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Authors Dr. Nidhi Sharma, Dr. Nitika, Dr. Annil Dhingra

Abstract

Traumatized anterior teeth need quick esthetic and functional repair. Esthetic requirements of anterior teeth require the use of composite materials which, in the most complex cases, can be used in association with fibers so as to improve their mechanical resistance. Many kinds of fibers are available. The authors considered parameters such as physical properties, water absorption, ease of cutting and of laying.
Polyethylene fibers appear to have the best properties in elasticity, translucency, adaptability, and tenaciousness, resistance to traction and to impact. In the case of a simple crown fracture, the missing part was restored by polyethylene fibers and composite resins. In the case of a complex crown fracture needing endodontic treatment, the fibers were used as a central core stump in order to restore the dental morphology.
At control examinations, the teeth restored by this technique were acceptable, both in function and in aesthetics. Thus, the authors recommend this combined technique for predictable restoration of traumatized anterior teeth.

INTRODUCTION

Provision of innovative treatment solutions to various problems has always been the motto of medical scientific brains. Dentistry is no exception to this endeavor. The acceptance of advances in material science has really helped this cause.
Ribbond is one such material, which has occupied an important place in the dentist's repertoire. It is bondable fibre reinforced material, made from the same ultra-high molecular weight polyethylene and ceramic fibers used to make bulletproof vests. The key to Ribbond's success is its patented leno weave. Designed with a lock-stitch feature, it effectively transfers forces throughout the weave without stress transfer back into the resin, providing excellent manageability characteristics.
Having virtually no memory,Ribbond adapts to the contours of the teeth and dental arch. It is translucent, practically colorless and disappears within the composite or acrylic without show-through offering excellent esthetics. Ribbond's fibers are the standard in biocompatibility. The same material is also used in the construction of artificial hip and knee joints. By virtue of such wide spectrum of intended properties, it enjoys varied applications in day to day dentistry like: endodontic posts, periodontal splints, aesthetic space maintainers, bondable bridges and single bridges and orthodontic retainers.

CASE REPORT

An 18 year patient reported in the Department Of Conservative Dentistry and Endodontics in Seema Dental College and Hospital with a chief complaint of fractured teeth in the anterior teeth region. The patient had history of trauma was hit by cricket ball.

On clinical examination it was found:
  1. Grade II mobility with respect to Right Maxillary Central Incisors
  2. Rotated crown portion in the Right Maxillary Central Incisors
  3. Periodontal was normal.


On radiographic examination: The two fracture segment was on approximation to each other Horizontal line fracture was present in the mid section of the root

A treatment plan was suggested to the patient which included:
 
  1. Stabilization of the fractured segments.
  2. Followed by the stabilization of the fractured root.
  3. Crown in relation to tooth

MANAGEMENT


The immediate goal was to stabilize the fracture segment The teeth was stabilized by composite material ((Tetric N-Ceram, Ivoclar Vivodent)
Working length was determined Calcium hydroxide with idoform was placed inside the canal as per to reduce any chance of any persisting perapical lesions Calcium hydroxide was removed after time duration of 15 days as the patient was asymptomatic A plugger was selected to make a MTA plug in the apical area of the canal as to prevent external/internal resorption MTA was mixed with chorhexidine as studies has indicated as it enhances antibacterial property by 35%which is statistically very significant MTA plug formation MTA plug formed slowly as it was carried through a no.25 K File whose tip was cut to make the instrument blunt
 


After MTA plug formed cotton pallet dipped in chlorhexidine was placed to the canal as MTA takes 72 hours to completely set. Patient recalled after 72 hours as MTA has set Ribbond material was selected for the filling of the root canal as per to maintain the stabilization of fracture segment and canal

Ribbond fibers

Placed the fiber in the bonding agent as per to increase the wettabilty to properly adhere to the root canal
 


Placed fibers in the canal Post operative radiograph after the placement of Ribbond fibers in the canal
 
 
 
 


CONCLUSION

The use of Ribbond, a polyethylene fiber, is based upon the clinical reports of tooth replacement by Bredenstein and Sperber, Marcus, Miller, and Portilla, among others. Ribbond. also has been described as being used for perio- dontal splints, strengthening removable prostheses, post and core fabrication, provisional and permanent bridges, denture repairs, and a framework for composite onlays and crowns.

Splinting teeth for periodontal, orthodontic, or posttraumatic reasons is a common procedure. Although traditional methods are successful, splinting teeth with reinforcement fibers that can be embedded in composites has gained popularity.

Ribbond is a biocompatible, esthetic material made from a high-strength polyethylene fiber. The various advantages of this material include ease of adaptation to dental contours and ease of manipulation during the bonding process. Because it is a relatively easy and fast technique (no laboratory work is need), procedures can often be completed in a single appointment. It also has acceptable strength because of good integration of fibers with the composite resin; this leads to good clinical longevity. Because a thinner composite resin is used, the volume of the retention appliance can be minimized. In addition, in case of fracture during wear, the appliance can be easily repaired. There is no need for removal of significant tooth structure, making the technique reversible and conservative. It also meets the patients’ esthetic expectations
 
 


FINANCIAL SUPPORT AND SPONSORSHIP

Department of Conservative Dentistry and Endodontics Seema Dental College and Hospital,Rishikesh, Uttrakhand

REFERENCES
  1. S. Belli, H. Orucoglu, C. Yildirim, G. Eskitascioglu., "The effect of fibre placement or flowable resin lining on microleakage in class II adhesive cavities," Abstract presented at The 2nd International Congress on AdhesiveDentistry Tokyo, Japan, April, 22-24 (2005).
  2. Bender A. J, "Single Appointment Crown and Bridge, An Innovative Technique," Dentistry Today 84-87, (2002)
  3. Deliperi S , Bardwell D, Colana C, "Reconstruction of Devital Teeth Using Direct Fiber-reinforced Composite Resins: A Case Report" Journal Adhesive Dentistry, 7, 1-7,( 2005).
  4. Dickerson W.G, "A Conservative Alternate to Single Tooth Replacement: A Three Year Follow-Up," Practical Periodontics and Aesthetic Dentistry, 43-49,(1993).
  5. Eskitascioglu G & Belli S , " Use of a Polyethylene ribbon to create a provisional fixed partial denture after immediate implant placement: A clinical report" Journal of Prosthetic Dentistry, 11-14( 2004).
  6. Fowler E.B & Breault L.G, "Esthetic Periodontal Splint with Ribbond Army Medical department Journal, 52-55. (1994)
  7. Hornbrook D.S. and Hastings J.H "Use of Bondable Reinforcement Fiber for Post and Core Build- Up in an endodontically Treated Tooth: Maximizing Strength and Aesthetics," Practical Periodontics and Aesthetic Dentistry. 33-44(1995).
  8. Iniguez I " Direct Composite Restoration on a Fractured Anerior Tooth," American Academy of Cosmetic dentistry Journal , 38-44. (2000)
  9. Karbhari V.M, Strassler H & Rudo D.N "The Development and Clinical Use of a Leno Woven UHMWPE Ribbond in Dentistry", Soceity for Biomaterials 29th Annual Meeting Transaction . 529. ( 2003)
  10. Kau K & Rudo D.N, "A Technique for Fabricating a Reinforced Composite Splint," Trends and Techniques in the Contemporary Dental Laboratory, 31-33:(1992)

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