International Journal of Science and Research (IJSR)

ISSN (Online): 2319-7064

Index Copernicus Value (2016): 79.57 | Impact Factor (2017): 7.296

Richmond’s Crown: The Ancient Dental Art

Dr. Gunjan Shah1, Dr. Chinmay Patel2, Dr. Kruti Kachoriya3 ,Dr. Kamal Bagda4 ,Dr. Kailash Attur5 ,
Dr. Payal Patel6
1
Department Of Prosthodontics, Crown & Bridge, Narsinhbhai Patel Dental Collage And Hospital,
SPU University Campus, Gandhinagar-Ambaji Highway, Visnagar-384351, Gujrat, India
2, 3, 4, 5, 6
Department Of Conservative Dentistry And Endodontics, Narsinhbhai Patel Dental Collage And Hospital,
SPU University Campus, Gandhinagar-Ambaji Highway, Visnagar-384351, Gujrat, India

Abstract: Endodontically treated teeth with the loss of coronal tooth structure when left untreated for a long period of time may cause
supraeruption, drifting, tipping, and rotation of adjacent and opposing teeth. Tooth with very less remaining crown height is indicated
for post and core with crown over it to restore the normal anatomy, function, esthetics. Richmond’s crown is very much indicated in
single tooth situation with very less incisal clearance. This case report describes two cases with fractured central incisors and reduced
interocclusal space treated with Richmond crown.

Keywords: Richmond’s crown, Post endodontic restoration, Overjet

1. Introduction challenges increased for restorative dentistry. Teeth that were

extracted without hesitations were now successfully treated
Present era of dentistry is focusing on conservation of natural with predictable endodontic therapy; and a satisfactory
tooth and since old ages endodontic dentistry is playing restorative solution was necessary.4
major role in restoring tooth function and after which
prosthetic dentistry brings its function and esthetics back. Richmond crown is fixed denture with post and crown (single
Wherever remaining crown structure is insufficient to retain unit) systems, where the post part goes into the root canal and
full coverage crown then post and core is required to increase its crown coveres the entire of the original tooth crown
retention and resistance form of tooth.1 surface. Indications for Richmond crown are not many,
usually it is done on a tooth which has been badly damaged
During the treatment procedure, a structurally compromised and remaining tooth structure is very less, or in case of
tooth can give rise to complications such as root fracture, loss incisal inclination repair (deep bite and less overjet). Due to
of restorative seal, dislodgement of core, and periodontal the remaining tooth structure in the cervical third when the
injury due to biological width invasion during margin load gets distributed, this design protects the cervical part of
preparation.2 post and core system than the others, so it protects the tooth
crown margin and reduce the possibility of restoration
Post and core procedure can give rise to complications such leakage.5 In this article, two case reports have been discussed
as dislodgement of assembly, fracture of post/root, loss of along with fabrication technique of Richmond crown.
restorative seal and periodontal injury. Such situations further
get complicated when there is deep bite with no/very less 2. Case report
overjet in anterior teeth; as oblique forces are maximum and
core reduction should be adequate to provide indicated Case 1
thickness for ceramic/metal ceramic crown to achieve A 27 years old female patient named Mubina Baloch
desirable esthetics. Richmond crown is best indicated reported to the department of Conservative Dentistry and
solution in such conditions.3 Endodontics at Narsinhbhai Patel Dental Collage and
Hospital with the chief complain of pain and sensitivity in
The Richmond crown was introduced in 1878 and upper front teeth region of jaw. On clinical examination
incorporated a threaded tube in the canal with a screw- generalized erosion was observed which was markedly
retained crown. It was later modified to eliminate the pronounced in the maxillary right central incisor(fig-a & b).
threaded tube and was redesigned as a 1-piece dowel and
crown (Hampson EL et al; 1958, and Demas NC et al; 1957),
which lost its popularity quickly because they were not
practical. This was obviously evident when divergent paths
of insertion of the post space and remaining tooth structure
existed, especially for abutments of fixed partial dentures.
One piece dowel crown restorations also presented problems
when the crown or FPD required removal and replacement.
These difficulties led to development of a post and core
restoration as a separate entity with an artificial crown
cemented over a core and remaining tooth structure. With the a. preoperative
advent of scientific endodontic therapy in the 1950s, the
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Paper ID: ART20182018 DOI: 10.21275/ART20182018 1634
 International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Index Copernicus Value (2016): 79.57 | Impact Factor (2017): 7.296
Crown structure preparation: Firstly, remaining crown
structure was prepared circumferentially for metal ceramic
crown with shoulder finish line (sub-gingival) buccally and
chamfer on palatally.

Post and core fabrication: Intra canal length was measured

and wooden tooth pick was cut and modified according to the
length and width of the canal. Intra canal impression was
captured by flowing green stick wax over tooth pick and
placing it inside the canal. Core structure was build up along
with full coverage extension all over prepared crown(fig-e).
b. preoperative radiograph

On clinical examination of centric occlusion is was found

that the patient had deep bite and less overjet. So the
treatment plan was decided as to undergo for fabrication of
Richmond’s crown in relation to maxillary right central
incisor after doing the complete root canal treatment(fig-c).

e. wax pattern fabrication

Crown fabrication: Prepared post and core with coping

assembly was casted in base metal alloy (fig-f) and after
finishing metal trial was done to check fitting. Finish line was
adjusted to equigingival and checked for ceramic clearance.
Ceramic build up was carried out(fig-g) and final prosthesis
was checked for fit and occlusion. Assembly was cemented
with glass ionomer cement used in luting consistency(fig-h &
i).
c. completed rootcanal treatment

After doing the standard root canal treatment the following

procedure was performed.

Post space preparation: post space was prepared with Pesso

reamer to remove guttapercha upto one third of roots length
(care was taken not to disturb apical seal). Under cuts within
the canal were blocked with glass ionomer cement and
preparation part was ended with the use of H-file
f. metal casting
(circumferentially) to smoothen the walls of the post
space(fig-d).

g. final prosthesis

d. post space preparation

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Licensed Under Creative Commons Attribution CC BY
Paper ID: ART20182018 DOI: 10.21275/ART20182018 1635
 International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Index Copernicus Value (2016): 79.57 | Impact Factor (2017): 7.296
On clinical examination of centric occlusion is was found
that the patient had deep bite and less overjet. So the
treatment plan was decided as to undergo for fabrication of
Richmond’s crown in relation to maxillary right central
incisor after doing the complete root canal treatment (fig-l).

h. postoperative radiograph

l. Completed root canal treatment

Treatment included standard root canal treatment followed

by fabrication of the Richmond’s crown. The clinical
procedure was same as described in the case 1(fig-m to r).
i. postoperative

The case was followed for 6 months in which no root

fracture, no loosening or dislodgement of post, and no
secondary caries were recorded.

Case 2
A 21years old male patient named Mahendra Thakor
reported to the department of Conservative Dentistry and
Endodontics at Narsinhbhai Patel Dental Collage and
Hospital with the chief complain of broken tooth in upper
front teeth region of jaw. History reveled episode of fall
before few years with maxillary left central incisor. On m. post space preparation
clinical examination Elli’s class III fracture was diagnosed in
maxillary left central incisor(fig-j & k).

n. wax pattern fabrication

j. Preoperative

o. Metal Casting

k. Preoperative Radiograph

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Paper ID: ART20182018 DOI: 10.21275/ART20182018 1636
 International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Index Copernicus Value (2016): 79.57 | Impact Factor (2017): 7.296
“Richmond crown,” a single-piece post-retained crown with a
porcelain facing, was engineered to function as a bridge
retainer. Richmond crown is not post and core system but it
is customized, cast able post and crown system as both are
single unit and casted together. Design include casting of
post and crown coping as single unit over which ceramic is
fired and cemented onside canal and over prepared crown
structure having same path of insertion. Ferrule collar is
incorporated to increase mechanical resistance, retention
p. final prosthesis apart from providing anti-rotational effect. A major technical
drawback of this design is excessive tooth preparation in
making two different axis parallel which results in weakening
of tooth and also this design increases stresses at post apex
causing root fracture.7

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.
Also, corrosion of metallic posts has been proposed as a
q. postoperative radiograph cause of root fracture.8

The restoration of the endodontically treated tooth is an

important aspect of successful endodontic therapy. There are
wide ranges of treatment options of varying complexity. The
clinician must be able to predict the probability of restoring
such teeth successfully. In general, endodontically treated
teeth experience significant coronal destruction as well as
loss of radicular dentin, secondary to endodontic treatment.
There is evidence that these teeth have reduced levels of
proprioception, which could impair normal protective
r. postoperative reflexes. Clinical longevity of the post and core restoration
can be influenced by many factors including magnitude and
3. Discussion direction of the occlusal load, design of dowel, thickness of
remaining dentin, quality of cement layer and creation of
Endodontic treatment has been in practice since ages with ferrule effect to enhance structural durability of the final
high success rate but restorative part was not much restoration (Goodacre et al., 1994). Comprehensive studies
understood previously. Whenever, a considerable amount of of the literature and cases have led us to draw meaningful
tooth structure is lost because of fracture/caries/secondary conclusions as to how the endodontically treated tooth must
decay around previous restorations/during endodontic be handled. The primary goal of retaining the treated tooth
treatment, then remaining crown structure is not sufficient must be planned strategically as per the present condition of
enough to retain large prosthetic crown. In such cases special the tooth for best and long-term results (Assif et al., 1993).9
procedures are needed with objective to increase remaining
crown length so that it manage arc of rotation under oblique The disadvantages with the Richmond crown are as follows:
forces (function) and there are crown lengthening (either they are time‑consuming, so more appointments are needed
surgically or by orthodontic extrusion) or post placement for the patient; cost is more and their modulus of elasticity is
with core build-up. Surgical crown lengthening is indicated higher than dentine; and in the case of ceramic fractures, it is
whenever there is esthetic and cosmetic need but very difficult to retrieve and may lead to tooth fracture. 10
disadvantage is it reduces root length and requires surgery
with long healing period. Orthodontic extrusion also reduces Hence, the clinician must judge every situation and select the
root length and is time consuming too. Post and core is most procedure that meets the requirement of both function and
commonly used method for such cases.6 esthetics. Although there were other techniques that involved
procedures to be carried out on the patient, we planned to
As early as 1728, Pierre Fauchard described the use of change the morphology of the crown in order to place the
“tenons” which were metal posts screwed into the roots of restoration within the interocclusal space that was present
teeth to retain bridges. In the mid-1800s, wood replaced between the upper and lower tooth.
metal as the post material, and the “pivot crown” a wooden
post fitted to an artificial crown and to the canal of the root,
was popular among dentists. In the late 19th century, the

Volume 7 Issue 4, April 2018

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Licensed Under Creative Commons Attribution CC BY
Paper ID: ART20182018 DOI: 10.21275/ART20182018 1637
 International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Index Copernicus Value (2016): 79.57 | Impact Factor (2017): 7.296
4. Conclusion
This case report highlights the importance of post and core
system in restoring badly broken or grossly decayed teeth in
spite the massive popularity of implants nowadays as it is less
time consuming and cost effective. Richmond crown is very
much indicated in situations with very less overjet to
accommodate core+cement+crown thickness.

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Volume 7 Issue 4, April 2018

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Licensed Under Creative Commons Attribution CC BY
Paper ID: ART20182018 DOI: 10.21275/ART20182018 1638