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DENTAL SCIENCE - CASE REPORT
Year : 2015  |  Volume : 7  |  Issue : 6  |  Page : 721-724  

Biological post


1 Department of Conservative Dentistry and Endodontics, RVS Dental College and Hospital, Kannampalayam, Coimbatore, Tamil Nadu, India
2 Department of Conservative Dentistry and Endodontics, J.K.K. Nataraja Dental College and Hospital, Komarapalayam, Namakkal, Tamil Nadu, India

Date of Submission28-Apr-2015
Date of Decision28-Apr-2015
Date of Acceptance22-May-2015
Date of Web Publication1-Sep-2015

Correspondence Address:
B Suresh Kumar
Department of Conservative Dentistry and Endodontics, RVS Dental College and Hospital, Kannampalayam, Coimbatore, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-7406.163500

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   Abstract 

Anterior tooth fracture as a result of traumatic injuries, is frequently encountered in endodontic practice. Proper reconstruction of extensively damaged teeth can be achieved through the fragment reattachment procedure known as "biological restoration." This case report refers to the esthetics and functional recovery of extensively damaged maxillary central incisor through the preparation and adhesive cementation of "biological post" in a young patient. Biological post obtained through extracted teeth from another individual-represent a low-cost option and alternative technique for the morphofunctional recovery of extensively damaged anterior teeth.

Keywords: Dual cure, dentin post, intraradicular post, monoblock


How to cite this article:
Kumar B S, Kumar S, Mohan Kumar N S, Karunakaran J V. Biological post. J Pharm Bioall Sci 2015;7, Suppl S2:721-4

How to cite this URL:
Kumar B S, Kumar S, Mohan Kumar N S, Karunakaran J V. Biological post. J Pharm Bioall Sci [serial online] 2015 [cited 2019 Dec 9];7, Suppl S2:721-4. Available from: http://www.jpbsonline.org/text.asp?2015/7/6/721/163500

Anterior tooth fracture is commonly associated with sports, road traffic accident, leisure activity, and caries lesion thus causing functional esthetics and psychosocial problems. [1]

A proper coronary reconstruction that produces satisfactory esthetic and functional conditions for endodontically treated and extensively damaged teeth is still a challenge for dentistry, to achieve these conditions. The making of intra-canal retention is aimed at a better retention and stability of the dental fragments, becomes imperative. This retention can be performed by using posts made from several materials such as fiber, nickel, and chromium. However, no commercially available prefabricated post meets all ideal biological and mechanical requirements.

The use of biological posts made from natural, extracted teeth represents a feasible option for strengthening root canals, thus presenting the potential advantages such as: (1) Does not promote undue stress on dentinal walls, (2) preserves the internal dentin walls of the root canal, (3) presents total biocompatibility and adapts to conduct configuration, favoring greater tooth strength and greater retention of these posts as compared to prefabricated posts, (4) presents resilience comparable to the original tooth, and (5) offers excellent adhesion to the tooth structure and composite resin, (6) at a low cost. [2]

This case report is an earnest effort to recover the function of an extensively damaged maxillary central incisor through the preparation and adhesive cementation of "biological post" in a young patient. [3]


   Case Report Top


A 21-year-old male reported to the Department of Conservative Dentistry and Endodontics, with a complaint of the fractured crown in the right maxillary central incisor. History revealed a loss of tooth structure due to fall, 5 years back. The clinical and radiographic examinations revealed a loss of tooth structure extending to the cervical third, as well as an exposure of the root canal, with necrosis of pulp [Figure 1].
Figure 1: Initial clinical presentation of maxillary anterior fractured tooth and preoperative radiograph

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   Treatment Plan Top


Conventional root canal treatment with lateral condensation of gutta-percha, followed by post placement and full crown rehabilitation for replenishing the lost tooth structure.


   Post-endodontic Treatment Plan Top


A post has to be placed to compensate for the amount of tooth been lost. Hence, we decided to use an intraradicular biological post made from cutting the root of extracted and properly sterilized canine and subsequent adaptation of post to the maxillary central incisor.


   Consent Top


The patient received instructions regarding the advantages and disadvantages of biological restoration, as well as information on other treatment options. After agreeing upon the proposed treatment, a consent form was duly signed. In addition, it was made clear to the patient that the post would be obtained from extracted teeth that had been previously sterilized by autoclaving in accordance with standards.


   Root Canal Treatment Top


First, all carious tissue were removed conventional access cavity was prepared, working length determined, cleaning and shaping done, and calcium hydroxide closed dressing given for 2 weeks. Obturation was completed by lateral condensation technique.

The restoration technique initially consisted of the preparation of the root canals for post space and direct molding of prepared space using addition silicon impression material [Figure 2].
Figure 2: (a) Radiographic aspect of endodontic treatment. (b) Post space preparation. (c) Anterior region mold with addition-type silicone

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   The Making of Dentin Posts Top


After having established the master cast from the impression, the extracted, donated canines, were autoclaved at 121°C for 15 min. Using a diamond disk, the crown portion was separated from the root, the root was sectioned mesiodistally along the long axis of the tooth. The cementum was removed by abrasion, using diamond drills, and each part of the root was cut in such a way as to form "biological post" [4] [Figure 3].
Figure 3: Post ready after cutting

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   Adaptation and Cementing of Post to Root Canal Top


After the intraradicular post had been shaped and suitably adapted to the master cast [Figure 4]; they were then conditioned with 37% phosphoric acid for 30 s [Figure 5], followed by washing, drying, and application of the adhesive system (Adper Single Bond 2, 3M ESPE, CA, USA) [Figure 6].
Figure 4: Post were adapted to the master cast

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Figure 5: Application of 37% phosphoric acid in the post

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Figure 6: Application of the adhesive system in the post

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The inner portion of the canal was conditioned with 37% phosphoric acid for 15 s [Figure 7]. Next, the adhesive system was applied to the post and polymerized [Figure 8].
Figure 7: Application of 37% phosphoric acid in the canal

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Figure 8: Application of the adhesive system in the canal

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Dual cured resin cement (varolink II, ivoclar) was applied to the inner portion of the canal with the help of a paste carrier [Figure 9] and also to the surface of the post. The post was then inserted into the canal under constant digital pressure [Figure 10]. Core buildup of the tooth structure was done using dual cure core buildup material (fluorocore dentsply) [Figure 11]. Tooth preparation was done, and an impression taken using addition silicone impression material metal free ceramic crown was fabricated and luted using same dual cure resin cement [Figure 12].{Figure 8}
Figure 9: Application of the dual cure resin into the canal

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Figure 10: Post were then inserted into the canals under constant pressure until the end of the cement polymerization

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Figure 11: Core build up, radiograph, crown preparation

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Figure 12: Postoperative, postoperative radiograph

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   Discussion Top


The use of a dentin post provides biocompatibility, a resilience that is comparable to the original tooth, excellent adhesion to the dental structure and composite resin, at a low cost, as dentin posts are made from donated extracted natural teeth. [5] Furthermore, the formation of a sole biomechanical system (monoblock) adhesive joining of dental structures, the cement agent, and the dentin post allow for a better distribution of stress along the root, minimizing the rate of adhesive and cohesive failure. [6] Steel and titanium posts have higher elastic modulus than dentin, causing a concentration of stress at the tooth restoration interface with an increased risk of tooth fracture when subjected to occlusal loads. When a fiber post, which has lower elastic modulus, is subjected to the same loads, debonding of the post-restoration joint occurs. Lower elastic modulus may raise the risk of spontaneous debonding of the post, instead of vertical fracture of the root. [7]

Concerning the ethical aspect, it is necessary to clarify to the patient and/or his parents or guardian that the post is made from duly donated and properly sterilized extracted teeth, thus preventing biosecurity risks.

 
   References Top

1.
Glendor U. Epidemiology of traumatic dental injuries - A 12 year review of the literature. Dent Traumatol 2008;24:603-11.  Back to cited text no. 1
    
2.
Galindo VA, Nogueira JS, Yamasaki E, Miranda DK. Biological posts and natural crowns bonding - Alternatives for anterior primary teeth restoration. J Bras Pediatric Dentistry Odontol 2000;16:513-20.  Back to cited text no. 2
    
3.
Tavano KT, Botelho AM, Motta TP, Paes TM. 'Biological restoration': Total crown anterior. Dent Traumatol 2009;25:535-40.  Back to cited text no. 3
    
4.
Corrêa-Faria P, Alcântara CE, Caldas-Diniz MV, Botelho AM, Tavano KT. "Biological restoration": Root canal and coronal reconstruction. J Esthet Restor Dent 2010;22:168-77.  Back to cited text no. 4
    
5.
Batista A, Lopes CG. Performed dentin post reinforcing teeth with immature apexes. Rev Bras Prot Clin Lab 1999;3:199-21.  Back to cited text no. 5
    
6.
Kaizer OB, Bonfante G, Filho LD, Cardinal L, Reis KR. Utilization of biological posts to reconstruct weakened roots. Rev Gaucha Odontol 2008;56:7-13.  Back to cited text no. 6
    
7.
Meira JB, Espósito CO, Quitero MF, Poiate IA, Pfeifer CS, Tanaka CB, et al. Elastic modulus of posts and the risk of root fracture. Dent Traumatol 2009;25:394-8.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12]



 

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  In this article
    Abstract
   Case Report
   Treatment Plan
    Post-endodontic ...
   Consent
   Root Canal Treatment
    The Making of De...
    Adaptation and C...
   Discussion
    References
    Article Figures

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