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Endodontics

Authors: Dr. Neha Dhaded, Dr. Kishore Kumar, Dr. Roopa Patil

Abstract

Customized glass fiber post that is well adjusted into the root canal and have mechanical properties similar to those of dentin may be suitable treatment for severely compromised teeth. This paper highlights the fact that many anterior teeth requiring restoration are severely weakened, having wide flared canal spaces and thin dentinal walls, and are at a high risk of getting fractured. This case was managed by the customization of fiber reinforced post by direct method.

Keywords: Structural rehabilitation, Customized fiber post,Weak roots

BACKGROUND

The structural rehabilitation of an endodontically treated tooth is critically important to ensure a successful restorative outcome.1 Weakened tooth with flared canals, arising as a result of carious extension, trauma to immature tooth, pulpal pathosis, iatrogenic or endodontic misadventures or idiopathic causes can cause problem to the practicing dentist.2 The post endodontic restoration of such teeth is commonly accomplished using intra - radicular restorations or post and core, to retain the coronal portion of the tooth.3

The introduction of fiber posts has made a great impact on the restoration of endodontically treated teeth.4 According to Boudrias et al post adaptation to the canal walls represents an important element in the biomechanical performance of the prosthetic restoration5 A significant improvement in fiber post adaptation and retention can be achieved by customization which reproduces the root canal morphology with best-produced esthetics4

This case report describes structural rehabilitation of a maxillary lateral incisor with a weakened root by a customized post and core.

CASE PRESENTATION

A 16-year-old girl reported to the Department of Conservative Dentistry and Endodontics, KLE V.K. Institute of Dental Sciences, Belgaum with the chief complaint of unpleasant smile due to a fractured and discolored upper front tooth. Patient presented with a history of trauma 4-5 years with noncontributory medical history.

Clinical examination showed Ellis class III fracture and discoloration with 21. IOPA with the same showed lateral shift. Pulp sensitivity tests (thermal and electric tests)gave a negative response. Provisional diagnosis of Chronic Periapical Granuloma/ Cyst was given. Endodontic treatment of 21 followed by Periodontal therapy was carried out. An osseous surgery was planned to get margins for post endodontic restoration maintaining the biologic width.

After 6 weeks of follow up, post-endodontic reinforcement by customization was planned as the remaining dentin thickness was less. Post space was created appropriate size of the fiber post (Glassix) was selected,etched with 9% HF acid for 1min (PorcelainEtch Ultradent Products,Inc.) and silanized (Ultradent Products ). A dual cure core build up material (Multicore Flow, IvoclarVivadent) was used to customize the fiber post directly into the canal. Canal was etched with 37% phosphoric acid and bonded (Adper Single bond 2, 3M ESPE). Selected fiber post was placed into the canal before the core build up material sets and then cured for 60 sec. Core build up was done with a dual cure material (Multicore Flow, IvoclarVivadent) with the help of a core former,temporization was done and after a week permanent restoration of PFM was given. Patient was referred to the department of orthodontics for further corrections of the alignment.

Customization of Pre-Fabricated Post & Core-21
 
 
 
 
 
 
DISCUSSION

Failure in endodontically treated teeth is more likely due to restorative failure than the endodontic treatment itself. Positive defects in casting are peculiar to custom cast system and when used in a flared canal produces more wedging forces.6

The use of prefabricated metal post for a weakened root, entail the obturation of large defects with the cementing medium, thus creating a weak link3 leading to unsalvageable fractures.8

The treatment options for the management of such compromised roots include customization by light transmitting post to build the composites in layers (Layered adhesion technique, Freedman & others, 1994.7 Other option is the use of bondable reinforcement fiber to be the alternative to conventional post materials.8 Since the anatomical post fits the root canal shape perfectly,a thin and uniform layer of resin cement is required .This reduces the effect of polymerization contraction of the resin material as well as the number and dimensions of bubbles within the cement itself, increases resistance to fracture and creates higher level of uniformity in distribution of occlusal forces transmitted to the tooth.4

TAKE HOME MESSAGE

The technique of customizing the fiber reinforced post is time saving, esthetically compatible, bonded to the root dentin, eliminating the number of composite interfaces that occur during layered adhesion technique, resulting in amonobloc that helps in better stress distribution.

REFERENCES
  1. Saupe W.A, GluskinA.H,Radke R.A. Comparitive study of fracture resistance between morphologic dowel and cores and a resin-reinforced dowel system in the intraradicular restoration of structurally compromised roots. Quintessence Int 1996; 27: 483-91
  2. Lui J.L. Composite resin reinforcment of flared canals using light transmitting plastic post.QuitessenceInt 1994;25: 313-19
  3. Deshpande SS, Sarin SP, Parkhedkar RD , Prosthetic rehabilitation weakened root canals:A case report. J of Clinical and Diagnostic Research2009;3: 1353- 56
  4. Savi A, ManfrediM,TamaniM,FazziM,Pizzi S, Use of customized fiber posts for the aesthetic treatment of severely compromised teeth:a case report. EndodDent Traumatol 2008;24:671-75
  5. Bateman G, TomsonP,Trends in indirect dentistry:2 Post and Core Restorations. Dent Update May 2005:190-97
  6. Morgano S.M, Milot P. Clinical success of cast metal posts and cores . J Prosthet Dent 1993;69:11-6
  7. ZalkiandM,HochmanN.Esthetic considerations in restoring endodontically treated teeth with posts and cores. JProsth Dent1198; 79: 702-5
  8. VelmuruganN,Parameswaram. Custom – made resin post and core .Oper Dent 2004; 29: 112-14
  9. Eskitasciogulu G, Belli S. Use of bondable reinforcment fiber for post and core build up in anendodontically treated tooth: A case report. QuintInt 2002;33:549-51
  10. Gonclaves LA, Vansan LP, Paulino SM, Neto MS , Fracture resistance of weakened roots restored with a transilluminating post and adhesive restorative materials. J of ProsthetDent 2006:96:339-44