|Year : 2017 | Volume
| Issue : 3 | Page : 198-201
Esthetic rehabilitation of severely decayed primary incisors using glass impregnated fiber post as post and core: A treatment option
Ajay Kumar Kapoor, Seema Thakur, Parul Singhal, Deepak Chauhan, Cheranjeevi Jayam
Department of Paediatric and Preventive Dentistry, HPGDC, Shimla, Himachal Pradesh, India
|Date of Web Publication||7-Aug-2017|
Ajay Kumar Kapoor
Department of Paediatric and Preventive Dentistry, HPGDC, Shimla, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
Restoration of primary incisors, which have been severely damaged by extensive caries or trauma, is a difficult task for the pediatric dentist. Primary teeth dictate the physical appearance, and their structural affects leads to loss of esthetics compromised mastication, poor phonetics, development of aberrant habits, neuromuscular imbalance, and difficulty in social and psychological adjustment of the child. Case description: This case report discusses the restoration of severely decayed primary maxillary incisors using composite resin restoration reinforced with glass impregnated post in anterior teeth in a 4-year-old male patient. The use of intracanal posts in endodontically treated teeth improves the retention of a eventual restoration. The use of impregnated fiberglass post together with flowable composite offers an alternative where all components are bonded together to form a firmly attached restoration. This technique of glass impregnated composite resin post and core has shown promising results and has presented pediatric dentists with an additional treatment option.
Keywords: Early childhood caries, esthetic rehabilitation, fiber posts
|How to cite this article:|
Kapoor AK, Thakur S, Singhal P, Chauhan D, Jayam C. Esthetic rehabilitation of severely decayed primary incisors using glass impregnated fiber post as post and core: A treatment option. Indian J Dent Sci 2017;9:198-201
|How to cite this URL:|
Kapoor AK, Thakur S, Singhal P, Chauhan D, Jayam C. Esthetic rehabilitation of severely decayed primary incisors using glass impregnated fiber post as post and core: A treatment option. Indian J Dent Sci [serial online] 2017 [cited 2022 Oct 6];9:198-201. Available from: http://www.ijds.in/text.asp?2017/9/3/198/212403
| Introduction|| |
Dental caries and trauma are predominant cause for tooth loss in primary dentition. Early childhood caries (ECC) is a rapidly developing and progressing type of dental caries with distinctive pattern most commonly involving maxillary central incisors, lateral incisors, and the maxillary and mandibular first primary molars. In extreme cases, ECC can even lead to complete loss of the crown structure.
In the last few decades, the new materials such as polycarbonate crowns, strip crowns, art glass crowns, and veneered stainless steel crown were introduced which restore the carious teeth with sufficient tooth structure. In cases where the teeth are severely damaged with loss of crown structure, these materials fail to withstand the occlusal forces.
The use of an intracanal post in endodontically treated teeth improves the retention for a longer-lasting restoration. A variety of materials can be used for this purpose, such as resin composite, metal, biologic and prefabricated posts, orthodontic wire posts, and recently, omega-shaped stainless steel wire posts.
A case of 4-year-old child is being presented here who had lost most of the coronal tooth structure of his upper anterior teeth due to ECC. The treatment was done by pulpectomy followed by placement of glass-fiber post in canal and building of coronal part with crown buildup technique using composite resin material.
| Case Report|| |
A 4-year-old male child presented to the Department of Pediatric and Preventive Dentistry, H.P. Government Dental College, Shimla (Himachal Pradesh) with the chief complaint of decayed upper front teeth.
The prenatal, natal, postnatal, and medical history were noncontributory. Diet patterns showed that child was fed cariogenic food frequently. The history of nighttime bottle-feeding was present till 3 years of age. This was the patient's first dental visit, and oral hygiene was neglected with fair maternal oral hygiene.
On clinical examination, 51, 52, 61, 62, 53, 54, 55, 63, 64, 75, and 85 were carious. The remaining tooth structure of maxillary anterior teeth were found to be firm, with an extension of the remaining crown of 1 mm above the gingival margin [Figure 1]. The child's parents were informed about the treatment plan, its advantage and drawbacks, other treatment option and consequence if treatment was not carried out.
Based on clinical and radiological findings the treatment plan was divided into the following two steps:
Restorative and endodontic phase
In first visit, all the active carious lesions were restored with glass ionomer cement (GIC).
Gross carious lesions were removed with a no. 330 round carbide steel bur. The pulp chamber was opened and for working length determination intraoral periapical radiograph was taken; pulp tissue was extirpated using K-files (Mani Inc., Tochigi, Japan). After copious irrigation, the root canals were dried using paper points. A thick mix of zinc oxide eugenol paste (Deepak Enterprise, Mumbai, India) was then condensed with hand pluggers (Mani Inc., Tochigi, Japan) into the canal, [Figure 2] by careful isolation using cotton rolls and saliva ejectors as teeth under treatment do not had enough crown structure for rubber dam application.
|Figure 2: (a) Preoperative intraoral periapical radiograph (51, 52, 61, 62). (b) Root canals obturated with Zinc oxide eugenol (51, 52, 61, 62)|
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Endodontic treatment of 54 and 64 was completed in subsequent visits followed with GIC (Fuji 2, GIC Corp, Tokyo, Japan) restoration and stainless steel crown (Kids crown, Shin Heung, Republic of Korea) [Figure 3] and [Figure 4].
|Figure 3: (a) Preoperative intraoral periapical radiograph of 54. (b) Postobturation intraoral periapical radiograph of 54. (c) Poststainless steel crown cementation intraoral periapical radiograph of 54|
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|Figure 4: (a) Preoperative intraoral periapical radiograph of 64. (b) Postobturation intraoral periapical radiograph of 64|
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Phase two: Esthetic rehabilitation
The postspace was prepared in anterior teeth during second appointment by removing approximately 4 mm of Zinc oxide eugenol (Deepak Enterprise, Mumbai, India) material using slow moving thin straight fissure bur and postspace radiograph was taken. A 1 mm base of GIC (Fuji 2, GIC Corp, Tokyo, Japan) was placed to isolate the obturated material from the rest of postspace [Figure 5]a. GIC sticking to walls of root canal was removed using sharp spoon excavator. For each canal a glass-fiber post (Interlig, Angelus Brasil) [Figure 6] of corresponding size was trail fit and adjusted to 3 mm into the canal and 2 mm outside the canal by measuring the post length up to 5 mm. Prepared cavity was acid etched for 15 s with a 37% phosphoric acid gel, rinsed, dried, and two coats of a dentin adhesive single bond (Adper™, 3M ESPE) were applied with micro brush. The tip of flowable composites was placed 2–3 mm below the cementoenamel junction and the composite was injected. The glass post was inserted into the canal and light cured. The coronary portion of the fiber post was completely restored using resin composite [Figure 5]b and [Figure 5]c. After checking the occlusion and the removal of any occlusal interference, final finishing and polishing of the restoration were performed thus restoring a new smile of the child [Figure 7]. After completion of restoration intraoral periapical radiograph was taken to check the status of completed restoration [Figure 8]. Fluoride varnish therapy was also given, along with dietary counseling, care of the restorations, and importance of maintenance of good oral hygiene as well as the importance of periodic dental visits (3, 6, 12, and 18 months follow-up) for preservation of the primary dentition was described to the patient and parents. Follow-up review visits were done at 6 and 18 months interval and shows successful restoration which was esthetically acceptable after 18 months; thus, predicting excellent retention of glass impregnated postrestoration for the treatment of severely damaged teeth due to caries [Figure 9] and [Figure 10].
|Figure 5: (a) Figure of plan for construction of restoration. (b) After placement and curing of glass impregnated post into root canals (c) esthetically completed restoration|
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|Figure 7: Postoperative photograph esthetic smile of the patient established|
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|Figure 8: Postoperative intraoral periapical radiograph (51, 52, 61, 62)|
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|Figure 10: (a) Postoperative photograph of esthetic restoration after 18 months. (b) Esthetic smile of the patient after 18-month follow-up|
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| Discussion|| |
Restoration of deciduous anterior and posterior teeth with severe loss of coronal structure is a challenging task for the dentists. The main aim is to avoid extraction of these teeth and restore them so that child is able to perform normal masticatory function, and good esthetics is maintained. The use of intracanal posts in endodontically treated teeth improves the retention of an eventual restoration. In the past, alpha- or omega-shaped orthodontic wires, stainless steel prefabricated posts, and natural teeth from a tooth bank have been used. Prefabricated posts are fast, cheap, and easy to use, but they do not consider the individual shape of the root canal. Although metal posts are indicated for primary teeth, because of their color metal post do not meet the esthetic requirement and may cause problems during the course of natural exfoliation. Composite post provides acceptable esthetics; however, there is risk of loss of retention owing to polymerization shrinkage.
The use of fiberglass post together with flowable composite and bonding agent offers an alternative where all components are bonded together to form a firmly attached restoration unit. This technique utilizes the coronal portion of the root, which is the strongest part of the root to transmit any functional stresses and may add to success.
In this case, the restoration showed good retention and marginal adaptation at 12-month follow-up. Various studies also show that fiberglass posts exhibit better retention and marginal adaptation than omega-shaped stainless steel wire.,
The direct restorative technique used in this report is an easy to perform single sitting procedure without any additional laboratory processes. The core length of the intracanal post system is equal to the recommended length of 3 mm for deciduous teeth occupying the cervical one-third of the canal to avoid interfering with the process of primary tooth root resorption and permanent tooth eruption.
In cases with multiple severe decayed primary anterior teeth, especially in smaller children with rampant caries, the presented technique is simple, economical, and easy to perform and practical for all dentists as evident from this report with successful esthetic restoration in all anterior teeth restored glass impregnated posts for 18 months. Hence, authors recommended the use of glass fiber posts for using esthetic rehabilitation of severely damaged anterior teeth due to caries in children when proper protocol is followed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]