Last week, just before the hurricane was predicted to strike, my office manager texted me on a Tuesday evening, “Broke my #9 off at the gum line!” Yeah… not a good look for a cosmetically-oriented dental practice front desk, eh?
As it turns out, Wednesday’s schedule had pretty much fallen apart. People were freaking out about the approaching Category 4 Hurricane, “Matthew.” Gas stations had lines for blocks. Supermarket shelves were being cleared by panicky citizens. The office phone was silent. Dental care falls to the bottom of the priority list during a hurricane (unless they’re in pain… a lot of pain).
I didn’t have a lot of time to document everything. We all wanted to get home to prepare for the storm. So, this is a quick and dirty presentation. (I’ll add an image of the radiograph when I get back to the office.)
![macgyver-2-9406](https://thedentalwarrior.com/wp-content/uploads/2016/10/MacGyver-2-9406.jpg)
Old crown, partially cleaned up.
The long-term viability of the tooth is certainly in question. But, Hurricane Matthew was bearing down. Jo-Ann just wanted her front tooth back!
![macgyver-2-9398](https://thedentalwarrior.com/wp-content/uploads/2016/10/MacGyver-2-9398-600x400.jpg)
Not much there to for retention, eh?
The first thing I did was just see if the existing crown still “fit” on the remaining root structure. The margins seated fine all the way around.
![macgyver-2-9401](https://thedentalwarrior.com/wp-content/uploads/2016/10/MacGyver-2-9401-600x430.jpg)
Root after post space preparation.
Fortunately (for our purposes / immediate goal), the tooth had already been endodontically treated. I placed an Optragate retractor for improved visibility and isolation. I prepped a post space and placed a fiber post (RelyX™ Fiber Post 3D).
![macgyver-2-9402](https://thedentalwarrior.com/wp-content/uploads/2016/10/MacGyver-2-9402-600x456.jpg)
Fiber post cemented in place (with Rely-X Unicem).
The next thing I did was remove all the fractured tooth structure and build-up inside the old crown with a handpiece. I confirmed that it would seat passively on the remaining tooth structure and clear the new post. Then I sand-blasted the inside of the old crown. I applied Interface (silane / porcelain primer from Apex Dental Materials) to the intaglio of the crown, to be followed by 3M Scotch Bond Universal bonding agent (air-thinned but not cured).
![macgyver-2-9404](https://thedentalwarrior.com/wp-content/uploads/2016/10/MacGyver-2-9404-600x446.jpg)
Old crown partially cleaned out with a handpiece and diamond. I finished removing residual cement / composite with a lab sandblaster.
Before I etched and bonded the remaining tooth structure and post, I packed some Ultradent retraction cord (Ultra-Pak) to eliminate any sulcular fluid contamination.
I filled the crown with 3M Filtek Bulk composite that had been warmed in hot water to make it temporarily more flowable. I filled the crown with the warmed composite and immediately transferred it to the tooth. The crown was firmly pressed into place as the excess composite extruded at the margins. I cleaned up the margins with a microbrush. Then I firmly pressed the crown down some more. Some more composite could be seen extruding from the margins. I cleaned it up again. Rinse and repeat until I saw no more composite extruding through my 3.5x surgical telescopes. I used some floss to make sure there was nothing left interproximally.
![macgyver-2-9409](https://thedentalwarrior.com/wp-content/uploads/2016/10/MacGyver-2-9409-600x376.jpg)
Crown re-bonded with retraction cord still in place. Picture is flipped horizontally, and I’m too lazy to fix it. 🙂
Once I was satisfied everything was in its place, I hit the crown on all sides with my Ultradent Valo curing light on the medium setting. I inspected the margins again to make sure they were clean and used floss to confirm the proximal margins were smooth. Then I cranked up my Valo “phaser” to the highest setting, “killer cure,” and cured again.
![macgyver-2-9408](https://thedentalwarrior.com/wp-content/uploads/2016/10/MacGyver-2-9408-600x311.jpg)
Post-op! It’s like nothing happened!
I adjusted the occlusion to take any unnecessary force vectors off of this rather precarious restoration. Jo-Ann said it felt great! And off we went to close the office and prepare our homes for Hurricane Matthew!
![Shutters and "scoreboard."](https://thedentalwarrior.com/wp-content/uploads/2016/10/hurricane-score.jpg)
Shutters and “scoreboard.”
Fortunately, our area was relatively unscathed by Hurricane Matthew. Back to work on Monday!
![Digiprove seal](https://thedentalwarrior.com/wp-content/plugins/digiproveblog/dp_seal_trans_16x16.png)
Hello dr,
I am thrilled by reading your post about the whole episode, and i really appreciate your quick response to your manager’s tooth problem.
Cheers!!!
There’s certainly a lot of artistry involved in restoring the teeth! When a tooth fractures or a crown falls off, it’s a good idea to get it replaced as soon as possible. It’s also important to make sure that the restoration doesn’t cause any discomfort in the mouth.
Wow that looked like a tough one to manage!