Original Article

TREATMENT OF ENDODONTIC TREATED MOLAR USING RICHMOND

CROWN — A CASE REPORT
1
MOHAMED FATTOUH ABDULLAH
2
ABDULRAHMAN ATEEQ ALMALKI
ABSTRACT
A clinical case report is presented where a 20 years old patient having damaged posterior tooth
with reduced occlusal clearance was treated by means of a single-unit post-core-crown restoration.
Restoration was cemented by adhesive resin cement and evaluated clinically and radiographically
for one year. The unification of the post, core, and crown in a single unit decreases the frequency of
failure by creating a monoblock effect.
Key Words: Richmond crown, endodontic treated teeth, resin cement.

INTRODUCTION not rounded and help to overcome retention problems

Endodontically treated teeth are more prone to
fractures than the vital teeth. Fracture occurrence
is more in posterior teeth than anterior teeth as the
masticatory forces are higher and teeth are weaker.1
In the late 19th century, the “Richmond crown,” a sin-
gle-piece post-retained crown with porcelain facing,
was introduced to function as a bridge retainer2, it
incorporated a threaded tube in the canal with a screw
retained crown. Then, It was modified to eliminate the
threaded tube and was redesigned as a 1-piece dowel
and crown.3 During the 1930s, the custom cast post-and-
core was developed to replace the Richmond crowns.
This procedure required casting a post-and-core as a
separate component from the crown; this 2-step tech-
nique improved marginal adaptation and allowed for a
variation in the path of insertion of the crown.4 Several
main causes of failure of post-retained restorations have
been identified, including: recurrent caries, endodontic
failure, periodontal disease, post dislodgement, cement
failure, post-core separation, crown-core separation, loss
of post retention, core fracture, loss of crown retention,
post distortion, post fracture, tooth fracture, and root
fracture.5-7 Also, corrosion of metallic posts has been
proposed as a cause of root fracture.7
Some researches advised that resin cements with
dentin bonding agents can be used when the length of
the post space is less than ideal or when the holes is
1
Mohamed Fattouh Abdullah, Head of Fixed Prosthodontics Division,
Oral and Maxillofacial Surgery Department, Faculty of Dentistry,
Umm Al-Qura University, Saudi Arabia. Fixed Prosthodontics De-
partment, Faculty of Oral and Dental Medicine, Cairo University,
Egypt. Email: mohamed.fattouh@dentistry.cu.edu.eg
2
Abdulrahman Ateeq Almalki, Undergraduate Student, Faculty of
Dentistry, Umm Al-Qura University, Saudi Arabia
Received for Publication: March 27, 2015
Revision Received: April 30, 2015
Revision Accepted: May 3, 2015
and may fills in the spaces and eliminates the need for
a cast post.8,9
CASE REPORT
A 20 years old male patient reported to Fixed
Prosthodontics Department, Faculty of Dentistry,
Umm Al-Qura University, Saudi Arabia with a chief
complaint of endodontic treated fractured left lower
second molar (Fig 1). Patient had no medical history.
Clinical examination revealed that tooth had short
clinical crown with deep bite, radiographic examination
of the obturation was found to be intact (Fig 2) and
tooth was asymptomatic. Due to patient deep posterior
bite, the tooth was planned for one piece post, core and
crown. The coronal tooth structure was modified with
rotary instruments to reduce undermined cusps. For
post space preparation, guttapercha was removed from
the pulp chamber using a thin straight fissure. Then
using Peeso Reamers (sizes 1 to 4) removing 5mm of
gutta percha was removed from distal canal (removing
more than 5mm inside root canal may lead to problem
in path of insertion of the crown). The prepared space
was cleaned with normal saline, impression of the post
space was taken with the tooth preparation using vinyl
polysiloxane impression material (Virtual, Ivoclar-Viva-
dent co., Liechtenstein) where light body was injected
inside the prepared post space and plastic post was
inserted to support the material. Additional rubber base
materials was then injected around the preparation and
the tray loaded with putty body impression material
and placed on the light body. Impression was poured in
die material (CAM-Stone N, Siladent, Goslar, Germany)
to obtain mater cast where wax pattern was made and
was checked intra-orally to assure its margin accuracy.
Subsequent investing and casting procedures were
carried out to obtain metal try in. Casting was checked

Pakistan Oral & Dental Journal Vol 35, No. 2 (June 2015) 343
 Endodontic treatment/Richmond crown

for retention and accuracy followed by application of

porcelain (VMK master, VITA Zahnfabric, Bad Sackin-
gen, Germany). The finished restoration was evaluated
for fit, and occlusion prior to cementation, finished
restoration was cemented with dual cured adhesive
resin cement (Multilink Automix, Ivoclar-Vivadent,
Liechtenstein) (Fig 3). The cemented restoration was
evaluated clinically and radiographically using bitewing
(Fig 4) and computerized tomography radiograph (Fig
5) and appeared to have good functional results. The
tooth was followed for a year-every three months- in
which no recurrent caries, no dislodgment nor fracture
Fig 1 of the restoration and no root fracture.

DISCUSSION
Restoration of teeth after endodontic therapy is
becoming a useful part in modern restorative den-
tistry. It is well known that the successful treatment
of a badly broken tooth with pulpal disease depends
not only on good endodontic therapy, but also on good
prosthetic reconstruction of the tooth.10 Appropriate
patient selection is of paramount criterion for ensuring
Fig 2 clinical success. One piece restoration is indicated for
the management of mutilated tooth requiring post-core
restorations where there is reduced occlusal clearance.
A single-unit post-core-crown restoration has various
advantages over two or three units components. When
the post and core are two separate parts; different coef-
ficients of thermal expansion of the various components
Fig 3 of post crown restoration may have a harmful effect on
the bonds between the tooth-post-core-cement-crown
complex. In addition, flexion of the post under function-
al forces stresses the post-core interface, resulting in
separation of the core due to permanent deformation of
post.10 By decreasing the number of interfaces between
components, the single unit restoration helps to achieve
a monoblock effect. Microetching of the fitted surface of
the restoration provides microscopic roughness of the
surface and thus enhances bonding with the resin ce-
ment. Also acid etching of the dentin opens the dentinal
tubules by removing the smear layer, and renders the
Fig 4 intertubular dentin rough due to selective demineral-
ization of the inorganic substance. This enhances the
condition for infiltration of the etched surface with the
primer resin leading to the formation of hybrid layer.
The formed hybrid layer bond chemically with the resin
cement. So this will lead to adhesive monoblock res-
toration. Failure to achieve this monoblock effect may
lead to breakdown of the core, distortion or fracture
of the core that may result in caries or dislodgement
of restoration. This case was followed up every three
months over a period of a year with no evidence of
clinical or radiographic failures. Long-term follow-up
and clinical studies will add to the credibility of this
Fig 5 restorative strategy.

Pakistan Oral & Dental Journal Vol 35, No. 2 (June 2015) 344

CONCLUSION
Resin cements with dentin bonding agents have
led to the development of new alternative treatment
modalities to restore endodontic treated teeth with deep
bite, one piece post, core and crown can be considered as
a treatment option for this badly broken endodontically
treated tooth without the need to increase the length
of post space, this treatment options could never be
achieved with conventional cements.
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