| Abstract|| |
Endodontically treated teeth with the loss of coronal tooth structure when left untreated for a long period may cause supraeruption, drifting, tipping, and rotation of adjacent and opposing teeth. This may be challenging to the clinician, when fabricating a crown because of inadequate interocclusal space. This case report describes a simple technique to restore an endodontically treated maxillary first premolar with the loss of coronal tooth structure and lack of interocclusal space. The maxillary first premolar had a single root canal and was endodontically treated. The lower premolar had supraerupted reducing the interocclusal space. A minimally invasive and esthetic technique was used to restore the tooth with limited interocclusal clearance. The tooth was restored with a Richmond crown, which had the morphology of a canine instead of a premolar. Thus, the tooth was salvaged by changing the morphology of the crown and the desired functional and esthetic results were obtained.
Keywords: Interocclusal space, richmond crown, supraeruption
|How to cite this article:|
Kini SK, Muliya VS. Restoration of an endodontically treated premolar with limited interocclusal clearance. Indian J Dent Res 2013;24:518-20
The goal of endodontics and restorative dentistry is to retain the natural teeth with maximal function and pleasing esthetics.  Endodontically treated teeth with the loss of coronal tooth structure when left untreated for a long period may cause supraeruption, drifting, tipping, rotation of neighboring and opposing teeth. This may be challenging to the clinician, when fabricating a restoration because of lack of interocclusal space. Many methods have been advocated for treatment of localized loss of space such as minor tooth movement, reducing the opposing teeth, elective root canal treatment and restoration with post retained restorations or combination of two or more of the above.  All these methods of gaining space require removal of healthy tooth structure and are time consuming. The aim of this case report is to describe a simple and minimally invasive technique to restore an endodontically treated tooth with limited interocclusal space.
|How to cite this URL:|
Kini SK, Muliya VS. Restoration of an endodontically treated premolar with limited interocclusal clearance. Indian J Dent Res [serial online] 2013 [cited 2019 May 21];24:518-20. Available from: http://www.ijdr.in/text.asp?2013/24/4/518/118383
| Case Report|| |
A 45-year-old female patient reported to the department of Conservative Dentistry and Endodontics for the restoration of upper right back tooth.
She gave a history of root canal treatment carried out with respect to the tooth 5 years back, and was advised for a crown. Clinical examination revealed an upper right maxillary premolar (14) with a temporary restoration and only the buccal one-third of the coronal tooth structure was present. The tooth was not tender to percussion and there was normal sulcus depth on probing. On occluding, the upper and lower teeth there was limited interocclusal clearance and supraeruption of the lower premolar [Figure 1].
Radiographic examination revealed a maxillary first premolar with a single root canal that was obturated with a normal periapex [Figure 2]. After clinical and radiographic evaluation, a Richmond crown was planned which looked like a premolar from buccal aspect with no lingual cusp (miniature canine). The temporary restoration was removed; post space prepared was prepared using Peeso reamer no 1-4 (Mani inc, tochigi, Japan) and rubber base impression made. In the next appointment metal try-in and shade selection was carried out. The Richmond crown was cemented with Glass ionomer cement (GC Corporation Tokyo, Japan) and a radiograph was taken [Figure 3], [Figure 4] and [Figure 5].
|Figure 3: Richmond crown which looks like a canine from the occlusal aspect|
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| Discussion|| |
Restoration of endodontically treated tooth is complex  and success requires analysis of the situation. Limited interocclusal space may be a challenge to the clinician as there is a reduced space for the restoration. Treatment for such cases include intrusion of the lower premolar to regain space by orthodontic tooth movement, intentional root canal treatment of the lower premolar and restorations for both the upper and lower teeth, extraction followed by the placement of an implant. All these treatment modalities are complex, invasive, time consuming and expensive.
Maxillary first premolar in our case presented with the loss of coronal tooth structure and had a single root with a single canal (Vertucci's type I) with incidence of 8.66%.  Such a root canal anatomy was most favorable to fabricate a Richmond crown. The Richmond crown is one piece dowel and crown, which provide a better geometric adaptation to excessively flared or elliptical canals and are indicated in roots with minimal coronal tooth structure.  Since, there was supraeruption of the lower tooth and inadequate interocclusal clearance the crown had a shape of a canine rather than a premolar. However, the disadvantages of the cast post and core placement procedure are their lower retention, difficult temporization between appointments, risk of casting inaccuracies, removal of additional tooth structure, greater number of visits needed to complete the treatment. Nickel-Chromium alloy was used in this case because of its high strength and greater resistance to masticatory force. However, their hardness might be a major disadvantage in adjustment and may predispose the tooth to root fracture. 
Hence, the clinician must judge every situation and select the procedure that meets the requirement of both function and esthetics. Although there were other techniques that involved procedures to be carried out on the patient, we planned to change the morphology of the crown in order to place the restoration within the interocclusal space that was present between the upper and lower tooth.
| Conclusion|| |
This case report highlights a simple and minimally invasive restorative technique to salvage a tooth with limited interocclusal space. Changing the morphology of the crown may be considered whenever there is a limited interocclusal clearance.
| References|| |
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Sandya K Kini
Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]