Glenn:

Nice case and excellent use of lasers to access the margins!!!!!

I’m not being critical at all but just want to offer some some thoughts on my experience with core buildups:

1) Contrary to my training, I placed my last pin in the Fall of 1989. With modern dentin bonding agents, particulary the new self etch primers combined with Erbium laser treatment, I bond my cores with absolutely no fear of them becoming dislodged during prep, impression or removal of provisional crown.

2) In past years I placed many cores with a composite which was radiolucent. Some were long-term treatment plans and I would take radiographs of these patients which had acrylic provisional crowns/bridges. When I viewed these radiographs, I couldn’t differentiate the core from the tooth and couldn’t tell if I had left caries.

Also, probably because I wasn’t using magnification, through long term recalls I found that I had placed some final crowns on radiolucent buildup margins. Difficult to tell whether recurrent caries at the margin or just a radiolucent composite buildup so I stopped using radiolucent core materials and now only use radiopaque light cured posterior composites.

Al