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Glass Fibre Reinforced Composite Resin Post & Core In
Decayed Primary Anterior Teeth – A Case Report.
Yusuf K. Chunawalla,1 Shweta S. Z ingade,2 Bijle Mohammed Nadeem Ahmed,3
Elisha A. Thanawalla4
Introduction
Early childhood caries is a rampant dental disease that affects mostly young children.
The American Academy of Pediatric Dentistry defines ECC “as the presence of 1 or
more decayed, missing (due to caries), or filled tooth surfaces in any primary tooth in a
child 71 months of age or younger”1. Clinical examination of this condition discloses a
distinctive pattern. The teeth most often involved are the maxillary central incisors,
lateral incisors and the maxillary and mandibular 1st primary molars2,3.The maxillary
primary incisors are the most severely affected with deep carious lesions usually
involving the pulp. In extreme cases, ECC can even lead to total loss of the crown
structure4, 5.
Earlier, the most pragmatic treatment was to remove the involved teeth. However, the
importance of preserving the integrity of the anterior teeth can be realized from the
fact that loss of these teeth can lead to space loss, masticatory deficiency, phoenetic
challenges, lack of pre-maxilla development and resulting malocclusion, development
of para- functional habits and mainly psychological problems that interfere with the
personality and behavior of the child2-10. Restoring the primary anterior teeth to its
previous function, form and esthetics presents a challenge to the Pediatric Dentist. The
children who require this treatment are usually the youngest and least manageable
group of patients.
In addition to that, technical problems of primary incisors have to be faced. These
teeth have short and narrow crowns leaving only a small surface for bonding, a pulp
chamber that is relatively large to the crown size and enamel which is inheritantly
difficult to etch due to its aprismatic structure11, 12. Because of the reduced coronal
structure, direct restorative procedures do not always give satisfactory results. Shape,
function and form can be better restored by means of prosthodontic techniques.
Various studies have shown that post and cores can be used to overcome this
problem. The introduction of fiber posts in 1990 provided the dental profession with
the first true alternative to cast/ prefabricated posts, pins and orthodontic wires.
Presented herewith is a clinical case report of an ECC patient, whose dentition was
restored with Glass fibre reinforced composite resin posts(GFRC), a new generation of
fiber posts.
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ABOUT THE AUTHORS
1. Dr. Yusuf K. Chunawalla
Professor & Head, Department
of Pedodontics & Preventive
Dentistry,
M.A. Rangoonwala College of
Dental Sciences & Research
Centre, Pune
2. Dr. Shweta S. Zingade
PG Student, Department of
Pedodontics & Preventive
Dentistry,
M.A. Rangoonwala College of
Dental Sciences & Research
Centre, Pune
3. Dr. Bijle Mohammed
Nadeem Ahmed
PG Student, Department of
Pedodontics & Preventive
Dentistry,
M.A. Rangoonwala College of
Dental Sciences & Research
Centre, Pune
4. Dr. Elisha A. Thanawalla
PG Student, Department of
Pedodontics & Preventive
Dentistry,
M.A. Rangoonwala College of
Dental Sciences & Research
Centre, Pune
Corresponding Author:
Dr. Bijle Mohammed
Nadeem Ahmed
Email: nbijle@yahoo.co.in
Abstract
Dental caries is the singled most common chronic childhood disease. In early childhood caries
there is early carious involvement and gross destruction of maxillary anterior teeth. This case
presents the clinical sequence of rehab ilitation of maxillary anterior primary teeth. Endodontic
treatment was followed by the placement of a new fibre post, glass fibre reinforced composite
resin post. The crown reconstruction was done with strip crowns.
KEYWORDS: Anterior restoration, Post, Glass Fibre Reinforced Composite Resin.
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CASE REPORT CASE REPORT
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CASE REPORT
A 4 year old, male patient reported to the Department of
Pedodontics and Preventive Dentistry, M. A.
Rangoonwala College of Dental Sciences and Research
centre, Pune with a chief complaint of decayed upper
front teeth. Patient’s medical history was non-
contributory. Patient’s mother gave a history of breast
feeding for 1 year after which the child was bottle fed for
2 years. The milk contained sugar and the child went to
sleep with the bottle in his mouth. Intra-oral examination
revealed a complete set of deciduous dentition. It was
observed that 55, 54, 52, 51, 61, 62, 64, 65, 74, 75, 84 and
85 were affected by dental caries. Intra-oral periapical
radiographs revealed pulp involvement with 54, 52, 51,
61, 62, 64 and 74. (Fig.a)
TREATMENT PLAN
Diet analysis, counseling and oral prophylaxis were
undertaken. 54, 64 were grossly carious and were
indicated for extraction followed by a Nance palatal
space maintainer. 74 were indicated for extraction due to
resorption of the distal root as observed on the intra-
oral periapical radiograph. The extraction was to be
followed by a band and loop space maintainer.
52, 51, 61, 62 were indicated for pulpectomy, followed by
glass fibre reinforced composite resin posts and strip
crowns. 55, 65, 75, 84 and 85 presented with pit and
fissure caries and were indicated for composite resin
restorations.
TREATMENT PROGRESS
The treatment plan was divided into 2 phases for 51, 52,
61 & 62:-Phase 1- endodontic phase & Phase 2-
construction of the restoration.
PHASE ONE: The Endodontic Phase
An infraorbital block was administered for 61, 62 & labial
& palatal infiltration was carried out for 51, 52. Rubber
dam isolation was carried out. Gross carious lesions were
removed with a no. 330 round carbide steel bur (S.S.
White, N.J USA). Unsupported enamel was not removed
so as to preserve as possible. As Muller De Vaan, a
Prosthodontist, stated, our objective should be
“perpetual preservation of what remains, rather than
meticulous reconstruction of what is lost.” The pulp
chamber was opened & working length determination
IOPA was taken with a no. 8 K-file pulp tissue was
extirpated using no.8 – no.30 K-files (Mani INC, JAPAN).
After irrigation with copious amounts of 2.5% NaOCl &
Normal Saline, the root canal was dried using paper
points. A thick mix of zincoxide eugenol paste was then
condensed with lentulo-spiral into the canal. The
obturated material was allowed to set for 10 minutes.
(Fig. b,c,d)
PHASE TWO: The Construction of Restoration
The post space was prepared in the second
appointment, 3 days after the endodontic treatment was
completed. The post space was created by removing
approximately 4mm of ZnOE material using a thin
straight fissure bur with rubber stopper attached to a
contra-angle handpiece. The diameter of the straight bur
used was less than the root canals .All visible ZnOE
cement on the walls of the post space was removed. The
post-space was air dried & a 1 mm base of glass
ionomer cement( Fuji 2, GIC Corp, Tokyo, Japan) was
placed to isolate the obturated material from the rest of
post space. (Fig.e)
The prepared post space was then cleaned with saline ,
air- dried & acid – etched with 37% phosphoric acid (
Prime Dental , Thane , India) for 15 seconds. This space
was rinsed and air dried with oil-free compressed air. A
light cured bonding agent (3M ESPE, M.N, USA) was
brushed on the etched surface & uniformly dispersed by
a compressed air blast. It was then light cured with (
StarlightPro, Mectron LED Light, Italy) for 20 seconds.
The GFRC post was then cured for 20 seconds in order
to gain rigidity, before insertion into the post space.
Light cured flowable composite resin (3M ESPE, MN,
USA) was then inserted into the canal chamber after
which the GFRC post was inserted .The fiber post &
composite were then cured together for 60 seconds. The
coronal portion of the glass fibre reinforced composite
post was splayed to increase the surface area for the
retention of the core. (Fig. f)
The coronal enamel was then etched for 20 seconds,
rinsed with water & air dried followed by application of
bonding agent – which was then light cured. The coronal
post was then covered with the flowable composite for
core build –up , followed by light curing it for 60
seconds.
An appropriate strip crown ( 3M ESPE, MN USA) was
then selected & trimmed ( to the cingulum) to create an
arched interproximal margin to accommodate the
interdental papilla. The strip crown was then filled with
composite resin & placed on the tooth. The composite
resin was cured for 60 seconds . The strip crown was
then peeled off with a sharp explorer.
The final finishing & polishing was done with finishing
burs(Jota, Swiss Precision). Occlusal interferences in
normal & paranormal mandibular movements were
removed & post – operative radiographs were taken as a
final step.(Fig. g)
DISCUSSION
Esthetic restoration of primary teeth has long been a
special challenge to pediatric dentists. Conventional
glass ionomer restorations have demonstrated high
failure rates in the primary dentition.15
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Figure a: Pre-Operative intra oral photograph
Figure b: Rubber dam isolation done
Figure c: Working length determination: IOPA
Figure d: Obturation completed: IOPA
Figure e: Removal of 3mm zinc oxide eugenol for post space creation
Figure f: Post insertion followed by core build-up
Figure g: Post- operative intra oral photograph
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When there is severe loss of coronal tooth structure, the
use of posts placed inside the canal after endodontic
treatment will give retention, provide stability to the
reconstructed crown17,and withstand masticatory forces
in function.13
There are a variety of root posts used in pediatric
dentistry. A resin composite post building up directly,18
resin composite short post placement19, alpha or omega
shaped orthodontic wires20,21, stainless steel pre
fabricated posts22,23, nickel- chromium cast posts with
macro retentive elements24, natural teeth from a tooth
bank15 or reinforced fibers.13
Regardless of the post system used, the teeth should
first be treated endodontically and root retention should
fill about 1/3 of the root length.6, 18
The development of the fibre reinforced composite
technology has brought a new material into the realm of
metal-free adhesive esthetic dentistry.25Different fiber
types such as glass fibers, carbon fibers, Kevlar fibers,
vectran fibers, polyethylene fibers have been added to
composite materials.26
Carbon fibers prevent fatigue fracture and strengthen
composite materials, but they have a dark colour, which
is undesirable esthetically.26, 27, 28 Kevlar fibers made of an
aromatic polyamide, increase the impact strength of
composites but are unaesthetic and hence their use is
limited.29 Vectran fibers are synthetic fibers made of
aromatic polyesters. They show a good resistance to
abrasion and impact strength, but they are expensive
and not easily wielded.26 Polyethylene fibers are esthetic
but their flexural strength is less as compared to glass
fiber reinforced composite posts.30 The biological posts
require the availability of a tooth bank and are still
subject to new studies for future conclusions.31
Glass fiber reinforced composite resin posts (GFRC) are
new to the pediatric world and can be used as an
alternative to the other post systems. The properties of
fiber- reinforced posts are dependent on the nature of
the matrix, fibers, interface strength and geometry of
reinforcement.
In this case, a new GFRC material composed of densely
packed silanated E glass fibers in a light curing gel matrix
(ever Stick, Stick Tech Ltd, Turku, Finland) has been used.
The advantages of this material over the older fibers
are:-
1) Greater flexural strength (1280 MPa) over 650
MPa of the older fibers.
2) Fibers do not fray; hence ease of handling.
3) Fibers are arranged parallel in a unique
interpenetrating polymer matrix (IPN) and hence
can be used in high stress bearing areas.
4) They can bond to any type of composites.
5) Fibre surfaces can be re- activated.
Studies state that a higher retention strength was
observed with glass fiber posts, followed by orthodontic
“γ” wire posts and composite posts.32 other factors
include better bonding of these posts to cementing
media, good adaptation to the root canal, and the fact
that these posts offer better light transmission, which
enhances the polymerization of resin at the apical region
during the cementation procedure.33
The fiber post technique offers certain advantages:-
1) Employs fiber posts that are ready to use.
2) Provides homogenous mechanical and chemical
bonding of all components.
3) Reduces the risk of root fracture, since its
modulus of elasticity is similar to that of root
dentine and its diametric tensile strength is low.
4) Presents no potential hazards of corrosion and
hypersensitivity.
CONCLUSION
This method of Glass Fibre Reinforced Composite Resin
post and core for restoring teeth affected by ECC has
shown promising results and has presented the pediatric
dental world with an additional treatment option.
ACKNOWLEDGEMENT
We acknowledge the support by StickTech Ltd. without
whom it would be a difficult task to get such beautiful
results.
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