Composite resin short-post technique for primary anterior teeth

Three-dimension model of root canal morphology of primary maxillary incisors by micro-computed tomography study

The success of root canal treatment for deciduous teeth depends upon the shape of the root canal, among other factors. Despite this, there are limited reports on the use of high-resolution micro-CT to describe the root canal morphology of primary maxillary incisors. In this study, we aimed to create a three-dimensional (3D) digital model of the root canal morphology of primary maxillary incisors using microcomputed tomography (micro-CT). To provide a reference for the development of restorative posts for the primary maxillary incisors. Primary maxillary central and lateral incisors (n = 10 each) were analysed. Micro-computed tomography was used to conduct 3D analyses of the root canal system of the primary maxillary incisors. The canal volume and surface area of the primary maxillary central incisors were larger than those of the primary maxillary lateral incisors. The structural model index value was significantly lower in central incisors. At the cervical level and the interface between the cervical and middle one-third cross-sectional levels, the root canals of the primary maxillary lateral incisors were significantly rounder. The labio-palatal dimension and the diameters of the central incisors at the four different levels were significantly smaller than the diameter of the mesio-distal dimension. The taper of the central and lateral incisors gradually increased from the apical one-third to the cervical one-third in the labio-palatal dimension. The data obtained from the 3D analysis of maxillary incisors in this study will contribute to the design of root canal posts.

Clinical Performance of Composite Resin Restorations of Primary Incisors with Extensive Carious Lesions Retained by Glass Fiber Post or Biological Post

AIM

Intracanal posts enhance the resistance of the restoration to mechanical loads and masticatory forces in primary teeth with extensive carious breakdown. This study was done to investigate the clinical performance of composite resin restoration retained by either glass fiber post or biological post in the restoration of primary anterior teeth with extensive carious lesions.

MATERIALS AND METHODS

A total of 21 children (with 82 primary anterior teeth) who met the inclusion criteria were involved in the study. The 82 primary maxillary incisors were randomly allocated into two equal groups: groups I (glass fiber post) and II (biological post). All the teeth underwent pulpectomy, followed by glass fiber post or biological post, followed by celluloid strip crown restoration. Clinical analysis of all the teeth in the two groups was performed at 1, 3, 6, 9, and 12 months to assess the success of treatment procedures. Statistical Package for the Social Sciences (SPSS) software version "17" was used for statistical analysis. Pearson's Chi-squared test and Fisher's exact test were utilized to evaluate the success of both treatment procedures. The significance level was predetermined at p < 0.05.

RESULTS

At the end of the 12-month follow-up period, 89.4 and 84.2% of composite resin restorations of primary incisors with extensive carious lesions were retained by glass fiber and biological posts, respectively. The intergroup comparison revealed no statistically significant differences pertaining to retention loss, marginal discoloration, and marginal adaptation at all follow-up intervals (p > 0.05).

CONCLUSION AND CLINICAL SIGNIFICANCE

Since biological posts are inexpensive and economical, they may replace the commercial post systems available to pediatric dentists.

HOW TO CITE THIS ARTICLE

Jaiswal N, Garg N, Pathivada L, et al. Clinical Performance of Composite Resin Restorations of Primary Incisors with Extensive Carious Lesions Retained by Glass Fiber Post or Biological Post. Int J Clin Pediatr Dent 2023;16(6):850-857.

Investigating the impact of flowable composite liner on the fracture strength and microleakage of large composite resin restorations of primary anterior teeth

PURPOSE

To investigate the effect of pre-cured and co-cured flowable composite liner on fracture strength and microleakage of primary anterior teeth with extended composite resin restorations.

METHODS

In the current in vitro experimental study, the crowns of 54 extracted primary canine teeth were cut 1 mm above the CEJ, and a pulpectomy procedure was performed. The samples were randomly divided into three groups to restore the coronal part up to 4 mm above the CEJ. In group 1, the samples were built up with Filtek Z250 packable composite resin. In group 2 (pre-cure), first, 1 mm of Filtek Z350 XT flowable liner was applied to the sample, and after curing, the restoration process continued using packable composite resin. In group 3 (co-cure), the flowable composite liner was cured while the first layer of packable composite resin was applied; then, the same restorative procedure similar to the other groups was followed. The samples' cross-sectional area in the fracture strength test was calculated by AutoCAD software. Subsequently, the samples were subjected to a force in a universal testing machine. The samples related to the microleakage experiment were cut vertically, and then, the dye penetration percentage (10% methylene blue) was measured under a stereomicroscope. ANOVA was used to analyze the data.

RESULTS

Mean fracture strength in group 2 was significantly higher than in group 1 (P = 0.016). The microleakage mean in group 3 was significantly lower than in groups 1 (P = 0.000) and 2 (P = 0.026).

CONCLUSION

The flowable composite liner and its relevant separate curing increased the fracture strength of composite resin restorations. However, less microleakage was reported in the group where the liner was applied as a co-cure.

Comparison of Fracture Resistance of Primary Incisors Restored with Different Intracanal-Reinforcement Materials

Aim

To evaluate the effects of placing short posts made of different restorative materials on the fracture resistance of root canals in primary incisors of primary teeth.

Materials and Methods

The root canals of 40 extracted primary incisors were prepared and filled with Vitapex and randomly divided into five groups of 8 each. In Groups 1–4, a post space was created and filled with different restorative materials (Tetric^® N-Ceram Bulk Fill, AeliteFlo, Filtek Z250 XT, and GC Fuji II LC^® capsule), while Group 5 was kept filled with Vitapex as a control. Fracture resistance was measured using a universal testing machine at a 0.5-mm/min crosshead speed. The results were statistically analyzed and compared.

Results

The highest fracture resistance was recorded for GC Fuji II LC capsules [439.82 N] and control [423.37 N], while the lowest fracture resistance was recorded for Tetric^® N Ceram Bulk Fill (239.91 N). A multiple comparison test showed that the Tetric^® N-Ceram Bulk Fill had a significantly lower average value than AeliteFlo (P = 0.030), as well as a significantly lower average value than GC Fuji II LC^® capsule (P = 0.001), and a significantly lower average value than the control group (P = 0.002). Multiple comparison tests showed no significant difference between Tetric^® N-Ceram Bulk Fill and Filtek Z250 XT (P = 0.39).

Conclusion

The fracture resistance of primary incisor root canals differs according to the material used for the intracanal posts. Three-millimeter intracanal posts in the primary incisors showed the highest fracture resistance for the teeth restored with GC Fuji II LC capsules and the control.

Fracture Resistance of Three Post Types in the Restoration of Anterior Primary Teeth

Background:

Extensive restorative treatments of anterior primary teeth are challenging in pediatric dentistry.

Objective:

This study aimed to compare the fracture resistance of three post types for restoring the anterior primary teeth.

Methods:

This in-vitro study was carried out on 90 extracted maxillary anterior primary teeth with intact roots. They were randomly allocated into six groups to be restored with conventional composite resin post, X-tra fill composite resin post, Tetric N Ceram composite resin post, prefabricated glass fiber post with conventional composite build-up, prefabricated glass fiber post with X-tra fill composite build-up, and prefabricated glass fiber post with Tetric N Ceram composite build up. The samples were polished and placed in acrylic resin blocks with 1 mm of part of cervical root being out, thermocycled (×5000) and tested for fracture resistance. Intra-class correlation test, Kruskal-Wallis test and one-way ANOVA were used for statistical analyses (α=0.05).

Results:

The mean fracture resistance was significantly different among the six groups. It was the highest in prefabricated glass fiber post with conventional composite build-up (418.64 N), prefabricated glass fiber post with X-tra fill composite build-up (403.63 N) and prefabricated glass fiber post with Tetric N Ceram composite build up (361.63 N); and the lowest in Tetric N Ceram group (280.65 N). The groups were significantly different concerning the fracture strength and fracture state.

Conclusion:

Since the anterior teeth restored with prefabricated glass fiber posts were far more fracture resistant, and prefabricated glass fiber posts can be promisingly used for the restoration of anterior primary teeth.

Clinical and radiographic comparative study to evaluate the efficacy of restoring destroyed primary incisors using two different techniques-A pilot study

Objective: The restoration of destroyed maxillary primary incisors is difficult because of the insufficient amount of coronal structure. This pilot study aimed to compare the efficacy of composite posts technique and glass fiber posts technique in restoring destroyed primary incisors.

Materials and Methods: Thirty‐six destroyed maxillary primary incisors in 11 children with early childhood caries were randomly assigned after endodontic treatment into two groups: glass fiber posts (n = 18) and composite resin posts (n = 18). Blinded clinical evaluation was made at 3, 6, 9, and 12 months and Blinded radiographic evaluation was made at 6 and 12 months. The evaluation was according to the FDI criteria. Data were analyzed with Fisher's exact test (α = .05).

Result: After 12 months post‐treatment, the success rates were 88.2% in glass fiber posts group and 70.6% in composite resin posts group. There was no statistically significant difference between the two groups according to the evaluation criteria (p‐value >.05).

Conclusion: Glass fiber posts technique and Composite posts technique may be used in the restoration of destroyed primary incisors.

A Comparative Evaluation of Fracture Toughness of Composite Resin vs Protemp 4 for Use in Strip Crowns: An In Vitro Study

Aim

The aim of this study was to compare the fracture toughness of pedo shade packable composite resin (Z100, 3M ESPE, St. Paul, USA) vs Protemp 4 (3M ESPE, Seefeld, Germany) when used inside a strip crown to restore primary incisors.

Materials and methods

Thirty-six exfoliated noncarious human primary central and lateral incisors were randomly divided into two equal groups. The teeth were prepared to standardized dimensions to receive a strip crown. All the teeth were etched, rinsed, and dried following which bonding agent was applied and light cured. In group I, pedo shade packable composite resin (Z100, 3M ESPE, St. Paul, USA) was packed into strip crowns, placed on the prepared tooth, and light cured. In group II, the strip crowns were filled with Protemp 4 (3M ESPE, Seefeld, Germany), placed on the prepared tooth, and left to autopolymerize for 10 minutes. The strip crowns were removed, and the teeth were tested using the universal testing machine until fracture. Fracture toughness of the two groups was recorded and analyzed statistically using Student's “t” test.

Results

The mean force required to fracture strip crowns restored with Protemp 4 (416.89 ± 124.58 N) was higher when compared with pedo shade packable composite resin (338.27 ± 130.99 N). However, statistical analysis did not show a significant difference in the fracture toughness between the two groups (p = 0.074), based on Student's “t” test results.

Conclusion

The fracture toughness of teeth restored with Protemp 4 was comparable with pedo shade packable composite resin when used inside a strip crown.

Clinical significance

The use of Protemp 4 is a possible alternative to pedo shade packable composite resin in restoring the primary anterior teeth, when used inside the strip crowns. The data also showed that the fracture toughness of Protemp 4 was comparable with pedo shade packable composite resin.

How to cite this article

Vignesh KC, Kandaswamy E, Muthu MS. A Comparative Evaluation of Fracture Toughness of Composite Resin vs Protemp 4 for Use in Strip Crowns: An In Vitro Study. Int J Clin Pediatr Dent 2020;13(1):57–60.

Fracture Resistance of a Bulk-Fill and a Conventional Composite and the Combination of Both for Coronal Restoration of Severely Damaged Primary Anterior Teeth

Objectives:

This study aimed to compare the fracture resistance of a bulk-fill and a conventional composite and a combination of both for coronal restoration of severely damaged primary anterior teeth.

Materials and Methods:

In this in vitro experimental study, 45 primary anterior teeth were randomly divided into three groups. After root canal preparation, the canals were filled with Metapex paste such that after the application of 1 mm of light-cure liner, 3 mm of the coronal third of the canal remained empty for composite post fabrication. Filtek Z250 conventional composite was used in group 1, Sonic-Fill bulk-fill composite was used in group 2 and Sonic-Fill with one layer of Filtek Z250 as the veneering were used in group 3. Adper Single Bond 2 was used in all groups. The teeth were thermocycled, and fracture resistance was measured by a universal testing machine. The mode of fracture was categorized as repairable or irreparable. Data were analyzed using one-way ANOVA.

Results:

The mean fracture resistance was 307.00±74.72, 323.31±84.28 and 333.30±63.96 N in groups 1 to 3, respectively (P=0.55). The mean fracture strength was 14.53±2.98, 15.08±2.82 and 15.26±3.02 MPa in groups 1 to 3, respectively (P=0.77). The frequency of repairable mode of failure was 80% for the conventional, 73.6% for the bulk-fill and 80% for the bulk-fill plus conventional group, with no significant difference (P>0.05).

Conclusion:

Bulk-fill composites can be used for coronal reconstruction of severely damaged primary anterior teeth similar to conventional composites to decrease the treatment time in pediatric patients.

Effect of Mechanical and Chemical Root Surface Treatment on the Shear Bond Strength of Intracanal Post in Primary Anterior Teeth: An In vitro Study

INTRODUCTION

Aesthetic restoration of severely mutilated primary anterior teeth still remains as a special challenge to paediatric dentist. Due to increased parent's concern for aesthetic rehabilitation for their children, paediatric dentist are in a state to improve technique sensitive restorative procedure to improve aesthetic rehabilitation in children.

AIM

The purpose of the study was to evaluate the effect of different root surface treatment on the shear bond strength of glass fibre reinforced post in primary anterior teeth using Universal Testing Machine (UTM).

MATERIALS AND METHODS

Twenty single rooted primary anterior teeth were selected. Coronal portions of the teeth were sectioned transversally 2 mm above the Cemento-Enamel Junction (CEJ) and specimens were treated endodontically and obturated using metapex. Then the specimens were randomly divided into four groups. Group 1: Control group; Group 2: Chemical surface treatment of the root with 2% chlorhexidine; Group 3: Mechanical surface treatment with mushroom-shaped undercut; Group 4: Combination of mechanical and chemical surface treatments. Samples were tested for shear bond strength. ANOVA and Post-hoc Tukey test were used for statistical analysis using SPSS version 20.0.

RESULTS

Combination of mechanical and chemical surface treatments exhibited higher mean shear bond strength (8.41 MPa), followed by mechanical surface treatment (4.68 MPa), chemical surface treatment (3.92 MPa) and control group (2.76 MPa).

CONCLUSION

Mechanical and chemical surface treatments together led to a improved shear bond strength and increased the retention of the post to the root surface.

Push-out bond strength of different intracanal posts in the anterior primary teeth according to root canal filling materials

Background:

This study was carried out to evaluate the effect of root canal filling on the bond strength of three intracanal posts in the primary incisors.

Materials and Methods:

Sixty primary incisors were prepared and then divided into two groups (n = 30). The first group canals obturated with zinc oxide eugenol (ZOE) and Group 2 canals obturated with Metapex. Further, the two group categories were divided into three subgroups (n = 10): (1) short composite post (SCP), (2) glass fiber posts (GFPs) cemented with flowable composite, and (3) GFP with glass ionomer cement (GFP + GIC). The push-out test was performed with a universal testing machine. The results were statistically analyzed with two-way analysis of variance.(α = 0.05).

Results:

The mean bond strength of the first group obturated with ZOE was lower than that of the second group obturated with Metapex (P = 0.046). Moreover, from a statistical point of view, in all three subgroups, the correlation of mean push-out bond strength between SCP and GFP coated with flowable composite was not substantial at P = 0.97. However, the mean bond strength of SCP was in fact significantly greater than that of the GFP coated with GIC since P = 0.034.

Conclusion:

Using ZOE resulted in the significant reduction of the mean bond strength of the intracanal posts when utilized in the primary anterior teeth. Likewise, SCP and GFP coated with flowable composite showed higher push-out bond strengths for restoring primary anterior teeth.

Fracture resistance of three different posts in restoration of severely damaged primary anterior teeth: An in vitro study

Background:

Restoration of anterior primary teeth with severe caries lesion is a big challenge. The aim of this study was to compare the fracture resistance of three types of post, including composite resin, customized quartz fiber and prefabricated glass fiber in restoration of severely damaged primary anterior teeth.

Materials and Methods:

Sixty extracted human primary maxillary incisors were randomly divided into three groups: Group 1: Customized quartz fiber post, Group 2: Composite post and Group 3: Prefabricated glass fiber post. Due to the effect of bonded area on the fracture resistance, the bonded surface of each sample was measured 1 mm above cementoenamel junction. An increasing force was subjected with a crosshead speed of 0.5 mm/min by a universal testing machine until fracture occurred, and the failure mode was assessed afterwards. Data were analyzed using One-way analysis of variance and Kruskal–Wallis tests. The level of significance was considered at P < 0.05.

Results:

The mean fracture resistance values of three groups were 343.28 N, 278.70 N and 284.76 N, respectively. Although customized quartz fiber post showed the greatest fracture resistance, statistical analysis revealed no significant difference between groups (P = 0.21). The mean fracture strength values of three groups were 12.82 N/mm^–2, 11.93 N/mm^–2 and 11.31 N/mm^–2, respectively; however, the differences were not statistically significant (P = 0.72). Favorable failure mode was more frequent in all groups (P = 0.12).

Conclusion:

Within the limitations of this study, it can be concluded that all three types of studied posts can be successfully used to restore badly destructed primary anterior teeth.

Methods of Intracanal Reinforcement in Primary Anterior Teeth-Assessing the Outcomes through a Systematic Literature Review

AIM

To assess how the various methods of intracanal reinforcement (short root canal posts) performed in their clinical and radiographic outcomes for restoring grossly broken down primary anterior teeth after pulpectomy for 1 year or longer follow-up period.

MATERIALS AND METHODS

Literature search of electronic databases (Sept 2013) and various journals (1980-Sept 2013) using medical subject headings and free text terms was conducted. For inclusion in quality assessment, prespecified inclusion criteria were applied. Quality assessment was performed by using 'The Cochrane collaboration's tool for assessing risk of bias'.

RESULTS

Seven relevant papers were selected for full text evaluation. After applying the inclusion criteria, only two trials could be considered for quality assessment. Both of these were classified as having high risk of bias.

CONCLUSION

The evidence to support any method of intracanal reinforcement for restoring grossly broken down anterior teeth is presently lacking. Further trials with well-defined methodology are needed. How to cite this article: Mittal N, Bhatia HP, Haider K. Methods of Intracanal Reinforcement in Primary Anterior Teeth- Assessing the Outcomes through a Systematic Literature Review. Int J Clin Pediatr Dent 2015;8(1):48-54.

Retentive strength of different intracanal posts in restorations of anterior primary teeth: an in vitro study

Objectives

To determine the retentive strength and failure mode of undercut composite post, glass fiber post and polyethylene fiber post luted with flowable composite resin and resin-cement.

Materials and Methods

Coronal parts of 120 primary canine teeth were sectioned and specimens were treated endodontically. The teeth were randomly divided into 6 groups (n = 20). Prepared root canals received intracanal retainers with a short composite post, undercut composite post, glass fiber post luted with flowable resin or resin-cement, and polyethylene fiber post luted with flowable resin or resin-cement. After crown reconstruction, samples were tested for retentive strength and failure mode. Statistical analysis was done with one-way ANOVA and Tukey tests (p < 0.05).

Results

There were statistically significant differences between groups (p = 0.001). Mean bond strength in the undercut group was significantly greater than in the short composite post (p = 0.030), and the glass fiber post (p = 0.001) and the polyethylene fiber post group luted with resin-cement (p = 0.008). However, the differences between the undercut group and the groups with flowable composite as the luting agent were not significant (p = 0.068, p = 0.557). Adhesive failure was more frequent in the fiber post groups.

Conclusions

Although the composite post with undercutting showed the greatest resistance to dislodgement, fiber posts cemented with flowable composite resin provided acceptable results in terms of retentive strength and fracture mode.

A simple method for reconstruction of severely damaged primary anterior teeth

Restoration of severely decayed primary anterior teeth is often considered as a special challenge by pedodontists. This case report presents a 5-year-old boy with severely damaged maxillary right canine. Subsequent to root canal treatment, a reversed (upside-down) metal post was put into the canal and composite build-up was performed. This new method offers a simple, practical and effective procedure for reconstruction of severely decayed primary anterior teeth, which re-establishes function and esthetics for time the tooth should be present and functional in the child's mouth.

Polyethylene fiber-reinforced composite resin used as a short post in severely decayed primary anterior teeth: a case report

The case report presented here is of a 4-year-old girl with severely decayed maxillary anterior teeth. After root canal treatment, the primary maxillary central and lateral incisors were reinforced using polyethylene fiber-reinforced composite resin short posts and restored using celluloid strip crowns. The technique described here offers a simple and effective method for restoring severely decayed primary anterior teeth that reestablishes function, shape, and esthetics.

Anterior crowns for primary anterior teeth: an evidence based assessment of the literature

AIM

To review the literature concerning the restoration of primary anterior teeth with pre-formed crowns or with the use of crown forms.

METHODS

A search of the dental literature was made electronically using key words: crowns, primary teeth, anterior teeth, strip crowns, stainless steel crowns, veneered crowns, (a)esthetic, restorative. All papers were reviewed and assessed for their relevance to paediatric dentistry and then graded according to a set or predetermined criteria. These criteria were used to identify those reports that met 100% of the criteria, graded A; 75% grade B1; more than 50% graded B2 and all others graded C.

RESULTS

There were 90 papers in all using the key words. Of these none were rated grade A; B1 or B2 and all remaining valid papers (not single restoration case reports), 50 were graded C. Failure rates varied between 0% and 50% for strip crowns; 32-39% for veneered metal crowns. The review indicated there is some evidence as to the efficacy and value of using anterior primary teeth crowns because of the improved aesthetics that they achieve. There was an obvious lack of prospective well controlled studies and more studies are needed.

CONCLUSION

No clinical studies concerning anterior crowns on primary teeth were identified that met all or even a majority of criteria, indicating that there was little, good scientific support for any of the techniques which clinicians have utilized for many years to restore primary anterior teeth. While a lack of strong clinical data does not preclude the use of these techniques it points out the strong need for well designed, prospective clinical studies to validate the use of these techniques.

Restoration of severely decayed primary incisors using indirect composite resin restoration technique

Caries of primary incisors is a common problem in paediatric dentistry in some countries. The restoration of primary incisors which have been severely damaged by early childhood caries or trauma is also a difficult challenge for clinicians. This case report describes an indirect technique for the restoration of primary anterior teeth using composite resin reinforced with a fibre-glass post. Over a one-year period, the crowns have demonstrated good retention and aesthetic results. The restorations were provided in two short chair-side sections, with satisfactory patient cooperation.