Use of ribbond and panavia F cement in reattaching fractured tooth fragments of vital maxillary anterior teeth

Comparative evaluation of the force required to fracture coronal segments reattached using different methods

BACKGROUND/AIM

Anterior teeth are prone to traumatic injuries. Their management is necessary in order to maintain the pulp and esthetics. Various methods have been reported for fragment reattachment of fractured teeth but there is no consensus on which is the best technique. The aim of this study was to compare the force required to fracture reattached fragments using polyethylene fibers in vertical grooves on the external surface of teeth, fiber-reinforced composite post and circumferential chamfer.

MATERIAL AND METHODS

Forty-eight extracted maxillary central incisors were sectioned using a disk and randomly divided into 4 groups (n = 12): Group 1: control group, Group 2: reattachment followed by placement of two external vertical grooves on the labial surface and restored with polyethylene fibers and hybrid composite, Group 3: reattachment followed by two external vertical grooves and filled with fiber posts and composite, and Group 4: reattachment followed by circumferential chamfer at the fracture line and restored with composite. The forces required to fracture the reattached fragments were measured using a Universal testing machine. Data were analyzed using the Kruskal-Wallis test. Pairwise multiple comparison procedure was done using the Student-Newman-Keuls Method.

RESULTS

The highest values for force required to fracture were observed in the fiber post group and the lowest in the Ribbond group (p < .05). The fiber post group had significantly different results compared to the Ribbond and Chamfer preparation groups (p < .05). However, the difference of rank between the fiber post and control groups was not significantly different (p > .05).

CONCLUSION

The force required to fracture the fiber post group was closest to that of intact teeth followed by the chamfer and Ribbond groups, respectively.

Restoration of endodontically treated cracked maxillary teeth: A case series

Cracks adversely affect the prognosis and survival of the teeth. Thus, the possibility of presence of crack should be considered after endodontic treatment and before the initiation of periodontal/prosthetic treatments. Attempts must be made to restore cracked teeth with efficient restorative materials to increase their survival and prevent additional costs.

Gingival-derived mesenchymal stem cells: An endless resource for regenerative dentistry

The gingiva, the masticatory portion of the oral mucosa, is excised and discarded frequently during routine dental treatments and following tooth extraction, dental crown lengthening, gingivectomy and periodontal surgeries. Subsequent to excision, healing eventually happens in a short time period after gingival surgery. Clinically, the gingival tissue can be collected very easily and, in the laboratory, it is also very easy to isolate gingival-derived mesenchymal stem cells (GMSCs) from this discarded gingival tissue. GMSCs, a stem cell population within the lamina propria of the gingival tissue, can be isolated from attached and free gingiva, inflamed gingival tissues, and from hyperplastic gingiva. Comparatively, they constitute more attractive alternatives to other dental-derived mesenchymal stem cells due to the availability and accessibility of gingival tissues. They have unique immunomodulatory functions and well-documented self-renewal and multipotent differentiation properties. They display positive signals for Stro-1, Oct-4 and SSEA-4 pluripotency-associated markers, with some co-expressing Oct4/Stro-1 or Oct-4/SSEA-4. They should be considered as the best stem cell source for cell-based therapies and regenerative dentistry. The clinical use of GMSCs for regenerative dentistry represents an attractive therapeutic modality. However, numerous biological and technical challenges need to be addressed prior to considering transplantation approaches of GMSCs as clinically realistic therapies for humans.

Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part I: vital pulp therapy

Mineral trioxide aggregate (MTA) is a bioactive endodontic cement (BEC) mainly comprised of calcium and silicate elements. The cement was introduced by Torabinejad in the 1990s and has been approved by the Food and Drug Administration to be used in the United States in 1997. A number of new BECs have also been introduced to the market, including BioAggregate, Biodentine, BioRoot RCS, calcium-enriched mixture cement, Endo-CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA, MTA Bio, MTA Fillapex, MTA Plus, NeoMTA Plus, OrthoMTA, Quick-Set, RetroMTA, Tech Biosealer and TheraCal LC. It has been claimed that these materials have properties similar to those of MTA without its drawbacks. In this article, the chemical composition and the application of MTA and other BECs for vital pulp therapy (VPT), including indirect pulp cap, direct pulp cap, partial pulpotomy, pulpotomy and partial pulpectomy, have been reviewed and compared. Based on selected keywords, all papers regarding chemical composition and VPT applications of BECs had been reviewed. Most of the materials had calcium and silicate in their composition. Instead of referring to the cements based on their chemical compositions, we suggest the term 'bioactive endodontic cements (BECs)', which seems more appropriate for these materials because, in spite of differences in their chemical compositions, bioactivity is a common property for all of them. Numerous articles were found regarding use of BECs as VPT agents for indirect and direct pulp capping, partial pulpotomy and cervical pulpotomy. Most of these investigations used MTA for VPT. In most studies, newly introduced materials have been compared to MTA. Some of the BECs have shown promising results; however, the number of their studies compared to investigations on MTA is limited. Most studies had several methodological shortcomings. Future investigations with rigorous methods and materials are needed.

Influence of different bonding agents and composite resins on fracture resistance of reattached incisal tooth fragment

STATEMENT OF PROBLEM

Reattachment of the fractured tooth fragment should be considered as a conservative treatment and valid alternative to a composite restoration.

PURPOSE

This in vitro study was to evaluate the influence of different adhesives and composite resins on fracture resistance of dental fragment reattached to the sectioned incisal edges.

MATERIALS AND METHOD

120 sound human maxillary central incisors were selected under standard conditions and randomly divided into 3 groups, 12 sound teeth were used as a control group and the remaining teeth were assigned to 3 groups (n=36) and each group into three subgroups (n=12). The incisal third of the samples was sectioned using a diamond disk and the respective fragments were then reattached utilizing different intermediate restorative materials, namely: i) adhesive materials alone (OptiBond S or OptiBond XTR or OptiBond All-in-One; ii) Premise flowable composite and iii) Point 4 composite in the one of the mentioned adhesive interface. After storage for two weeks at 37°C and 100% humidity and then thermocycling; shear bond strength (SBS) was recorded in kilogram force (kgf) by applying a load in the middle incisal third with a Zwick Universal Testing Machine at a cross-head speed of 1 mm/min. Data was analyzed with one-way ANOVA and Tukey HSD (p< 0.05).

RESULTS

The control group had a significantly higher SBS than other groups (p= 0.001); the highest SBS values were obtained using the Premise flowable composite and OptiBond S adhesive (112.44±30.46 MPa); and the lowest with OptiBond All-in-One alone (33.97± 15.63 MPa).

CONCLUSION

Although, none of the tested materials provided fracture resistance similar to that found with the intact maxillary central incisors; utilizing the Premise flowable composite and OptiBond S adhesive improved the SBS of the reattached fragment than other materials.