Cervical margin relocation of endodontically treated teeth

Fig. 1

A 25 yrs old man came to our office complaining discomfort related to the second upper right premolar.

You can see from the pictures a gingival inflammation affecting the distal papilla of 15, inflammation which also led to the loss of the most coronal portion of the papilla.

The cause is a large cavity that leads to the accumulation of plaque in that area.

Biologically, a distance of 3mm is recommended between the restorative margins and the alveolar crest in order to avoid detrimental effects on neighboring soft and hard periodontal tissue and fortunately in this case the distance was respect so a cervical margin relocation was chosen to restore the tooth.

Fig. 3

After the rubberdam placement the old composite restoration was carefully removed using a cylindrical medium-grain bur and the margins were clean and smoothened using a silicon bur.

Deep cervical margins often leaves only dentin and cementum as the main substrates for adhesion. Adhesive bonding to etched enamel has proven to be efficient and stable . Adhesion to dentin, on other hand, depends on numerous factors related to the substrate morphology(4), the type of adhesive used, and the sensitivity of the application technique.

Fig. 4

Another problem that is encountered during the relocation procedure of a cervical margin is the positioning of a wedge which often deforms the matrix. a useful alternative is to use a dental floss to block the matrix without risking deforming it

Fig. 5

A total etch adhesive procedures was performed, 

Etching for 30 sec the enamel and 15 sec the dentin.

Then a three step etch and rinse adhesive system was placed

lightcuring for at least 30 sec. 

Then i layered the proximal wall with a nano ibrid composite.

Fig. 6

 After an endodontic retreatment was performed, the working length was checked radiographically and the subsequent irrigation protocol consisted in 5,25% NaOCL and 17% EDTA. The canal was dried and the filling was performed with warm vertical condensation.  Then  a composite build up was performed and the tooth was prepared for a veneerlay.

Fig. 7

The preparation for a veneer lay was necessary for esthetic reason.

During another appointment the veneerlay was cemented. The tooth surface was treated with air abrasion and a 3 step etch and rinse adhesive system, the lithium disilicate surface was treated with hydrofluoric acid, orthophosphoric acid, silane and bonding. Then the veneerlay was cemented with a nano filled composite.

Fig. 8

This is result 1 year later. As you can see the infiammation of the papilla disappeared and the coronal part of the papilla regrow. Meaning that a cervical margin relocation, if done correctly it is a valid type of treatment.

Fig. 9

fundamental is the control of the closing margin both between tooth and composite and between composite and inlay, for this reason it is always important to perform intraoral and bitewing xrays.