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| CASE REPORT |
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| Year : 2017 | Volume
: 2
| Issue : 2 | Page : 109-111 |
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Restoration of anterior esthetics with Richmond crown
Faisal Khan1, Sunil Kumar Mishra2
1 Department of Maxillofacial Prosthodontics and Implantology, Rishiraj College of Dental Sciences and Research Center, Bhopal, Madhya Pradesh, India
2 Department of Maxillofacial Prosthodontics and Implantology, Peoples College of Dental Sciences and Research Center, Bhopal, Madhya Pradesh, India
| Date of Submission | 14-Jun-2017 |
| Date of Acceptance | 11-Sep-2017 |
| Date of Web Publication | 15-Dec-2017 |
Correspondence Address:
Dr. Sunil Kumar Mishra
Department of Maxillofacial Prosthodontics and Implantology, Peoples College of Dental Sciences and Research Center, Bhopal, Madhya Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/bjhs.bjhs_16_17
Conservation of natural tooth is the main focus of the present era of dentistry, and endodontist and prosthodontist play a major role in conserving and restoring tooth function and esthetics. Restoring grossly destructed endodontically treated teeth is a challenge in restorative dentistry. Restoring such compromised teeth often requires additional support from the root canal with the help of post and core restoration. This case report describes a patient with grossly decayed central incisor and reduced interocclusal space treated with Richmond crown.
Keywords: Cast post-core, endodontic treated tooth, fractured tooth, Richmond crown
How to cite this article:
Khan F, Mishra SK. Restoration of anterior esthetics with Richmond crown. BLDE Univ J Health Sci 2017;2:109-11 |
To restore badly damaged endodontically treated teeth is a common problem faced by many restorative dentists. The broken teeth often require extra support from the root canal for the additional retention of the restoration.[1] In cases where the remaining crown structure is not sufficient to retain full-coverage crown, post and core is a treatment option to increase the retention and resistance form of tooth.[2] The major concern with the post and core procedure is fracture of post or root, dislodgement of post–core assembly, loss of the restorative seal, and injury to the periodontium.[3],[4] The situation may be further worsening in patient with deep bite, which leads to maximum oblique forces. In such cases, there should be adequate core reduction, so that the required thickness for metal ceramic crown can be obtained for better esthetics.[2]
In 1878, the Richmond crown was introduced with a threaded tube incorporated into the root canal with a screw-retained crown. The Richmond crown was indicated for grossly decayed single tooth with very much reduced crown height and with increased deep bite and decreased overjet.[5] This case report describes a patient with grossly decayed central incisor and reduced interocclusal space treated with the Richmond crown with a simple and minimally invasive technique.
| Case Report | |  |
A 17-year-old female patient reported to Department of Prosthodontics with a complaint of fractured upper right front teeth and want it to be replaced with artificial tooth [Figure 1]. On taking a detailed history, it was revealed that the patient underwent trauma 1 year back and her maxillary right central incisor got fractured. Radiographic evaluation revealed that the root canal treatment was done with the right (11) and left central incisor (21) and left lateral incisor (22) [Figure 2]. There was no discoloration of tooth with 21 and 22. The diagnostic impressions were made, and model analysis was done to assess the amount of space available for restoration. It was found that there was increased overbite and decreased overjet to restore the tooth to normal function and esthetics, so it was planned to give a Richmond crown with 11 to the patient. The entire treatment plan was explained to the patient and consent was obtained from the patient. | Figure 2: Intraoral periapical radiograph showing fractured right central incisor
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Post space was prepared with the help of Peeso reamer (Mani Inc., Tochigi, Japan), and an antirotational groove and finish line were made. An impression was made with an addition silicone impression material (Dentsply, Milford, USA), and cast was obtained [Figure 3]. Indirect technique was followed for making the wax pattern on the cast, for the post and core, and try-in was done in the patient's mouth. The pattern was casted and checked on the cast, and again try-in was done in the patient's mouth. An intraoral periapical radiograph was taken to check the proper seating of the post and core, and finally ceramic build was done over the core [Figure 4]. The Richmond crown was checked for proper margin adaptation and esthetics and then cemented with glass ionomer cement (GC Corporation, Tokyo, Japan) [Figure 5].
| Discussion | | |
Since ages, the endodontic treatment has been in practice; however previously, the restorative part was not much understood. Whenever a tooth undergoes fracture, in such case, the amount of crown structure remaining is not sufficient to retain the prosthesis.[6] In such compromised cases, the crown length can be increased with special procedures such as orthodontics extrusion and surgical crown lengthening.[7]
In the 19th century, an alternative treatment was introduced as the Richmond crown in such compromised cases. The Richmond crown is a castable customized single-unit post and crown system with ceramic layer over the crown coping.[1] To increase the mechanical resistance and retention, a ferrule collar is incorporated which provides the antirotational effect.[7] This design has advantages such as they are custom-fitted to the root configuration, there was little or no stress at the cervical margin, and also they provide high strength and considerable space for ceramic firing with enough incisal clearance. The disadvantages with the Richmond crown are as follows: they are time-consuming, so more appointments are needed for the patient; cost is more and their modulus of elasticity is higher than dentine; and in the case of ceramic fractures, it is very difficult to retrieve and may lead to tooth fracture.[2]
In this case, a minimally invasive technique was followed, and it was decided to give Richmond crown as the patient had grossly decayed central incisor with reduced interocclusal space.
| Conclusion | | |
This clinical report describes the prosthodontic rehabilitation of a female patient with fractured maxillary central incisor with the Richmond crown to improve the function and esthetics with a minimally invasive procedure. Hence, it is the prime responsibility of the clinician to judge the clinical situation and select the appropriate procedure best suited for the patient to improve the function and esthetics.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Chakravarthy Y, Chamarthy S. Richmond crown for restoration of badly mutilated posterior teeth: A case report. J Evid Based Med Healthc 2015;2:4500-7.  |
| 2. | Dausage P, Mallikarjuna K, Gupta S, Marya J. Richmond crown esthestics importance for lost tooth structure. Univ J Dent Sci 2015;3:60-3. |
| 3. | Zuckerman GR. Practical considerations and technical procedures for post-retained restorations. J Prosthet Dent 1996;75:135-9. |
| 4. | Sirimai S, Riis DN, Morgano SM. An in vitro study of the fracture resistance and the incidence of vertical root fracture of pulpless teeth restored with six post-and-coresystems. J Prosthet Dent 1999;81:262-9. |
| 5. | Mishra P, Mantri SS, Deogade S, Gupta P. Richmond crown: A lost state of art. Int J Dent Health Sci 2015;2:448-53. |
| 6. | Hudis SI, Goldstein GR. Restoration of endodontically treated teeth: A review of the literature. J Prosthet Dent 1986;55:33-8. |
| 7. | Fernandes AS, Dessai GS. Factors affecting the fracture resistance of post-core reconstructed teeth: A review. Int J Prosthodont 2001;14:355-63. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
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