Insight 84 — Restoring a Tooth After Removing a Large Brass Pin: Questions and Answers

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Clinical Explanation

Situation

A radiograph of a mandibular premolar that had a large brass pin inside it, which has been removed. The colleague's question was what treatment plan to give for this tooth and how to rebuild it, even if it only lasts two years, that would be enough.

Can a treatment plan be made from this radiograph alone?

No. A treatment plan can never be made from a radiograph alone. What follows are general points that should be kept in mind during the examination, not a final decision.

What does the radiograph show?

Because of the brass pin, the cervical walls appear to have lost their thickness and are thin.

Why is a conventional crown not a suitable option?

Because in this situation we effectively have no ferrule. The walls are thin, and if we prepare even these walls for a conventional crown, the little that remains becomes even less. So instead of conventional treatment we should move toward adhesive treatment.

Direct restoration or indirect restoration?

Definitely indirect. If we want to work directly, controlling that volume of composite is difficult, its shrinkage puts a lot of stress on the hybrid layer, and building correct form, contour and occlusion is also harder at this volume.

Summary

All of this has been said on the basis of the radiograph and without a direct examination, and it is purely conjecture, but these points should be kept in mind during the examination.

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