| Abstract|| |
A variety of post systems, from metal to ceramics are available for the post-endodontic management of severely fractured teeth. The reinforcement of the composite resins by fibers improves their fracture toughness and resistance. The Fiber reinforced composite resin can be a good alternative to conventional post systems. The purpose of this article was to present a clinical case of fractured anterior teeth where fiber reinforced composite was used for the intraradicular rehabilitation of an endodontically treated tooth as well as extraradicular rehabilitation of a fractured tooth. This technique offers a conservative, esthetic and non-invasive treatment. Moreover this technique is economically more acceptable. The polyethylene FRC post and core can serve as a long-lasting provisional treatment in pediatric cases where the growth is not completed yet, or as a permanent treatment option in older patients.
Keywords: Post system, Fiber reinforced composites and Flexible post.
|How to cite this article:|
Hemamalathi S, Babu NV, Kandaswamy D. Intra-radicular rehabilitation and management of fractured teeth. J Conserv Dent 2006;9:119-22
|How to cite this URL:|
Hemamalathi S, Babu NV, Kandaswamy D. Intra-radicular rehabilitation and management of fractured teeth. J Conserv Dent [serial online] 2006 [cited 2020 Feb 19];9:119-22. Available from: http://www.jcd.org.in/text.asp?2006/9/4/119/42312
| Introduction|| |
Trauma is most common in the age group of 9-10 years  . During this age, the roots are still in the process of maturing. During the root formation, the dentin thickness is less. Hence they are more prone to fracture.
The most common fracture site for immature teeth is the cemento-enamel junction. These fractured immature teeth have to be rehabilitated, with minimum tooth structure removal and with good esthetics. Most post and core systems require more removal of tooth structure, further weakening the tooth ,, .Moreover the currently available post systems only aid in retention of the crown; they do not reinforce the tooth. Flexible post systems are preferred over rigid materials, as they closely resemble dentin to create a mechanically homogenous unit  .
A fractured tooth also has an adverse psychological impact on young patients. Hence the tooth should be restored as early as possible in less number of visits and with minimum tooth removal. Fiber reinforced composite (FRC) materials when used, as posts are more advantageous than the conventional post systems  . They do not require removal of dentin. Thus they do not weaken the remaining tooth structure. The Fiber reinforced composite along with the composite core acts as a monobloc and reinforces the tooth and the tooth can be restored in the same visit.
Ribbond is a FRC, which is made up of polyethylene fibers. It is a spectrum of 215 fibers with a very high molecular weight. These fibers have a very high coefficient of elasticity (117 Gpa), so it has an excellent resistance to stretch and distortion. They also have a very high resistance to traction (3 Gpa), as a result of their closed stitch configuration and a good adaptability. Bondable reinforcement fibers arc also characterized by impact strength five times higher than that of iron. They are translucent and assume the color of the resin to which they are added. Bondable reinforcement fibers easily absorb water because of the gas plasma treatment to which they are exposed. This treatment reduces the fibers superficial tension, ensuring a good chemical bond to composite materials ,,.
Surcan Eskitascioglu reported a case where a bondable reinforcement fiber was used for post and core build up in endodontically treated teeth  . Marina Consuelo Vitale reported two cases using polyethylene fibers and composite resins in restoration of traumatized anterior teeth.
In this article, the use of fiber-reinforced composite (Ribbond) in management of fracture teeth is discussed.
| Case report|| |
A 13 year-old boy reported to the Department of Conservative dentistry and Endodontics, Meenakshi Animal Dental College and Hospital with a chief complaint of broken upper front teeth. He gave a history of fall on the previous day. On examination, the maxillary right and left central incisor was fractured. In maxillary right central incisor an incisal third crown fracture involving enamel and dentin was present. In the maxillary left central incisor fracture was present in the middle third of the crown, which was involving the pulp [Figure 1]. Radiograph revealed an incisal third fracture of the crown in maxillary right central incisor and middle third crown fracture in maxillary left central incisor which was involving the pulp. No mobility was present in both the teeth. We decided to restore the maxillary right central incisor with composite resin using a scaffold of fiber-reinforced composite and in maxillary left central incisor, an endodontic treatment followed by post and core with fiber-reinforced composite was planned.
In the maxillary left central incisor, local anesthetic agent was administered and tooth was isolated with rubber dam. Access opening was done and pulp extirpated [Figure 2]. The canal was irrigated with 2.5% of sodium hypochlorite and & saline. Obturation was done by lateral condensation method using gutta percha and zinc oxide eugenol sealer. The next day gutta percha was removed from the canal leaving behind an apical 5mm of gutta percha. The length of the pulp space coronal to remaining gutta-percha was measured. This length was doubled and length of the fiber was measured. Two pieces of fiber were then cut with special scissors. Ribbon pieces (Ribbond Reinforcement Ribbon, Scottle, WA, USA) were coated with bonding agent (Scotchbond 1,3M Dental products, St.Paul, MN, USA) and excess was blotted out. The ribbons were folded in a V shape and the inside of Vs was coated with dual cure resin (Relyx Arc, 3M ESPE, St.Paul, USA). The first piece of ribbon was then placed in the post space in a facio lingual orientation [Figure 3].A second V of ribbon was then placed at right angles to the first ribbon piece [Figure 4]. The ribbons were condensed and a small drop of dual cure resin was then placed between the ribbons. Then the core build up was done with composite resin (3M ESPE, St.Paul, USA) [Figure 5].
In the maxillary right central incisor, FRC (Ribbond) was coated with bonding agent and was folded and placed from palatal surface to labial surface. Flowable composite was placed both on the palatal and labial surfaces to hold the ribbon and then cured. This acted like a scaffold for the composite resin restoration. The tooth was then restored with composite resin. Thus both the maxillary right and left central incisors were restored using FRC and composite resin [Figure 6].
| Discussions|| |
Traumatized anterior teeth require quick functional and esthetic repair. Composite materials are commonly used in clinical dentistry for esthetic restorations, particularly in anterior dentition. However, these materials have poor mechanical resistance. Approaches to strengthening composite materials have included reinforcing their resinous matrix with fibers  . Poly ethylene fibers improve the impact strength, modulus of elasticity and flexural strength of the composite resins.
In pediatric patients where the teeth would not have reached their final occlusal table, FRC is the most conservative post option. The other advantages of FRC include minimum tooth structure removal and immediate treatment. This esthetic and flexible fiber-resin composite is reported to minimize micro crack propagation in the root  .
Amir Chafai reported a case where FRC was used to replace traumatically missing permanent right central incisor  .
These polyethylene fibers can be used in pediatric dentistry to splint traumatized teeth, restore fractured teeth, as a space maintainer, and as fixed retainers following orthodontic treatment  .
| Conclusion|| |
FRC technique presented in this article suggests a new conservative treatment option for the replacement of fractured anterior teeth. This technique restores esthetics and function. It is easy, effective and less expensive method. It does not require any tooth removal. Moreover a full coverage crown cannot be given when the tooth has not reached the occlusal plane. In such cases the FRC is the ideal treatment option.
| References|| |
|1.||Charles H.Stuart, DDS, Scott A. Schwartz, Thomas J. Beenson, DDS Reinforcement of immature root with a new resin filling material. J Endod 2006, 32:350-353. |
|2.||Surcan Eskitascioglu, DDS, Sema Belli, and DDS. Use of a bondable reinforcement fiber for post and core build up in an endodontically treated tooth: A case report. Quintessence Int 2002,33: 549-551. |
|3.||Donovan T, Chee WW. Endodontically treated teeth: A summary of restorative concerns. J Calif DentAssoc 1993,21:49-56. |
|4.||Abou Rass M, Donovan T. The restoration of endodontically treated teeth. J Calif Dent Assoc 1993,21: 61 -67. |
|5.||Gurcan Eskitascioglu, DDS, Sema Belli, DDS, and Mustafa Kalkan, DDS. Evaluation of two post core systems using two different methods (Fracture strength test and a finite elemental stress analysis). J Endod 2002, 28:629-63 |
|6.||Marina Consuelo Vitale, Claudia Caprioglio, Alessandara Martignone, Umberto Marchesi, A.R.Botticelli. Combined technique with polyethylene fibers and composite resins in restoration of traumatized anterior teeth.DentTraumatol 2004, 20: 172- 177 |
|7.||Vallittu PK. Ultra high modulus polyethylene ribbon as reinforcement for denture poly methyl methacrylate, a short communication. DentMater 1997; 13: 381 -382 |
|8.||Gutteridge DL. The effect of including ultra high modulus polyethylene fiber on the impact strength of acrylic resin. Br Dent J 1988, 164:177-180. [PUBMED] |
|9.||Dixon DL, Breeding LC. The transverse strengths of three denture base resins reinforced with polyethylene fibers. J Prosthet Dent 1992; 67:417-419 [PUBMED] |
|10.||Samadzadeh A,Kugel G.Fracture strengths of provisional restorations reinforced with plasma treated woven polyethylene fiber. J Prosthet Dent 1997; 78:447 -44 9. |
|11.||Hornbrook D, Hastings Rj. Use of bondable reinforcement fiber for post and core build up in an endodontically treated tooth: maximizing strength and aesthetics. Pract Periodont Aesthet Dent 1995; 7; 33-42 |
|12.||Amir Chafaie, DDS, Richard Portier, DDS. Anterior Fiber reinforced composite resin bridge: A case report. Pediatr Dent 2004; 26: 530-534 |
Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospital, Maduravoyal, Chennai-600095
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]