Print this page Email this page | Users Online: 536
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 6  |  Issue : 3  |  Page : 206-210

Fiber-reinforced composite: Post and core material in a pediatric patient: An alternative to usual


1 Department of Pediatric Dentistry, Institute of Dental Sciences, SOAU, Bhubaneswar, Odisha, India
2 Department of Pediatric Dentistry, Uttar Pradesh Dental College, Lucknow, Uttar Pradesh, India

Date of Web Publication4-Aug-2015

Correspondence Address:
Sonu Acharya
Hig-48, Phase-I, 7 Acres, HB Colony, Chandrasekharpur, Bhubaneswar, Odisha - 751 016
India
Login to access the Email id


DOI: 10.4103/0976-433X.162188

Rights and Permissions
  Abstract 

Fractured teeth have always presented a challenge to the dentists. The predictability of root canal therapy, as it is today, can retain almost indefinitely, even very badly broken teeth. One of the widely accepted techniques involving restoration of extensively carious or badly fractured teeth is the fabrication of a post and core, utilizing the root canal space for anchorage. Thus far, the only materials that have been available to the dentists for this procedure have been a variety of metallic alloys. Hard and unyielding, these metals have to be cast in the precise shape of the prepared canals and cemented into place. Today, materials are available, which eliminate all the intermediate steps, and control is rendered in the hands of the dentists, to fabricate on the chair, a resilient, esthetic and bonded post and core. One such material is discussed here in pediatric permanent anterior tooth.

Keywords: Fiber-reinforced composite, pediatric patient, post and core, Ribbond


How to cite this article:
Acharya S, Tandon S. Fiber-reinforced composite: Post and core material in a pediatric patient: An alternative to usual. SRM J Res Dent Sci 2015;6:206-10

How to cite this URL:
Acharya S, Tandon S. Fiber-reinforced composite: Post and core material in a pediatric patient: An alternative to usual. SRM J Res Dent Sci [serial online] 2015 [cited 2019 Dec 6];6:206-10. Available from: http://www.srmjrds.in/text.asp?2015/6/3/206/162188


  Introduction Top


Fiber-reinforced composite (FRC) is a bondable, biocompatible, esthetic, translucent and easy-to-use reinforced ribbon. By virtue of its wide spectrum of properties, it enjoys multiple uses in clinical dentistry. The development of FRC technology has brought a new material into the realm of metal-free, adhesive esthetic dentistry. [1] Not only has the combination of composite resin and FRC been shown to have significant benefits in terms of mechanical properties, the possibility of direct chairside application and the ability to bond to tooth structure make FRC an attractive choice for a variety of dental applications. [2],[3] Different fiber types such as glass fibers, carbon fibers, kevlar fibers, vectran fibers, polyethylene fibers have been added to composite materials. Glass fibers consisting of glass interlaced filaments, improve the impact strength of composite materials. They have excellent esthetic properties but do not easily stick to resinous matrix. Carbon fibers prevent fatigue fracture and strengthen composite materials, but they have a dark color, which is undesirable esthetically. [4],[5] Kevlar fibers made of an aromatic polyamide, are the evolution of nylon polyamide. [6] They increase the impact strength of composite materials. However, they are also unesthetic, and hence, their use is limited. Vectran fibers are synthetic fibers of a new generation, made of aromatic polyesters. They show a good resistance to abrasion and impact strength, but they are expensive and not easily wielded. Polyethylene fibers improve the impact strength, modulus elasticity, and flexural strength of composite materials. Unlike carbon and Kevlar fibers, polyethylene fibers are almost invisible in a resinous matrix and for these reasons, seem to be the most appropriate and esthetic strengtheners of composite materials. [7] The restoration for an endodontically treated tooth should be conservative and should not increase horizontal and vertical forces. Thus far, the only materials that have been available to the dentists for this procedure have been a variety of metallic alloys. Hard and unyielding, these metals have to be cast in the precise shape of the prepared canals and cemented into place. If too tight, they wedge the root and if too loose; they come off. Several intermediate steps in their fabrication (impression, poured cast, the wax pattern, casting, finishing), are extremely conducive to errors being committed. A recently developed bondable reinforcement fiber, Ribbond, (Ribbond THM, Ribbond Inc., Seattle, WA) is reported to be an alternative to conventional post materials because of its esthetic qualities, mechanical properties, and the neutral color of the reinforcing material. [8] Ribbond is a spectrum of 215 fibers with a very high molecular weight. First introduced to the market in 1992, Ribbond consists of bondable, reinforced ultra-high-strength polyethylene fibers. [9] The open and lace like architecture of Ribbond allows it to adapt closely to the teeth and dental arch. This is an advantage over prefabricated fiber posts where adaptability to root canals is difficult. Apart from this feature the Ribbond can be condensed properly in the canals with little microleakage. The application of a fiber layer increases the load bearing capacity of the restoration and prevents crack propagation from the restoration to the tooth. When prefabricated fiber post is placed in flexure, cracks appear on the tensile face and due to brittleness of the material rapidly propagates causing failure. [10] The purpose of using Ribbond as post and core material in the present case report stems from the above said features of Ribbond that made our choice for this material to be used as post and core.


  Case Report Top


A 12-year-old female patient visited the department of pediatric dentistry with complain of broken left lower front tooth since 4 months. The patient did not complain of any pain [Figure 1]. On enquiry from the parent of the child, it was revealed that the mentioned tooth had been root canal treated 6 months back and restored, but the restoration came out within a month. The re-restoration also did not last >15 days. On examination lower left central incisor was fractured, and there was neither pain reported nor tenderness to percussion. The tooth structure was less for a composite make-up or a crown. After thorough examination, it was decided to go for a post and core and composite make-up. As it was an anterior tooth in a young patient it was decided to go for FRC (Ribbond, Ribbond THM, Ribbond Inc., Seattle, WA) as post and core material as it is esthetic and has adequate strength. As the tooth was adequately obturated [Figure 2], preparation of the canal space was done [Figure 3] and [Figure 4]. The use of Ribbond does not require additional tooth preparation as is required for metal posts. The remaining tooth structure being less, rubber dam isolation could not be accomplished, and we decided for high suction evacuation with cotton rolls to be suitable for isolation. Gutta percha was removed using gutta percha solvent (Endosolv, Septodont, USA) until the desired length for the post was achieved. The post hole was shaped using gates glidden drills (Roydent, West Palm Beach, FL), cleaned with 5% sodium hypochlorite and dried. The width of Ribbond (Ribbond THM, 2, 3 or 4 mm, Ribbond Inc., Seattle WA) is decided on the root canal space available. The depth of the post space was measured using a periodontal probe, and a 3 mm wide Ribbond was cut using special scissors provided with the kit (Ribbond starter kit, Ribbond THM, Seattle), measuring twice the depth of the post space and 3-4 times the height of the core build-up [Figure 5] and placed in dual cure adhesive resin and set aside in light protected container. The root canal wall was etched for 15 s, washed for 30 s and then gently air-dried. Excess water was removed from the post space using paper points (Spident, SPI Dental Mfg. Inc., Korea). The dual cure adhesive resin (Ed Primer II A and B) was applied using a microbrush in 2 consecutive coats and gently air-dried to evaporate the solvent. Dual cure resin cement (Panavia F, Kuraray, Japan) is injected in the canal space. The Ribbond was removed from the resin and the excess resin was removed using a hand instrument [Figure 6], folded in a V-shape and coated with dual-curing resin cement (Panavia, Kuraray Medical Inc., Japan). The piece of ribbon was then placed in the post space in a facial-lingual direction with an endodontic plugger [Figure 7]. Excess resin cement was removed, and the cement was cured for 20 s. These two protruding ends of the Ribbond strips formed the reinforcement for the core build-up to replace the lost coronal portion of the tooth. The remaining resin mix from the syringe was extruded onto this framework to create a core resembling the shape of the central incisor. It was ensured that the space between the protruding ribbon ends was filled with resin so as not to leave any voids. Composite resin was also placed so as to cover the Ribbon ends completely and leave none of them exposed on the outer surface of the core. All the material was thoroughly light cured to create an external set surface. The material was left in the mouth for a couple of hours to ensure a complete set of the self-curing component of the resin mix. What emerged from this procedure was a post-cum-core (single piece), which was bonded onto the root, creating a solid structure without any wedging effect on the root. Moreover, the resin conforming to the inside shape of the canal space ensured no voids and eliminated "fitting" problems normally associated with cast post and cores. The bands of Ribbond reinforced the resin material and made it extremely strong and durable. Bonding of the entire entity also created a monobloc, which is the essence sought for favorable occlusal force transmission and for resistance against debonding of the entire unit. Best of all, there was no metal to mask with the crown since the base shade of the composite was a close enough match to the tooth and was translucent. The Ribbond strips, though opaque, were white in color and after being completely encased in the composite, were not visible anyway. However, they did not contribute to the color of the core in any adverse way. The restorative procedure was completed by building up the tooth using dual cure hybrid composite resin following technique of small progressive build-up without any matrix [Figure 8]. All these increments were fully light-cured. Finishing and polishing procedures were performed using Sof-Lex contouring and polishing discs (Sof-Lex; 3M ESPE, St. Paul, MN, USA) [Figure 9]. The patient was advised for a crown at a later stage after complete development of occlusion. The patient has been under follow-up for 4 years now with 6-month follow-up intervals, and the restoration is still in good condition. As because the occlusion is not yet established we have decided to give the crown on a later date.
Figure 1: Broken tooth

Click here to view
Figure 2: Radiograph showing good obturation

Click here to view
Figure 3: Radiograph showing postspace

Click here to view
Figure 4: Postspace prepared

Click here to view
Figure 5: Measured amount of Ribbond prepared

Click here to view
Figure 6: Ribbond prepared to be inserted in the canal

Click here to view
Figure 7: Ribbond packed inside canal

Click here to view
Figure 8: Composite build-up done

Click here to view
Figure 9: Postoperative view

Click here to view



  Discussion Top


Fiber-reinforced composite can be used in stabilizing traumatized teeth, restoring fractured teeth and creating a fixed partial denture and for direct-bonded endodontic posts and cores, orthodontic fixed lingual retainers and the space maintainer. [11] Despite this versatility, there are few reports on the use of Ribbond in pediatric dentistry. Various types of FRC posts have recently come into widespread use as an alternative to cast or prefabricated metal posts in the restoration of endodontically treated teeth. Few authors have also suggested that restoration of endodontically treated teeth with fiber post and direct resin composites is a treatment option that in the short term conserves remaining tooth structure and results in good patient compliance. [12] Earlier the post systems were simple, quick and inexpensive. [13] These posts were usually cast in precious alloy or prefabricated in stainless steel, titanium or precious alloy. They did not take into account the individual shape of the root canal and hence their adaptation was not ideal. [14] The post and core system should show differing rigidity in their components. The more rigid component can resist forces without distortion and so the stress would be transferred to less rigid component which may well be fractured. [15] The difference in modulus of elasticity of dentin and that of post material may, therefore, be a source of stress to the root structures. FRCs root canal posts with modulus of elasticity close to dentin were introduced in 1990s. [16] Esthetic fiber posts fabricated from fiber ribbons to restore endodontically treated teeth provide for root reinforcement and retention of composite resin cores. [17] Ribbond is used in combination with composite resin. The physical properties of this material allow the fabrication of a conservative, esthetic post and core system that adapts well to roots individually and prevents root fractures. [18] The relative flexibility of fiber composite laminate post minimizes crack propagation in the roots. [19] Thus, we have a very good option of utilizing Ribbond as post and core material. Compared to preformed posts, there is no additional tooth removal after endodontic treatment. This maintains the natural strength of the tooth. Eliminates the possibility of root perforation. Because it is made when the and Ribbond is in a pliable state, it conforms to the natural contours and undercuts of the canal and provides additional mechanical retention. There are no stress concentrations at the tooth-post interface. The Ribbond post and core is passive and highly retentive. Furthermore, because Ribbond's translucent fibers take on the color characteristics of the composite it allows for the natural transmission of light through teeth and crowns. This provides an exceptionally esthetic result. [20],[21] Although there are so many advantages discussed in favor of FRCs, there are certain limitations also. The disadvantages of nonmetal posts also have to be taken note of. Metal posts have a well-established record of successful clinical service. High success rates have been reported from retrospective studies over periods of time that have not yet been matched by nonmetal posts. Also, the cast metals have greater strength in thin sections than the composites adjacent to the posts. This allows for the production of ferrules that is not possible with nonmetal posts. There have been some reported cases of fiber ribbons being used as post and core material in primary teeth. [22],[23],[24] The results suggested that this material is quite good as post and core material when used in primary teeth for pediatric patients [Figure 9]. Traumatized permanent anterior teeth in children need quick esthetic and functional repair because of psychological damage they can create in children. Esthetic requirements of anterior teeth require the use of composite materials that, in the most complex cases, can be used in association with fibers so as to improve their mechanical resistance [Figure 10]. The authors considered parameters such as physical properties, water absorption, ease of cutting and of laying. Polyethylene fibers appear to have the best properties in elasticity, translucency, adaptability, tenaciousness, resistance to traction and to impact. This material also has been utilized in permanent anterior teeth in adult patients, but few have reported the use in children. [5],[20] Hence, we tried to use fiber ribbons as post and core in permanent anterior tooth in a child and obtained reasonably good result.
Figure 10: Follow up after 6 months

Click here to view



  Conclusion Top


The number of endodontic procedures has increased steadily in the past decade with highly predictable results. Therefore, restoration of teeth after endodontic treatment is becoming an integral part of the restorative practice in dentistry. FRCs have been used for similar cases in pediatric dentistry in deciduous teeth, but there are very few cases reported for permanent anterior teeth in pediatric patients. We have tried to use this as a post and core material in a permanent tooth for a pediatric patient with satisfying esthetic results and improved mechanical properties. Long-term follow-up of more cases is required for this material to become more popular especially in pediatric dentistry.

 
  References Top

1.
Vallittu PK. Flexural properties of acrylic resin polymers reinforced with unidirectional and woven glass fibers. J Prosthet Dent 1999;81:318-26.  Back to cited text no. 1
    
2.
Ahlstrand WM, Finger WJ. Direct and indirect fiber-reinforced fixed partial dentures: Case reports. Quintessence Int 2002;33:359-65.  Back to cited text no. 2
    
3.
Tezvergil A, Lassila LV, Vallittu PK. Strength of adhesive-bonded fiber-reinforced composites to enamel and dentin substrates. J Adhes Dent 2003;5:301-11.  Back to cited text no. 3
    
4.
Miller TE. A new material for periodontal splinting and orthodontic retention. Compendium 1993;14:800-812.  Back to cited text no. 4
    
5.
Vitale MC, Caprioglio C, Martignone A, Marchesi U, Botticelli AR. Combined technique with polyethylene fibers and composite resins in restoration of traumatized anterior teeth. Dent Traumatol 2004;20:172-7.  Back to cited text no. 5
    
6.
Vallittu PK, Vojtkova H, Lassila VP. Impact strength of denture polymethyl methacrylate reinforced with continuous glass fibers or metal wire. Acta Odontol Scand 1995;53:392-6.  Back to cited text no. 6
    
7.
Uzun G, Hersek N, Tinçer T. Effect of five woven fiber reinforcements on the impact and transverse strength of a denture base resin. J Prosthet Dent 1999;81:616-20.  Back to cited text no. 7
    
8.
Eskitascioglu G, Belli S. Use of a bondable reinforcement fiber for post-and-core buildup in an endodontically treated tooth: A case report. Quintessence Int 2002;33:549-51.  Back to cited text no. 8
    
9.
Berrong JM, Weed RM, Young JM. Fracture resistance of Kevlar-reinforced poly(methyl methacrylate) resin: A preliminary study. Int J Prosthodont 1990;3:391-5.  Back to cited text no. 9
    
10.
Samadzadeh A, Kugel G, Hurley E, Aboushala A. Fracture strengths of provisional restorations reinforced with plasma-treated woven polyethylene fiber. J Prosthet Dent 1997;78:447-50.  Back to cited text no. 10
    
11.
Ganesh M, Tandon S. Versatility of ribbond in contemporary practice. Trends Biomater Artif Organs 2006;20:53-8.  Back to cited text no. 11
    
12.
Grandini S, Goracci C, Tay FR, Grandini R, Ferrari M. Clinical evaluation of the use of fiber posts and direct resin restorations for endodontically treated teeth. Int J Prosthodont 2005;18:399-404.  Back to cited text no. 12
    
13.
Kern SB, von Fraunhofer JA, Mueninghoff LA. An in vitro comparison of two dowel and core techniques for endodontically treated molars. J Prosthet Dent 1984;51:509-14.  Back to cited text no. 13
[PUBMED]    
14.
Chan FW, Harcourt JK, Brockhurst PJ. The effect of post adaptation in the root canal on retention of posts cemented with various cements. Aust Dent J 1993;38:39-45.  Back to cited text no. 14
    
15.
Purton DG, Payne JA. Comparison of carbon fiber and stainless steel root canal posts. Quintessence Int 1996;27:93-7.  Back to cited text no. 15
    
16.
King PA, Setchell DJ. An in vitro evaluation of a prototype CFRC prefabricated post developed for the restoration of pulpless teeth. J Oral Rehabil 1990;17:599-609.  Back to cited text no. 16
    
17.
Akkayan B, Gülmez T. Resistance to fracture of endodontically treated teeth restored with different post systems. J Prosthet Dent 2002;87:431-7.  Back to cited text no. 17
    
18.
Pitel ML, Hicks NL. Evolving technology in endodontic posts. Compend Contin Educ Dent 2003;24:13-6, 18, 20.  Back to cited text no. 18
    
19.
Strassler HE, White M. An adhesive-aesthetic post and core technique. Est Dent Update 1995;6:34-40, 49.  Back to cited text no. 19
    
20.
Hornbrook DS, Hastings JH. Use of bondable reinforcement fiber for post and core build-up in an endodontically treated tooth: Maximizing strength and aesthetics. Pract Periodontics Aesthet Dent 1995;7:33-42.  Back to cited text no. 20
[PUBMED]    
21.
Iniguez I. Direct composite restoration on a fractured anerior tooth. Am Acad Cosmet Dent J 2000;9:38-44.  Back to cited text no. 21
    
22.
Island G, White GE. Resin composite restoration in primary anterior teeth using short-post technique and strip crowns: A case report. Quintessence Int 2004;35:689-92.  Back to cited text no. 22
    
23.
Viera CL, Ribeiro CC. Polyethylene fiber tape used as a post and core in decayed primary anterior teeth: A treatment option. J Clin Pediatr Dent 2001;26:1-4.  Back to cited text no. 23
    
24.
Ribbond Inc. Post and Core Restored Tooth after Endodontic Treatment. Dental Products Report; 1995.  Back to cited text no. 24
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]


This article has been cited by
1 A Predictable Aesthetic Rehabilitation of Deciduous Anterior Teeth in Early Childhood Caries
Priyanka Agarwal,Rashmi Nayak,Ghayathri Elangovan
Case Reports in Dentistry. 2018; 2018: 1
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case Report
Discussion
Conclusion
References
Article Figures

 Article Access Statistics
    Viewed2097    
    Printed12    
    Emailed0    
    PDF Downloaded348    
    Comments [Add]    
    Cited by others 1    

Recommend this journal