Effective Reduction of Mental Trauma with a Multidisciplinary Approach to Treatment of Dental Trauma

The purpose of this case report and review is to present the successful management of complicated crown-root fracture of maxillary central incisor with a multidisciplinary approach. A 57-year-old male patient reported with a complaint of unpleasant appearance due to a broken 21. Clinical and radiological examination revealed a complicated oblique crown-root fracture extending below the gingival margin. The tooth was endodontically treated. Surgical crown lengthening with osseous recontouring was performed. After 7 days prefabricated temporary crown was cemented, 6 weeks after surgery fiber post was placed followed by composite core build up. The tooth was restored with a permanent restoration of porcelain fused to the metal crown with gingival porcelain. Examination after 3 months revealed the good periodontal health, esthetic, normal function and patient satisfaction. The key factor in the successful functional and esthetic rehabilitation of a complicated crown-root fracture is weighing of all the available options with a multidisciplinary approach.

To Evaluate the Influence of Pre-Treatment of Fiber Post on Bond Strength Between Fiber Post and Root Dentin in Push out Test-An Invitro Study

Restoration of the endodontically treated teeth is complicated by the fact that much or all of the coronal tooth structure has been destroyed by caries, previous restorations and the endodontic access preparation. Post-andcore has been most commonly used when insufficient dentin remains. Methods: Fourty translucent glass fiber post (Tenax fiber Trans Coltene Whaledent) of diameter 1.3 mm and 40 extracted premolars were used. Post were divided into 4 groups of 10 each depending on the pre –treatment of post surface.In Group 1: Multilink N primer A & B was applied on post surface and root dentin for 15 sec, (Control group), group 2 : Monobond S primer was applied for 60 sec, followed by multilink N primer A & B, Group 3: Immersion in 30% H2O2 for 5min, rinsing and application of Monobond S Primer (silane) and multilink N primer A & B and Group 4: application of 25% polyacrylic acid for 5 sec, rinsing, silane and multilink N primer A & B dual cure adhesive. The specimens were then sectioned horizontally into 1- mm-thick post-dentin sections. The post space (9mm) were divided into 3 halves: the coronal, middle and the apical third.The push out bond strength (MPa) were measured using a universal testing machine at a crosshead speed of 0.5mm/sec.Failure mode of each debonded specimen were analyzed using a stereomicroscope. Maximum failure mode were adhesive failure between post and resin cement. Results: The bond strength values were higher in group 3 and group 4 compared to group 2 and group 1. Conclusion: The pre-treatment of fiber post increases bond strength between fiber post and root dentin.

Reattachment of coronal fragment using fiber reinforced post.

Anterior crown fractures are a common form of injury that mainly affects children and adolescents due to their position in the oral cavity especially in the maxillary arch. Reattachment of original tooth fragment to the fractured tooth forms a relatively quick, biologic and esthetic restoration. A 28 years old male reported to the Department of conservative dentistry & endodontics with a complex crown fracture of 21 and 22 one day after the trauma had occurred. Following endodontic treatment, a glass fibre post was used to increase retention and distribute stresses along the tooth. The dental restoration was completed using the original fragment and a dual cure resin composite. Clinical and radiographic examination at 3, 6 & 11 months recall showed the glass fiber post and restoration was in place, indicating the success of the treatment in maintaining the fractured tooth.

A comparative evaluation of the fracture resistance of endodontically treated teeth with compromised intra radicular tooth structure using three different post system.

Intra-radicular loss of tooth structure in endodontically treated teeth poses a challenge. Available methods for treatment are cast post-core, intra-radicular resin reinforcement using composite resin followed by placement of prefabricated metal/fibre post (glass or carbon).This study is an attempt to investigate the validity of treatment of such teeth using above methods and evaluate which post system is best suited for rehabilitation. Thirtysix endodontically treated anterior teeth were prepared by uniformly removing intra-radicular tooth structure from buccal, lingual, mesial & distal surfaces such that only 0.75mm-1mm remained. Twelve teeth were subsequently restored with cast metal post & core, 12 with intra-radicular resin reinforcement followed by prefabricated titanium post (Luminex post system) & 12 with intra-radicular resin reinforcement followed by glass fibre post (Luscent Anchor post system). Statistical analysis used was t-test. There was no statistically significant difference between the 3 post systems, but it was observed that cast post & cores caused more apical & oblique fractures, rendering the teeth unrestorable. Teeth restored with intra-radicular resin reinforcement & placement of titanium or glass fibre post failed with root fractures limited to the coronal aspect along with dislodgement of post. Intra-radicular resin reinforcement offers advantages like preventing the metal display of the post through the thin dentinal wall, reinforcement of the thin walled teeth & comparable fracture resistance to cast post and core.

Technique to repair iatrogenically-damaged roots during post canal preparation using resin composite and optic fibre posts

During post crown restoration, the preparation of the post canal can be fraught with difficulties resulting in widening, gouging and transportation of the post canal; sometimes with near root perforation. A technique is described to repair such iatrogenically damaged internal root canal walls using reinforcing resin composite and optic glass fibre posts. The root dentine, resin composite and glass fibres, having similar moduli of elasticity, will result in a repaired root with a ‘monolithic’ structure and possessing numerous desirable characteristics. This repair technique can easily be carried out in one sitting at the chairside thereby allowing the continued serviceability of the iatrogenically compromised root-filled tooth.