Restoration of Ellis Class IV Fracture with Fiber Post

INTRODUCTION

Restoration of the endodontically treated tooth is very important as it has impact on the long-term prognosis of tooth. The root canal treated tooth is mostly associated with the loss of coronal and radicular tooth structure from preexisting restorations, restorative failures, trauma, dental caries, and endodontic access preparation. When a huge amount of the clinical crown has been lost due to damage, it is often impossible to achieve the sufficient anchorage of a restoration in the remaining dentin. This hard tissue tooth structure leads to decreased occlusal load carrying capacity of the root canal treated tooth. Therefore, posts are essentially indicated for the root canal treated teeth to prevent fracture of the remaining tooth structure and to prevent tooth loss.¹

Traditionally, prefabricated posts were made with metal, which are at times visible through the structure of ETT especially in the anterior region.² Metallic materials have much higher moduli of elasticity than that of the supporting dentin, this mismatch in the moduli could lead to stress concentrating in the cement lute, leading to its failure. This has led to a search for a plastic-based material that has a modulus closer to that of dentin.³

In 1990 Duret et al. described a non-metallic material for the fabrication of posts based on the carbon-fibre reinforcement principle. Laboratory-based studies have shown that these posts have a high tensile strength⁴ and modulus of elasticity, similar to dentine.⁵

Currently available fibre-based posts are essentially composite materials. They are composed of fibres of carbon or silica surrounded by a matrix of polymer resin, usually an epoxy resin.⁶

The article highlights a case report of the effective management of endodontically treated with fibrepost, followed by all ceramic crown.

CASE REPORT

A 26 year old male patient reported to our department with the chief complaint of broken teeth in upper front region of mouth since 3 months. Patient gave history of trauma 3 months back. Electric pulp testing revealed Elli’s class IV fracture in relation to 22. Radiographic finding showed presence of periapical radiolucency in relation to 22 (Fig.1). Medical history was non contributary. Based on patients demand fibrepost followed by all ceramic crown was indicated.

Access opening was done in relation to 22. Working length was determined with no. 10 k file (Dentsply) (Fig. 2). BMP was done till 55 no. K file with copious irrigation with 3%NaOCl and 17% EDTA. Caoh was given as an intracanal medicament and patient was recalled after one week. Sectional obturation was done followed by post space preparation till No. 3 peeso reamer (Mani)(Fig. 3).

Post space was etched with 37% phosphoric acid for 15 seconds and then rinsed. Bonding agent was applied in the canal for 10 seconds and air dried (Fig.4&5).

Fig.4

Fig.5

Bonding agent was applied on fibrepost. Dual core cement (DMG Luxacore Z) was placed inside the canal along with fibrepost and cured for 15 seconds (Fig. 6&7).

Fig.6

Fig.7

Composite build was done, followed by all ceramic crown cutting in relation to 22 (Fig. 8&9).

Fig.8

Fig.9

Putty impression was taken and after 2 days crown cementation was done (Fig. 10& 11).

Fig.10

Fig.11

DISCUSSION

A various post and core systems have been investigated till date for the restoration of the root canal treated tooth. In fact, post failure and prosthetic failure have been cited as the most common cause of failure in endodontically treated teeth.

Traditionally, prefabricated posts were made with the metal, which sometimes visible through the structure of endodontically treated teeth commonly in the anterior region. Carbon fiber post is among the many prefabricated fiber post and core systems which were introduced to reduce the failure rate of post-retained restored teeth. In addition, quartz and glass fiber posts embedded in a filled resin matrix have been developed to fulfill esthetic requirement.¹

Fiber post itself is a new advancement in the field of dentistry. The unfavorable transmission of stress from post to tooth structure resulting from the high modulus of elasticity of the metal post leading to frequent decementation or even fracture of the tooth can be attributed for failure of the metal post system. This led to decreasing preference of metal post and rising popularity of fiber posts.⁶

The few clinical trials that have been published, suggest, at least in the short term, reasonable success for fibre-based post restorations. The authors feel however that before these posts are adopted fully in the clinical practice, high quality randomised controlled prospective clinical trials are necessary, investigating the success of fibre-based post restorations.⁷ Various other treatment options can also be taken into consideration like luminex post, Edelweiss post and core and Richmond crown.

REFERENCES