When restoring an endodontically treated tooth, what characteristics make the restoration ideal?
- Strong, supportive and functional
- Excellent fit
- Easy to prep and seat
The Bernstein VIP restoration (Vectris Integrated Post) provides an excellent solution in those cases where the ideal treatment would be a custom post and core under a full coverage crown.
Problems with previous post-core/crowns included:
- Difficulty in retrieving metal or ceramic posts (if required)
- Metal shows through
- Weak adhesion to metal
- Metal is less flexible than dentin leading to root fractures
- Compromised esthetics
- Extra steps with 2 piece post-core/crown techniques
The VIP restoration solves these problems using a single unit Vectris integrated post (VIP) with Empress. Similar to an LVI bridge, the Vectris fibers are packed into the Empress in the lab to create a very strong and beautiful restoration that is easy to bond. By making the post and crown as a single unit, the lab can verify an extremely accurate fit on the model.
Preparation is simply a standard custom post prep with a chamfer or rounded shoulder on a 3mm ferrule. The gutta percha should be capped with glass ionomer or composite resin during the preparation of the canal. In making impressions, it is helpful to blow the impression material down into the canal with an air syringe. It is also helpful to coat the canal with Tempbond Clear (Kerr) when fabricating the provisional to facilitate removal of the Bis-Acryl provisional material from the canal at delivery. Bonding the final restoration is easily accomplished with auto curing luting materials preferred by the clinician using standard bonding techniques.
The Bernstein VIP restoration satisfies the requirements of outstanding clinicians who wish to easily provide excellent restorations for endodontically treated teeth with minimal clinical crowns.
The laboratory techniques should be done under a 20x microscope with multiple solid models and virgin dies to ensure accuracy of the VIP system. Models should be properly equilibrated as well to allow for minimal occlusal adjustments.
The post is fabricated in 2 steps after the Empress is fabricated in the conventional manner. As well as being easier to deliver clinically, the system is homogenous in strength after processing. The processing takes place internal to an etched and silinated Empress crown.
Standard verification techniques are used to ensure minimal occlusal adjustments (properly equilibrated models to simulate a power clench) and on multiple pours of original impression for both solid models and virgin dies with the goal of no bite adjustments at chairside.
- Wax post and prep space
- Wax full contoured Empress restoration and press conventionally.
- Duplicate wax-up of post and prep inside empress crown
- Make Siltec putty stent of post and Empress and remove wax pattern leaving the pattern and empress intact
- Press pack Vectris fibers into remaining space and process to etched and silinated Empress restoration in Vectris VS1 machine
- Remove remaining vectris from apex of prep and fit to verification die, solid model and working model and die. One of the most important steps in this process is to be certain that the post and crown assembly fits exactly under a 20x microscope on the untouched virgin die.
The strength gained from processing the vectris to the Empress in the Vectris VS1 machine is higher than would be obtainable intraorally without the uncertainty of whether the post and crown will fit the tooth .
This technique is new and somewhat time consuming but shows excellent promise.
Josh Bernstein, DDS, is a Clinical Instructor at LVI. He maintains a private practice in Piedmont, California, focusing on restorative cosmetic dentistry, smile design and outstanding guest services. Bob Clark, CDT, is co-owner of Williams Dental Laboratory located in Gilroy CA. Williams Dental Lab is a full service, LVI-trained Aesthetics NM laboratory, providing their clients with all that is taught at LVI.