A 1-year follow-up case report of a biomimetic no post/no crown fiber-reinforced restoration of a structurally compromised tooth

Abstract

Treatment of structurally compromised endodontically treated teeth (ETT) is still a controversial topic faced daily in clinical practice. A correct diagnosis and treatment planning is mandatory to accomplish success and survival of the restoration, but most importantly, to stop the cycle of death of the tooth. This 1-year follow-up case report presents a no post/no crown fiber-reinforced restoration of a structurally compromised endodontically treated tooth. A 65-year-old female sought treatment for her upper left first premolar that had had endodontic treatment and an old MOD amalgam filling from a long time ago before it broke down. The buccal cusp was fractured, leaving less than 50% of the coronal tooth structure. While a conventional approach would require a cast metal or fiber post and a full-coverage crown, a biomimetic approach was chosen for this case. Therefore, a biobase was used for dentin replacement, and a ceramic restoration replaced the enamel. The biobase was reinforced with polyethylene fiber at its base to reduce the stress generated in the hybrid layer. Reconstruction of the dentin core was carried out with a short fiber-reinforced composite resin, which has mechanical properties similar to dentin. The palatal cusp was maintained, and a vonlay preparation was made, covering the remaining cusp. For enamel replacement, a lithium disilicate ceramic was used. The follow-up of this clinical report presents success and survival for 1 year.