Part one: The restoration of non-vital teeth: structural, biological, and micromechanical issues in maintaining tooth longevity.

Department of Restorative Sciences, Division of Operative Dentistry, University of Minnesota School of Dentistry, Minneapolis, MN 55455, USA.
Northwest dentistry 85(5):29, 31, 33-5 passim.
Source: PubMed


This manuscript will review research from 1967 to the present to find the best evidence for the reconstruction of non-vital teeth. The paper will review the contention that non-vital teeth are "more brittle" by analyzing the relevant physical properties of vital versus non-vital teeth; describe the structures of the tooth used to manage stress and strain; describe the formation of dentinal cracks and propagation of fracture planes through dentin; and analyze forces placed on human teeth and their effects on the tooth in Part One. In Part Two, the paper will describe the strength of various dowel and core designs relative to strength, retention, and durability and describe the results of testing various dentin bonding materials in strength and retention of dowels in non-vital teeth. The review will conclude with recommendations as to the materials and techniques in specific clinical situations best capable of single tooth reconstruction to ensure tooth longevity together with the scientific basis for their adoption.

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    ABSTRACT: The aim of this study was to compare the fracture strength of three techniques used to re-attach tooth fragments in sound and endodontically treated fractured teeth with or without fiber post placement. Ninety human lower incisors were randomly divided into three groups of 30 teeth each. In group A teeth were not subjected to endodontic treatment; while teeth from groups B and C were endodontically treated and the pulp chamber restored with a composite resin. All teeth were fractured by an axial load applied to the buccal area in order to obtain tooth fragments. Teeth from each group were then divided into three subgroups, according to the re-attachment technique: bonded-only, buccal-chamfer and circumferential chamfer. Before the re-attachment procedures, fiber posts were placed in teeth from group C using dual cure resin luting cement (Duo-Link). All teeth (groups A-C) had the fragments re-attached using a same dual cure resin luting cement. In the bonded-only group, no additional preparation was made. After re-attachment of the fragment, teeth from groups buccal and circumferential chamfer groups had a 1.0 mm depth chamfer placed in the fracture line either on buccal surface or along the buccal and lingual surfaces, respectively. Increments of microhybid composite resin (Tetric Ceram) were used in subgroups buccal chamfer and circumferential chamfer to restore the chamfer. The specimens were loaded until fracture in the same pre-determined area. The force required to detach each fragment was recorded and the data was subjected to a three-way analysis of variance where factors Group and Re-attachment technique are independent measures and Time of fracture is a repeated measure factor (first and second) and Tukey's test (alpha=0.05). The main factors Re-attachment technique (p=0.04) and Time of fracture (p=0.02) were statistically significant. The buccal and circumferential chamfer techniques were statistically similar (p>0.05) and superior to the bonded-only group (p<0.05). The first time of fracture was statistically superior to second time of fracture (p<0.001). The use of fiber post is not necessary for the reinforcement of the tooth structure in re-attachment of endodontically treated teeth. When bonding a fractured fragment, the buccal or circumferential re-attachment techniques should be preferable in comparison with the simple re-attachment without any additional preparation. None of the techniques used for re-attachment restored the fracture strength of the intact teeth.
    Journal of Dentistry 04/2008; 36(4):249-55. DOI:10.1016/j.jdent.2008.01.001 · 2.75 Impact Factor