Clinical Research Dental) fibre post segments (covered with a bonding agent which is first light cured) are verified for fit into the distal and two mesial canals.

Fig. 12: The Cosmecore A2 is injected into the bottom of the pulpal area filling to one half of the crown height, followed by the placement of the MacroLock X-RO segments at the canal orifices.

Fig. 13: Occlusal view of the Cosmecore placed half way up the coronal tooth structure with the three segments placed. This first layer was light cured and followed with the completion of the final Cosmecore layer cured.

Fig. 14: Post-operative radiograph of the completed restoration.

Fig. 15: Occlusal view of the final restoration, trimmed and adjusted to the occlusion. The tooth is now ready for a full coverage crown or onlay to protect the clinical crack.