|Year : 2022 | Volume
| Issue : 1 | Page : 101-104
|Corono-radicular reinforcement with minimal invasion: A novel case report
Tasneem Alirajpurwala1, Murtuza Zhabuawala2, Roopa R Nadig3
1 Sharada Polyclinic and Dental Centre, Pune, Maharashtra, India
2 Department of Conservative Dentistry and Endodontics, M. A. Rangoonwala College of Dental Sciences and Research Centre, Pune, Maharashtra, India
3 Department of Conservative Dentistry and Endodontics, Dayananda Sagar Dental College, Bengaluru, Karnataka, India
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|Date of Submission||15-Sep-2021|
|Date of Decision||30-Nov-2021|
|Date of Acceptance||21-Dec-2021|
|Date of Web Publication||02-May-2022|
| Abstract|| |
Maxillary premolar with an oval-shaped canal always poses a challenge while reconstruction using the post and core system. Fiber-post has many advantages over metallic-post and so fiber-post is becoming more popular and particularly widely used than metallic-post nowadays. Fiber-post has benefits of esthetic and strength, and its combination with flexible material, Ribbond has provided it with a high rise in the field of dentistry. The purpose of this case report was to show an innovative technique to place both glass fiber-post and Ribbond as a single assembly into the canal which gives a monoblock effect. This technique is feasible and may eradicate some of the problems associated with the cementation of ill-fitted fiber-post in an oval-shaped canal with widened canal space.
Keywords: Endodontically treated tooth; fiber-post; maxillary premolar; oval shaped canal; reinforcement; ribbond
|How to cite this article:|
Alirajpurwala T, Zhabuawala M, Nadig RR. Corono-radicular reinforcement with minimal invasion: A novel case report. J Conserv Dent 2022;25:101-4
|How to cite this URL:|
Alirajpurwala T, Zhabuawala M, Nadig RR. Corono-radicular reinforcement with minimal invasion: A novel case report. J Conserv Dent [serial online] 2022 [cited 2022 Aug 17];25:101-4. Available from: https://www.jcd.org.in/text.asp?2022/25/1/101/344521
| Introduction|| |
The successful outcome of an endodontically treated tooth (ETT) depends on factors such as the quality of the root canal treatment performed and the type of coronal restoration given to ensure an adequate marginal seal. The inherent part of the root canal system such as isthmus, inter-canal communications, curvatures, and oval-shaped canals can make disinfection, obturation as well as post endodontic restoration a considerable challenge. When the tooth has no or few surrounding tooth structures remaining but needs to be retained, a dental post is generally required to retain a core restoration, which retains the final crown.
Due to improvements in the adhesive techniques, glass fiber-post has become popular and is extensively used in the restoration of an ETT. Studies suggest that the teeth restored with fiber-post using resin luting cement demonstrate an improved mechanical performance than metallic post restorations. The major advantage of such kind of post system is that it is possible to build up missing coronal tooth structures using composite restorative material, which provides interfacial integrity through the use of materials of similar elastic moduli.,
A leno-woven polyethylene ribbon is used in many clinical situations nowadays. In recent years, there has been a great deal of interest in the use of resin cement to bond ribbond into a prepared canal. Studies have reported that polyethylene reinforced resin provides adequate retention required for clinical success of post and core system and good fracture resistance with increased incidence of repairable fracture.
Widened canal spaces are often seen in the clinical practice and if not adequately restored can lead to fracture. Several clinical protocols were outlined in the studies for the treatment of widened canal space with a large amount of lost tooth structure. Several authors have treated widened canal space using different techniques with resin luting cement but the majority of these cases have shown adhesive failure over a while.
Therefore, this case report addresses an innovative technique of using glass fiber-post in combination with polyethylene fiber ribbon reinforced composite resin in an oval-shaped canal as a post and core build-up which gives an excellent bonding as well as reinforces the tooth structure.
| Case Report|| |
A 20-year-old female patient reported with a chief complaint of severe pain in the maxillary right 2nd premolar (tooth no: 4 in the universal numbering system). The patient informed that the pain had increased in the last 3–4 days and that the pain aggravated on mastication and was relieved on taking medications. On clinical examination, a deep proximal caries was seen and radiographic examination revealed caries involving enamel, dentin, and pulp with periapical-radiolucency suggestive of irreversible pulpitis. Root canal treatment was advised and initiated under local anesthesia (lignocaine and adrenaline injection I. P. Harson laboratories, Baroda, Gujarat, India) using the rubber dam application. After the access opening, it was noticed that the canal is oval shaped and flared [Figure 1]a, [Figure 1]b, [Figure 1]c. Working length was measured using an electronic apex-locator (J. Morita Root ZX Mini Apex Locator, Athena Marketing, Vadodara, Gujarat, India) and confirmed radiographically, and then, the canal was irrigated with 5.25% sodium hypochlorite solution (Prime Dental Products, Mumbai, India) and biomechanical preparation was done using rotary universal Protaper till F3 (Dentsply Maillefer, Tulsa Dental Corp, OK) and dried using paper points. (Sure-Endo Dental Products, Mumbai, Maharashtra) Finally, the canal was adequately obturated with F3 universal gutta-percha points (Sure-Endo Dental Products, Mumbai, Maharashtra) [Figure 1]d.
|Figure 1: (a) Preoperative intraoral periapical (IOPA) radiograph of tooth 15 shows deep mesioocclusal caries involving pulp. (b) Clinical picture of tooth 15 showing deep proximal caries. (c) Clinical picture of tooth 15 showing access opening (Oval shaped canal).(d) Post obturation intraoral periapical radiograph of tooth 15. (e) Intraoral periapical -Radiograph shows post-space preparation with tooth 15 maintaining apical seal. (f and g) During post -trial, intraoral periapical and clinical picture of tooth 15 shows additional space around fiber post. (h) Clinical picture of tooth 15 shows Ribbond rolled and bonded over fiber post. (i and j) Intraoral periapical and clinical picture of tooth 15 shows the placement of RibbondFiber Post assembly inside the canal and cemented using resin cement. (k) Composite build up done and occlusion is reestablished of tooth 15|
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Post space preparation
It was observed that the remaining coronal tooth structure was <50% after the completion of the root canal treatment. Therefore, it was decided to go ahead with the post placement to retain the core. No. 2 and No. 3 Peeso-Reamers (Mani, INC. New Delhi DL India) were used for gutta-percha removal from the root canal maintaining 5 mm of apical GP [Figure 1]e. After gutta-percha removal, the fiber-post was checked for proper fit inside the root canal [Figure 1]f.
Innovative TECHNIQUE: “Roll-over Technique”
As the canal was oval shaped and flared, additional space was noticed around the fiber-post [Figure 1]g. To manage this extra space, an alternative approach was adopted. First, the fiber post was treated with a silane coupling agent (Monobond plus, Ivoclar-Vivadent, Mumbai, India) for 1 min using a disposable micro brush, and the surface was gently air-dried for 5 s. A piece of fiber ribbond (Kerr connect reinforcement ribbond: Kerr corp, orange, CA) 3 mm wide and 5 mm longer was cut off. A one-step adhesive system (Adper Prompt L-Pop, 3M ESPE, India) was applied on the fiber-post and Ribbond was rolled over the fiber-post and light-cured for 10 s [Figure 1]h.
Fiber-post with ribbond cementation
Thirty-seven percent phosphoric acid gel (Total etch, Ivoclar Vivadent, Mumbai, India) was used to etch the root canal for 15 s. A self-adhesive resin cement (SoloCem dentin, coltene\ whaldent inc., Mumbai, India) was applied into the root canal space with an intracanal mix tip (easy mix, coltene whaldent inc, Mumbai, India) and the mutated fiber post was seated. The excess resin cement was removed using a disposable brush, and the remaining cement was light-cured with the light-curing unit (Elipar S10, 3M ESPE, St. Paul, MN) through the post system for 20 s from all the surfaces of the tooth to ensure adequate polymerization of the resin cement [Figure 1]i and [Figure 1]j.
After fiber-post cementation, the coronal portion of the tooth was restored with composite resin (empress direct dentin A2 shade, Ivoclar Vivadent, Mumbai, India) using a centripetal build-up technique. Each 2 mm composite resin increment was light-cured for 20 s. Occlusion was established and the final procedure of finishing and polishing was performed using the composite contouring and polishing disc [Figure 1]k.
| Discussion|| |
In the present case report, an oval-shaped canal was recognized with widened space and thin remaining root dentin, and therefore, we opted for a different approach regarding management as compared to normal root canal configuration. Wu et al. reported that the prevalence of long oval root canal is more than 50% in maxillary second premolars. Very often, it is found that the endodontically treated teeth are left with little remaining coronal tooth structure and such teeth usually require a post to retain the core and restoration. We chose the placement of fiber post as it has a plethora of advantages over a metal post. Following isolation of the tooth, gutta-percha was removed from the root canal using rotary instruments and solvents until the desired length for the post is achieved. To preserve the apical seal and prevent leakage 5 mm, gutta-percha was left in situ. A greater amount of resin cement would have been required for the cementation of conventional fiber posts to fill the space surrounding the fiber post and the tooth structure. This condition might lead to debonding and ultimately adhesive failure.,
A ribbon reinforcement material is an incredible material that has gained a lot of popularity today, is composed of preimpregnated, silanized, plasma-treated, lenowoven, ultrahigh molecular weight polyethylene fibers. The ultimate use of ribbond offers numerous advantages as it bonds to composite and acrylic giving us a material with manifold use, there is no need to remove additional tooth structure and thus eliminates the possibility of root perforation and also it prevents the stress concentration at the tooth post interface.,
The major disadvantage of placing fiber-post or Ribbond alone cemented with resin-luting cement in the flared canal is that more amount of space would be occupied by resin cement and therefore could lead to adhesive failure as the C-factor of a root canal is 100. Hence, to overcome the above disadvantage, we have introduced a beautiful innovative technique described as the “Rollover Technique” where the ribbond is rolled over glass fiber-post and placed inside the flared canal and cemented with resin luting cement and light-cured. The advantages of using the above technique would be: first of all, it eliminates the need for laboratory procedures for placing the indirect restoration. In addition to it, this method also provides better postretention, as it avoids adhesive failure because of reduced resin cement thickness for cementation. This monoblock technique simplifies the post and core restoration since it can be used for postcementation and core buildup. The idea followed in this case report represents a smooth and facile way to restore endodontically treated teeth. The entire system works in harmony toward reinforcing tooth structure. This technique minimizes the chance of root fracture.,,
According to Xie et al., cuspal coverage with the full crown in maxillary premolars involving a proximal surface is not required as it reduces the fracture strength of the tooth and therefore in the present case report after post cementation, the core build-up was done using direct composite resin restoration and the occlusion is re-established followed by finishing and polishing of the restoration.
| Conclusion|| |
An incredible and innovative “Roll Over Technique” is a quick and easy choice that will not only allow us to preserve the weakened tooth structure but also avoid the use of prosthesis. In this effort, glass fiber-post and Ribbond as a highly versatile material with an array of desirable properties certainly help us in achieving this goal. However, long-term follow-ups are still required and should be the center of attention for future studies. Furthermore, further in vitro and ex vivo studies are required to evaluate the fracture pattern whether it results in favorable or unfavorable fractures.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Dr. Murtuza Zhabuawala
Department of Conservative Dentistry and Endodontics, M. A. Rangoonwala College of Dental Sciences and Research Center, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
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