|Year : 2015 | Volume
| Issue : 2 | Page : 86-89
Esthetic Restoration of Severely Decayed Primary Incisors Using Polyethylene Fiber as Post and Core: A Treatment Option
Neena I Eregowda, Sneha Yadav, P Poornima, KB Roopa
Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davangere, Karnataka, India
|Date of Web Publication||17-Dec-2015|
Neena I Eregowda
Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Pavilion Road, Davangere - 577 004, Karnataka
Source of Support: None, Conflict of Interest: None
Within the field of dentistry, loss of primary teeth due to caries, pulp conditions, and crown fractures has been recognized as one of the most severe etiological factors of dental problems in the pediatric dentistry field. One of the greatest headways in dentistry in the last years encompasses the adhesion to enamel of primary teeth; this has led to the development of many techniques to restore the tooth. In spite of all the preventive measures adopted, caries still remains a most common chronic childhood disease.
Keywords: Primary teeth, pulpectomy, strip crown
|How to cite this article:|
Eregowda NI, Yadav S, Poornima P, Roopa K B. Esthetic Restoration of Severely Decayed Primary Incisors Using Polyethylene Fiber as Post and Core: A Treatment Option. Indian J Oral Health Res 2015;1:86-9
|How to cite this URL:|
Eregowda NI, Yadav S, Poornima P, Roopa K B. Esthetic Restoration of Severely Decayed Primary Incisors Using Polyethylene Fiber as Post and Core: A Treatment Option. Indian J Oral Health Res [serial online] 2015 [cited 2019 May 23];1:86-9. Available from: http://www.ijohr.org/text.asp?2015/1/2/86/172047
| Introduction|| |
Increased in the prevalence of dental caries has been reported in very young children known as early childhood caries (ECC). According to the American Academy of Pediatric Dentistry, ECC is the presence of one or more decayed, missing (due to caries), or f illed tooth surfaces in any primary tooth in a child 71 months of age or younger.  The culprits for the occurrence of this situation are night-time feeding (breast or baby bottle), poor oral hygiene habits and the consumption of a cariogenic diet after weaning.  ECC shows a very distinctive pattern because it mainly involves the maxillary central incisors, lateral incisors, and the maxillary and mandibular f irst primary molars. Out of these maxillary, primary incisors are the most severely affected involving the pulp or in extreme cases leading to total loss of the crown structure.  However, such loss of teeth structure can be devastating to the child as it leads to neuromuscular imbalance with reduced masticatory eff iciency,  loss of vertical dimension, development of para-functional habits, and esthetic-functional problems such as malocclusion and space loss, and psychologic problems that can interfere in the personality and behavioral development of the child. In addition, the pattern of speech of child gets disturbed by interference with the pronunciation of tongue-tip consonants and the labial sounds of "f" and "v."  Not only the child but also the parents gets affected by the guilt feelings or a feeling of helplessness which prevail. 
The principal objective of pediatric operative dentistry is the restoration of damaged teeth to healthy function  and being it is our duty to fulf ill it. In early days, the only option for such condition was the extraction of the affected teeth and replaces them with a prosthetic substitute. This treatment line was justif ied on the basis that these extracted teeth would soon be replaced by permanent teeth. However, with the advancement of new adhesive systems and restorative materials, many ways are open for a pedodontist. An acceptable restoration for maxillary anterior incisors should have matching material color, durability, adhesive cementation that is biocompatible with pulp, an ability to be easily and rapidly placed, and only one treatment visit required.  The technique which fulf ills almost all these criteria is post and core. A post and core are a dental restoration used to suff iciently build up tooth structure for future restoration with a crown when there is not enough tooth structure to properly retain the crown. In simple words, it is an anchor placed in the tooth root following a root canal to strengthen the tooth and help hold a crown in place. It is the most eff icient, durable and functional restorations, which is simple to perform and would enhance the management of patient and easy to use.  Posts may be constructed of a variety of materials, including resin composite, metal, and biologic material and prefabricated posts, orthodontic wire posts, and, recently, omega-shaped stainless steel wire posts. ,
Here, we present a case of 4-year-old child who has lost almost all of the coronal tooth structure of his upper anterior teeth due to ECC. The treatment of this child was done by pulpectomy followed by placement of f iber post in canal and building of coronal part using strip crown and composite.
| Case report|| |
A 4-year-old, male child presented to the Department of Pedodontic and Preventive Dentistry, College of Dental Sciences, Davangere with the chief complaint of grossly decayed maxillary primary teeth. Regarding the history of chief complaints; they informed that currently there is no presence of pain, and the only problem was decayed teeth which were getting chipped off. The patient's medical history was noncontributory. He was born after full term by normal delivery. Growth was normal with milestone occurring at the proper age. One signif icant f inding was the child's diet consists of the high amount of cariogenic substance. Patient's mother gave a history of breastfeeding for 1 year after which the child was bottle fed for 2 years. This was the patient's f irst dental visit, and oral hygiene was neglected. Following this clinical examination was done which showed grossly carious 51, 52, 61, and 62 along with occlusal pit caries in 74 and 84. The patient was in primary dentition stage. Owing to the condition of teeth it was decided to take an intraoral periapical radiograph of the maxillary anterior region. Radiographically all maxillary anterior teeth showed caries affecting pulp with a root which has not started resorbing. Thus, after assessing the clinical and radiographical condition and considering the root condition and age of the patient it was decided to save the teeth by pupectomy and reconstruct the teeth using post and core. 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. Treatment was done in two phases where phase 1 was the endodontic treatment and stage two was the restoration part. Initially, gross carious lesions were removed with a no. 330 round carbide steel bur. Unsupported enamel was not removed so as to preserve as possible. Access opening followed by working length determination was done. Once the cleaning and shaping of the canal were done, they were dried using paper points. Then obturation was done using Diapex Plus (Dia Dent, South Korea) till the apical closure. The access opening was sealed by glass ionomer cement. The patient was scheduled for his f inal coronal restoration after 1 week for the second phase of treatment. The patient was asymptomatic on the second visit. For the placement of the postspace was created in these obturated canals of 2-3 mm using thin straight f issure bur with high-speed airotor. Next a trial f it of the post (Glass Fiber Post, 3M, ESPE) was done into the canals to check for proper f itting and proper length which was then conf irmed by taking a radiograph. Post was not inserted to full canal length as it would have hampered the eruption of succedaneous teeth as described by Rifkin, 1983 and other advantage being the strength of coronal portion of the root which prevent the root fracture. The teeth were dried and isolated with cotton rolls. Thirty-seven percentage phosphoric acid was applied on the root canal walls using applicator with a thin tip and etched for 15 s, washed and dried. The dentin bonding agent was applied using a microbrush and then gently air-dried to evaporate the solvent and cured. The glass f iber post of predetermined thickness and length was placed to a distance of 3 mm into the canal and 2 mm outside the canal along with luting resin (RELY-X U 200, 3M ESPE) and cured for 40 s using an light emitting diode curing unit. For the reconstruction of crown structure composite resin build up was done around the post with the help of celluloid strip crowns which were selected based on the mesiodistal dimension of the tooth. The excess composite was removed through small holes punched in the palatal surfaces of the crown. After polymerization for the buccal, palatal, and incisal surfaces, the celluloid crown form was removed by the sharp tip of an explorer. Occlusion was checked interferences in normal and paranormal mandibular movements and f inally f inished with carbide f inishing burs and composite polishing discs was performed. The parents were satisf ied with the outcome of treatment. After the procedure, the parents and patient were instructed about the care of the restoration and were given proper dietary and oral hygiene instruction. The patient is now on follow-up. A major diff iculty faced during the whole procedure was young age of the patient which made him little restless and inability to open his mouth for a long time [Figure 1],[Figure 2] and [Figure 3].
The treatment plan was divided into two steps for 51, 52, 61, and 62.
| Discussion|| |
Endodontic techniques give a chance to save of pulpal compromised primary teeth and saving it from the unwanted sequel of extraction.  As in the presented case, the child showed the presence of all maxillary incisors pulpally involved. Taking all the factors into consideration it was decided to treat the teeth with pulp therapy (pulpectomy) followed by obutaration of canals. Diapex was the material of choice for obturation as the resorptive potential of the material is same as that of tooth.
The pulp therapy treated teeth needed to be restored, but a very little portion of tooth was left to support the restoration.  A coronary reconstruction that produces satisfactory esthetic and functional conditions for extensively damaged teeth is still a challenge for restorative dentistry  and even more diff icult in pedodontics considering the young age and behavioral problem encountered in children.  Development in technology has introduced restorative material with a better aesthetic which require minimal sacrif ice of any additional tooth structure without interfering with root resorption.  One of such material is f iber post. Supporting this technique. in 1990, reported a 100% success rate for composite crowns utilizing short posts for retention. 
The prime function of a post is to retain the coronal restoration in an endodontically treated tooth along with preservation of tooth tissue, presence of a ferrule effect, and adhesion which help us to achieve a long-term success.  There are a variety of root posts used in pediatric dentistry ranging from resin composite post building up directly to alpha, or omega-shaped orthodontic wires, stainless steel prefabricated posts, nickel-chromium cast posts with macro retentive elements, natural teeth from a tooth bank, or reinforced f ibers. Thus, use of post was done in the present case to increase the retention of the composite restoration and achieve long-term success.
Mortada and King in 2004 used orthodontic wire for mechanically retention of direct composite resin restoration. Advantages of this technique were single visit procedure, simplicity, and high strength. , However, using metallic post can be a problem as it requires the use of an opaque resin to mask the post thus adversely affecting the restoration's f inal appearance.  Moreover, these may hinder the physiological process of tooth exfoliation and does not always ideally adapt to the canals which might lead to the radicular fracture. 
A more esthetic option may be the use of biological posts made from extracted primary teeth.  These posts are less costly, highly functional, and esthetic outcomes are excellent. Furthermore, does not promote dentin stress, preserves the internal dentin walls of the root canal and offers excellent adhesion to the tooth structure and composite resin. However, the shortcoming of this technique are diff iculty of f inding teeth with a similar color and shape, the long clinical hours spent in preparation of the fragments, lack of availability of tooth bank, refusal of the patient, or the parent in accepting tooth fragment from another patient.  Furthermore with the awareness and strict policies regarding infection control this technique does not comply.
Glass f iber-reinforced (FiberKor Post) composite root canal post is an alternative method. With time improvement are made in composition, aesthetics, radiopacity, and shape of glass f iber posts to create a better adaptation to root canal walls and are easy to use. The glass f iber post has a modulus of elasticity similar to that of dentine thus decreasing the incidence of root fracture. Other property of this material is greater f lexural strength thus can be used in high-stress bearing areas. Along with this, it has the property of chemically and mechanically adheres to the restorative materials. In addition, f iber posts are relatively easy to remove using an ultrasonic or a rotary instrument.
After insertion of the post into the canal resin-bonded composite strip crowns is the most common choice for the restoration of primary incisors, mainly because of the superior esthetics and the ease of repair if chipped or fractured.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]