JIDAM “An Official Journal of IDA - Madras Branch” ©2021. Available
online

ISSN No: 2582-0559

Volume No: 8, Issue No: 2

REVIEW ARTICLE

REHABILITATION OF FRACTURED CENTRAL INCISOR WITH

RICHMOND CROWN- A CASE REPORT

Dr.Yusuf Shaikh, Dr. Babita Yeshwante, Dr. Nazish Baig, Dr. Kalyani Deshmukh

Department of Prosthodontics, CSMSS dental college Aurangabad, Maharashtra, India

DOI:1.37841/jidam_2021_V8_I2_06

Address for Correspondence

Dr.Yusuf Shaikh,

Post Graduate Student

Kedy tower, Nagpada Mumbai central,

India.

Email id: yusufshaikh36@gmail.com

Received:

10.03.2021 First Published

29.05.2021

Accepted:

25.05.2021

Published:

xxxxxx

ABSTRACT

Rehabilitation of badly broken endodontically

treated  teeth  is  a  common  problem  in  restorative
dentistry.  Tooth  with  less  remaining  crown  height  is
indicated for post and core followed by crown to restore
normal  anatomy,  function  and  esthetics.  Patients  having
reduced interocclusal clearance and are most difficult to
manage. Richmond crown is a feasible approach for such
cases that can be performed with less incisal clearance as
it accommodates post, core and crown thickness. In this
case  report,  diagnosis  and  treatment  planning  for  a  case
with  fracture  of  maxillary  central  incisor  along  with
fabrication  technique  of  Richmond  crown  has  been
discussed.

KEY WORDS:

Fractured tooth, Richmond crown,

Dowel and Core

JIDAM “An Official Journal of IDA - Madras Branch” ©2021. Available
online

ISSN No: 2582-0559

Volume No: 8, Issue No: 2

INTRODUCTION:

Challenges have increased for restorative dentistry, with

the  advent  of  scientific  endodontic  therapy  in  the  1950’s.
Teeth  are  now  successfully  treated  with  predictable
endodontic therapy  that were extracted without hesitation; a
satisfactory restorative solution was necessary.

In 1879 A.D, C.M Richmond resolved the retention

problem  encountered  between  porcelain  crowns  and  posts
commonly  made of  wood  by fusing porcelain  to  a  platinum
post  (Richmond  crown,  Fig.1).  The  Richmond  crown  is  “a
post-retained crown made for an endodontically treated tooth
that  uses  a  porcelain  facing”  (GPT9).

It is customized

castable  post  and  crown  system  as  both  are  single  unit  and
casted  together.  Cast  metal  restorations  are  easier  to  make
with  the  aid  of  posts  for  retention  and  lasting  service.
Whenever  possible  the  metal  can  be  camouflaged  by
veneering

with

tooth-colored

restorations.

2,3,4,5

The

Richmond crown is indicated in cases with grossly decayed
single tooth with very much reduced crown height and with
increased deep bite and decreased overjet.

Fig.1 1-post, 2-cap, 3-crown, 4-root

This case report describes a patient with fractured

central incisor treated with a simple and minimally invasive
technique of restoration with Richmond crown.

Materials and methodology:

A 37-year-old patient reported to the Department of

Prosthodontics  with  the  complaint  of  bad  aesthetics  due  to
fractured upper right front teeth. After detailed history taking
and  examination  of  patient,  it  was  revealed  that  the  patient
underwent trauma 1 year back and his maxillary right central
incisor  had  got  fractured  and  was  root  canal  treated  but
crown was not given (Fig.2). On examination of oral cavity,
it  was  found  that  tooth  21  was  fractured  (Fig.3).
Radiographic  evaluation  revealed  single  canal,  with  root
canal treatment done and horizontal crown fracture  with the

right  central  incisor.  No  periapical  changes  were  noted.
Thus, there was no need of re-root canal treatment. Layered
zirconia  Richmond  crown  was  planned  as  it  can  be  a  better
option instead of prefabricated posts because of major loss of
tooth structure. The treatment plan was explained to patient.

Fig.2 Pre-operative extra-oral photograph

Fig.3 Pre-operative intra-oral photograph

Post space preparation:

It is important to preserve 3 to 5 mm of apical gutta

percha  to  maintain  the  apical  seal  (proportionist  approach).
Thus,  gutta  percha  was  removed  from  canal  with  Gates
Glidden drill (size 1 to 4), without disturbing the apical seal
and  maintaining 4mm of gutta  percha  in  the  apex.  The  post
should be surrounded by a minimum of 1mm of sound dentin
(Preservationist approach & conservationist approach).  Post
space  preparation  was  done  with  paeso  reamer  drill  up  to
size #04. Intra-oral periapical radiograph was taken to check
for adequate post-space preparation (Fig.4).

JIDAM “An Official Journal of IDA - Madras Branch” ©2021. Available
online

ISSN No: 2582-0559

Yusuf et al: Rehabilitation of fractured Central Incisor with Richmond Crown

Volume No: 8, Issue No: 2

Fig.4 Intra-oral periapical radiograph showing post space

preparation

Crown structure preparation:

Crown structure was prepared circumferentially for

zirconia crown with shoulder finish line. Incisal edge was
then given with crown ferrule effect for better retention.

Impression:

For making final impression, the canal was coated with

light body impression material (Impressiv) and then a small
piece of orthodontic wire, coated with light body was placed
in  the  canal.  Later  light  body  was  injected  around  the
prepared tooth, putty impression material (Perfit) was loaded
in  stock  tray  and  final  impression  was  made  (Fig.5).  The
impression  was  examined  for  defects  in  recording  of  post
space.

Fig.5 Final impression with impression of post space

Fabrication and cementation of Richmond crown:

It was then poured with die stone and wax pattern was

fabricated  for  Richmond  crown  and  scanned  for  fabrication
of  zirconia  coping  (Fig.6).  Coping  try-in  was  done  before
layering  (Fig.7).  The  restoration  was  sandblasted  with
aluminum oxide after try-in of final prosthesis. Cementation
was  done  with  automatic  self-adhesive  resin  cement
(RelyX).  Small  amount  of  cement  was  discarded  onto  the
mix-pad to ensure a perfect mix. Cement was applied on the
post  surface  and  lentulo  spiral  was  used  to  spin  the  cement
into  the  canal.  Filling  the  canal  with  cement  before  seating
the  post  will  avoid  air  entrapment  and  ensure  a  dense
uniform cement lute. Light cured for 20 seconds per surface.
Excess cement was removed (Fig.8).

Fig.6 Wax pattern was fabricated and scanned for fabrication

of zirconia coping

Fig.7 Zirconia coping try-in

JIDAM “An Official Journal of IDA - Madras Branch” ©2021. Available
online

ISSN No: 2582-0559

Yusuf et al: Rehabilitation of fractured Central Incisor with Richmond Crown

Volume No: 8, Issue No: 2

Fig.8 Cementation of richmond crown done with resin

cement

Fig.9 Post-operative extra-oral photograph

Discussion:

Pierre Fauchard described the use of “tenons,”, as early

as  1728,    which  were  metal  posts  screwed  into  the  roots  of
teeth  to  retain  bridges.7  In  the  late  19th  century,  the
“Richmond crown,” a single-piece post-retained crown with
a  porcelain  facing,  was  engineered  to  function  as  a  bridge
retainer. Design include casting of post and crown coping as
single  unit over which ceramic is fired and cemented inside
canal and over prepared crown structure having same path of
insertion.

2,3,4,5

For providing antirotational effect, ferrule

collar  was  incorporated.  Also  creating  ferrule  effect,
increases  mechanical  resistance  and  retention.  Major
limitation  of  this  design  is  excessive  preparation  in  making
two  different  axis  parallel  which  results  in  weakening  of
tooth  and  also  this  design  increases  stress  at  post  apex
causing  root  fracture.  Indications  for  Richmond  crown  are
grossly  decayed  or  badly  broken  single  tooth  where
remaining  crown  height  is  very  less  and  incases  with  steep
incisal guidance (deep bite and very less overjet) (Fig.9).

The advantages of this design are custom fitting to the

root configuration, high strength, availability of considerable
space  for  ceramic  firing  and  incisal  clearance,    little  or  no
stress  at  cervical  margin,  eliminates  cement  layer  between
core  and  crown  so  reduces  chances  of  cement  failure.
However  certain  disadvantages  include;  that  it  requires
multiple appointments, it is time consuming, high cost, high
modulus  of  elasticity  than  dentin  (10  times  greater  than
natural  dentin)

, less retentive than parallel-sided posts, and

acts as a wedge during occlusal load transfer and if the
ceramic part fractures, then it is difficult to retrieve which
can finally lead to tooth fracture.

The all-zirconium posts are quite rigid, with a modulus

of elasticity higher than stainless steel (Meyerberg KH et al;
1995 and Rovatti L 1998).

9,10

Other investigators reported

that it possess high flexural strength, fracture toughness
(Hulbert SF et al; 1972)

, radiopaque, biocompatible and

with physical properties similar to steel (Ichikawa Y et al;
1992).

The disadvantages include lower fracture resistance

than metal posts, difficult retrieval of the fractured post
within the root canal, and poor resin-bonding capabilities of
the post to radicular dentin (Rovatti L et al; 1998, Cohen BI
et al; 2000).

10,13

The clinician must judge every situation on individual

basis and select a procedure that fulfills the needs of the case
while minimizing stress and maximizing retention.

CONCLUSION:

Despite the rarity of HPC, it can be considered as one of

the  differential  diagnosis  of  tumors  of  the  head  and  neck
region.  Though  surgical  excision  is  the  most  accepted
management  of  HPC.  Early  diagnosis  reduces  the
postsurgical  morbidity.  Since,  local  recurrences  are  very
common  and  late  distant  metastasis  has  reported,  long-term
follow-up, is mandatory both clinically and radiologically.

ACKNOWLEDGEMENT

‘a’  designed  the  study,  searched  relevant  articles  and
collected  data.  ‘a’  and  ‘b’  participated  in  the  data
interpretation  and  analysis.  ‘a’  and  ‘c’  prepared  the
manuscript. All the three authors read and approved the final
manuscript.

CONFLICTS OF INTEREST

There are no conflicts of interest.

ISSN No: 2582-0559

Yusuf et al: Rehabilitation of fractured Central Incisor with Richmond Crown

Volume No: 8, Issue No: 2

References:

The Glossary of Prosthodontic Terms. J Prosthet Dent
2005; 94:10-92

Smith CT, Schuman N. Prefabricated post – and - core
systems: an overview. Compend Contin Educ Dent.
1998; 19:1013 -1020

Hudis SI, Goldstein GR. Restoration of endodontically

treated teeth: a review of the literature. J Prosthet Dent.
1986; 55:33-38.

Fernandes AS, DessaiGS. Factors affecting the fracture
resistance of post-core reconstructed teeth: a review. Int
J Prosthodont 2001 Jul-Aug; 14(4):355-63.

Rupika  Gogna,  S  Jagadish,  K  Shashikala,  and  BS
Keshava  Prasad.  Restoration  of  badly  broken,
endodontically  treated  posterior  teeth.  J  Conserv  Dent
2009 Jul-Sep; 12(3): 123–128.

Mishra P, Mantri SS, Deogade S, Gupta P. Richmond
crown: A lost state of art. Int J Dent Health Sci
2015;2:448‑53.

Smith CT, Schuman NJ, Wasson W. Biomechanical

criteria for evaluating prefabricated post-and-core
systems: a guide for the restorative dentist. Quintessence
Int 1998;29:305-312.

Freedman G. The carbon fibre post: metal-free, post-
endodontic rehabilitation. Oral Health 1996;86:23-30.

Meyenberg KH, Lüthy H, Schärer P. Zirconia posts: a
new all-ceramic concept for nonvital abutment teeth. J
Esthet Dent 1995;7(2):73-80.

10. Rovatti L, Cavalleri G, Dallari A. A new matrix in

esthetic posterior restorations. Compend Contin Educ
Dent 1998;19(3):332,334, 6.

11. Hulbert SF, Morrison SJ, Klawitter JJ. Tissue reaction to

three ceramics of porous and nonporous structure. J
Biomed Mater Res 1972; 6:347–374.

12. Ichikawa Y, Akagawa Y, Nikai H, Tsuru H. Tissue

compatibility and stability of a new zirconia ceramic in
vivo. J Prosthet Dent 1992;68 (2):322–326.

13. Cohen BI, Pagnillo MK, Newman I, Musikant BL,

Deutsch AS. Retention of a core material supported by
three post head designs. J Prosthet Dent 2000;83(6):624