Stress-reduced Direct Composites for the Restoration of Structurally Compromised Teeth: Fiber Design According to the "Wallpapering" Technique.

PURPOSE: The purpose of this work was to present a restoration technique based on an understanding of the biomechanical properties of the dentinoenamel complex (DEC) and the physical-mechanical properties of the resin-based composite including the stress generated from both polymerization shrinkage and occlusal forces. Technique Summary: The DEC is a functional interphase that provides crack tip shielding; the DEC should be preserved during restorative procedures. Dentists can design the strategic placement of restorative materials into the cavity to both resist the mode of failure and mimic the performance characteristics of the intact natural tooth. The term "wallpapering" describes a concept of covering the cavity walls with overlapping closely adapted pieces of Leno weaved ultra-high-molecular-weight polyethylene (LWUHMWPE) ribbons. The key for success is that the ribbons are adapted and polymerized as closely as possible against the contours of residual tooth substrate. The resulting thin bond line between the fibers and the tooth structure creates a "bond zone" that is more resistant to failing due to the intrinsic stress and energy absorbing mechanism of the LWUHMWPE ribbons. The formation of defects and voids, from which crack propagation may start, is also reduced. The fibers' tight adaptation to tooth structure allows a dramatic decrease of the composite volume between the tooth structure and the fiber, thus protecting the residual weakened walls from both the stress from polymerization shrinkage and the occlusal load. CONCLUSION: By using a similar approach, fiber-reinforced stress-reduced direct composite restorations may be performed in the restoration of structurally compromised vital and nonvital teeth.

Physical behaviors of fiber reinforcement as applied to tooth stabilization.

This article presents an understanding of the mechanical response of polymer matrix composite materials that are reinforced with fibers that have high levels of failure strain. Also discussed are the basic principles for the use of the materials and techniques to optimize the clinical success for the applications in which these fibers are used to restore and maintain form and function to the masticatory structures.

Immediate and indirect woven polyethylene ribbon--reinforced periodontal-prosthetic splint: a case report.

The patient described in this case report required removal of several mandibular incisor teeth because of severe periodontal disease. She demanded an immediate replacement for these teeth, but, because of the periodontal conditions, it was not possible to use conventional approaches to fulfill her request. The decision was made to fabricate an immediate indirect-direct, reinforced, bonded composite resin periodontal prosthesis. The patient's extracted mandibular central incisors were used as pontic replacements. The procedure was expedient, inexpensive, and conservative, and the results were esthetic.

Emergency direct fabrication of a resin fixed partial denture by using a ceramometal crown with reinforcing woven polyethylene ribbon as a pontic.

In this emergency case of a fractured tooth, immediate short-term treatment was necessary to relieve pain and replace a missing coronal portion of the maxillary central incisor. The need to remove additional fractured root fragments subgingivally precluded accessibility to the remaining root for conventional restorative procedures. The patient could not decide which course of treatment to accept, so a fixed partial denture was fabricated, with the ceramometal crown restoration as a provisional pontic splinted to the adjacent teeth. Restoring and reinforcing the posterior composite splint with a gas plasma-treated woven polyethylene ribbon has been detailed and illustrated. This ribbon material reputed to be 10 times stronger than steel by volume, is a true reinforcing material because it is woven. Mechanically, it becomes an integral part of the splint. Because it is gas plasma-treated, the superficial layer, when placed in BIS-GMA or polymethyl methacrylate, reacts chemically with the resin. The pliable, memory-free fiber--together with the open, woven, lacelike, lock stitch leno--allows the ribbon to follow the contours of the teeth and dental arch easily. The ribbon design reduces and dissipates forces exerted onto the splinting resin. The neutral color of the material permits it to have a chameleonlike effect on the color of the resin into which it is positioned. This ribbon product has been used in other dental applications: periodontal splinting, orthodontic retention, indirect composite fixed partial dentures, long-term temporary restorations with applicability in implant treatments, repair and conversion of prostheses, and reinforcing endodontically treated teeth, and complete dentures and orthodontic retainers when weaknesses are anticipated, such as shallow palatal vaults of complete dentures against a full complement of mandibular natural teeth, and the horseshoe mandibular removable modified Hawley retainer.