#7 broke off near the gingiva. Ferrule for a crown would be limited. I felt the best chance for success would be a direct composite buildup. Activa is very strong, bonds well to tooth and composite, quick and easy to place and is bioactive. I believe these properities make it an excellent core material.


Step 1

All caries removed and root canal completed

Step 2

Gutta Percha removed 7 mm into canal space

Ferrule practically nonexistent after all caries have been removed

Step 3

Greater curve "Wide" in place

Step 4

Greater Curve "wide" cut back for access

Step 5

Contact openings made mesial and distal. Retainer secured with Triad Gel to provide more stability for the setup.

Core sequence:

Step 6

Clean and Boost (Apex Dental)

Consepsis (Ultra Dent)

Prelude SE (Danville)

Ribbond stuffed longitudinally into the A3 Activa (Pulpdent)

Activa with its' Ribbond Core will be the restorative for the lingual 1/2 of the tooth.

Filtek Placement

Step 7

At the cervical 1/3 A3 Filtek Body (3M) is tapered toward the incisal. A2 Filtek Body covers the incisal 2/3rd's. Both Filtek's were placed using the snowplow technique.

Labial shaping

Step 8

Prior to band removal I do most of the labial shaping with the band left in place. This incisal view is critical for establishing proper labial contours and line angles.

Shaping interproximal contours

Step 9

#12 blade is excellent tool for shaping interproximal contours. 

Final restoration #10

Step 10

Incisal view

Step 11

An important final look before releasing patient.

Over the years I have had a lot of success with similar cases. However, I never fail to share with my patient an extensive CYA statement about long term prognosis.