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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 17  |  Issue : 5  |  Page : 404-408

Biological posts and crown: An esthetic recovery of smile


Department of Conservative Dentistry and Endodontics, Vokkaligara Sangha Dental College and Hospital, Bengaluru, Karnataka, India

Date of Web Publication7-Sep-2020

Correspondence Address:
Dr. Shilpi Tiwari
Department of Conservative Dentistry and Endodontics, Vokkaligara Sangha Dental College and Hospital, Room No. 6, V. V. Puram, K R Road, Bengaluru - 560 004, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1735-3327.294333

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  Abstract 


Anterior teeth fracture is a common form of dental trauma that mainly affects children and adolescents. Maxillary incisors are the most commonly affected teeth. Loss of coronal tooth structure might affect esthetics and function. In recent decades, dentistry has shown many scientific and technological advances in restorative materials. However, no synthetic restorative material can replicate the natural tooth structure. Hence, the use of natural tooth as a restorative material has been suggested in literature and is termed as a biological restoration. The present case report represents the successful use of biological post and crown and was adequate with respect to adhesion, function, and esthetics with the follow-up period of 1 year. Hence, it may be concluded that the biological restoration, if feasible, is a cost-effective way to restore a damaged tooth with acceptable esthetics and tooth functions in the stomatognathic system.

Keywords: Biological, fracture, maxillary central incisors


How to cite this article:
Tiwari S, Adarsha M S, Santosh A, Murthy CS. Biological posts and crown: An esthetic recovery of smile. Dent Res J 2020;17:404-8

How to cite this URL:
Tiwari S, Adarsha M S, Santosh A, Murthy CS. Biological posts and crown: An esthetic recovery of smile. Dent Res J [serial online] 2020 [cited 2020 Sep 22];17:404-8. Available from: http://www.drjjournal.net/text.asp?2020/17/5/404/294333




  Introduction Top


Anterior teeth fracture is a common form of dental trauma that mainly affects children and adolescents,[1],[2] and maxillary central incisors are the most commonly affected teeth.[3] Loss of coronal tooth structure might affect esthetics and function.[1]

In recent decades, dentistry has shown many scientific and technological advances in restorative materials.[4] However, no synthetic restorative material can replicate the natural tooth structure. Hence, the use of natural tooth as a restorative material has been suggested in literature and is termed as biological restoration.[5]

The following case report represents a clinical case performed by means of a biological post and crown by reattachment of fractured crown using biological post with 1-year follow-up.


  Case Report Top


A 21-year-old male patient was referred to the department of conservative and endodontics after sustaining a complicated crown fracture on his permanent maxillary left central incisor in a road traffic accident, while riding a bike.

Clinical and radiographic examination

Clinical examination revealed complicated Ellis class III fracture of maxillary left central incisor with retained fractured segment and Ellis class II of maxillary right central incisor and lateral incisor [Figure 1]a. Maxillary right central and lateral incisor showed no tenderness on percussion and no mobility. Intraoral periapical radiograph (IOPAR) was advised with respect to maxillary incisors. IOPA revealed an oblique crown fracture in tooth 21 [Figure 2]a.
Figure 1: (a) Preoperative, (b) after removal of fractured fragment.

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Figure 2: (a) Preoperative intraoral periapical radiograph, (b) working length intraoral periapical radiograph, (c) master cone intraoral periapical radiograph, (d) obturation intraoral periapical radiograph, (e) postspace preparation.

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Treatment plan

Proposed treatment to restore maxillary left central incisor included root canal treatment followed by flap refection and placement of biological post, made from the root cutting of extracted canine as well as the subsequent adaptation of patient's own crown fragment and direct composite restoration for maxillary right central incisor and lateral incisor. After agreeing upon the proposed treatment, a consent form was duly signed.

Fractured segment was removed from maxillary left central incisor [Figure 1]b and stored in artificial saliva until cementation. Single-visit endodontic treatment of maxillary left central incisor was completed [Figure 2]a, [Figure 2]b, [Figure 2]c, [Figure 2]d. In next visit, postspace was prepared using peeso reamers (Mani) till size #3 and 5 mm of apical seal was preserved [Figure 2]e, followed by intraradicular impression with addition silicone (President). Finally, impression was poured with die stone to obtain a model, which served as a guide during the making of the post.

The making of dentin post and core

A freshly extracted permanent maxillary canine was collected and thoroughly cleaned to remove soft tissues and then autoclaved at 121C for 15 min.[6] Using a diamond disk, tooth was sectioned mesiodistally along the long axis of the tooth and then cementum was removed using tapered fissure diamond bur under coolant to obtain a dentin post [Figure 3]a, [Figure 3]b. Model was used as a reference in orienting shape, thickness, and length of the dentin post which was verified radiographically [Figure 3]c, [Figure 3]d.
Figure 3: (a) Sectioned maxillary canine, (b) fabricated dentin post, (c) verification of dentin post inside patient mouth with intraoral periapical radiograph, (d) model used as a reference during fabrication of post, (e) seating of crown fragment over dentin post.

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Preparation of fractured crown fragment

The internal surface of crown segment was prepared to receive dentin post [Figure 3]e. Finally, both biological dentin post and crown were autoclaved just before cementation.

Cementation of biological post and crown

In the next visit, flap surgery was planned to expose the fracture line which was subgingival on distopalatal aspect. After administration of local anesthesia (2% lignocaine with 1:80,000 adrenaline), flap was raised to expose the fracture line [Figure 4]a, ViscoStat (Ultradent) was used for hemostasis, then retraction cord (#000, Ultradent) was inserted to assist the restorative procedures. The dentin post, inner surface of crown, and the root canal were conditioned with 37% phosphoric acid for 15 s, followed by the rinsing, drying, and application of dual cure-bonding agent (Adhesive [A + B] of Paracore, Coltene) [Figure 4]b. Finally Paracore (a dual cure resin cement) was injected into the prepared post space and the dentin post was inserted into the root canal. Simultaneously crown segment was also reattached in place followed by curing for 40s on each surface. [Figure 4]c, [Figure 4]d. Then all margins were polished and the flap was repositioned with the sutures and the necessary occlusal adjustments were made. Postsurgical instructions were given to the patient. After 7 days, sutures were removed, and the patient was rescheduled for the next appointment for direct restorations of 11 and 12. In the final visit, direct composite buildup was done using layering technique in 11 and 12 [Figure 4]e, [Figure 4]f.
Figure 4: (a) Flap reflection, (b) adhesive treatment of dentin post and crown, (c) cementation of dentin post, (d) cementation of crown, (e) postoperative clinical view after 1 week, (f) postoperative intraoral periapical radiograph.

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After 1-year follow-up, the clinical and radiographic findings [Figure 5]a, [Figure 5]b, [Figure 5]c, [Figure 5]d showed that the adaptation of reattached crown and biological post as well as the esthetics and the tooth function was preserved. The treatment outcome of this case so far could be considered a success based on the characteristics of clinical and imaging outcomes given by Estrela et al. in 2014. Clinical examination included the absence of tooth pain, absence of periodontal pocket, tooth with retained definitive restoration and in masticatory function, while imaging aspects included the absence of periapical radiolucency.[7]
Figure 5: (a) Preoperative view, (b) postoperative view, (c) 1-year follow-up, (d) 1-year follow-up intraoral periapical. radiograph.

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  Discussion Top


Sometimes, remaining tooth structure requires additional intraradicular retention;[3] to achieve this, various post systems can be used, such as custom-made post or prefabricated post made of fiber glass, carbon fiber, metal, or ceramics. However, no commercially available posts fulfill all the mechanical and biological requirements. The only material that can have all these properties is none other than the dentin itself.[8] Hence, the use of biological dentin post and biological crowns have been suggested in the literature.[1],[2],[9],[10]

In the present case, since the coronal destruction extended to the cervical third of tooth, the use of intraradicular retention was deemed necessary. This retention was achieved with biological posts,[11] and esthetics was maintained by reattaching patient's own crown fragment.

Although the tooth fragment reattachment is usually done with more predictable results in simple cases with clinically visible fracture line, this case report with a 1-year follow-up demonstrated that this procedure can be performed even in complex crown fractures where the biologic width is violated, corroborating Peixoto et al.,[12] Durkan et al.,[13] and Rajput et al.[14] However, periodontal health is an important determinant in the success of these cases. Peixoto et al. presented a case with an oblique crown fracture in the maxillary right lateral incisor, extending from the buccal to palatal side, as well as biological width invasion. Hence, the reestablishment of biological width was obtained by periodontal surgery to achieve clinical crown lengthening and tooth fragment reattachment with a glass fiber post to increase retention. After 3 years of follow-up, the rehabilitated lateral incisor remained in good condition, with satisfactory esthetic and periodontal health.[12] However, long-term follow-up visits should be planned for clinical and radiographic confirmation of good esthetics, function, and periodontal health. Hence, the success rate of the technique is case dependent. Furthermore, advanced imaging techniques like cone-beam computed tomography could be considered for further evaluation of the treatment outcome.

Corrêa-Faria et al. published a case report of successful use of biological dentin posts and biological crowns to recover the esthetics and functions of extensively damaged maxillary central incisors with 1-year follow-up.[1] Vaz et al. reported a case of fractured maxillary central incisors restored with the use of biological post followed by direct composite restoration of maxillary right central incisor, while maxillary left central incisor was restored with prefabricated fiberglass followed by direct composite restoration.[4]

Biological dentin post has several advantages as it exhibits similar mechanical properties and esthetics as that of dentin.[11],[15] This is a low-cost procedure and could be accepted as a useful technique for cost-conscious patients with good oral hygiene and satisfactory periodontal health.[11] However, it has some limitations such as patient acceptance, difficult retrieval, availability of teeth with similar structure, and similar tooth color.[16] Furthermore, adaptation of the post to the root canal may be less accurate. Hence, CAD-CAM may be used in future research to achieve the accurate dimensions of biological posts as that of post space.


  Conclusion Top


The present case study represents the successful use of biological post and crown and was adequate with respect to adhesion, function, and esthetics with the follow-up period of 1 year. Hence, it may be concluded that the biological restorations, if feasible, is a cost-effective way to restore a damaged tooth with acceptable esthetics and tooth functions in the stomatognathic system.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

The authors of this manuscript declare that they have no conflicts of interest, real or perceived, financial or nonfinancial in this article.



 
  References Top

1.
Corrêa-Faria PA, De Alcântara CE, Caldas-Diniz MV, Botelho Am, Tavano Kt Biological restoration: Root canal and coronal reconstruction. J Esthetic Restor Dent 2010;22:168-77.  Back to cited text no. 1
    
2.
Macedo GV, Diaz PI, De O Fernandes CA, Ritter AV. Reattachment of anterior teeth fragments: A conservative approach. J Esthet Restor Dent 2008;20:5-18.  Back to cited text no. 2
    
3.
Nogueira LC, Tavano KT, Ferraz NK, Glória JC, Botelho AM. Biological restoration of a fractured anterior tooth with the use of dentine pin (Biopins). Case Rep Dent 2015;2015:138474.  Back to cited text no. 3
    
4.
Vaz VT, Presoto CD, Paleari AG, Mandarino F, Minto AM, de Oliveira Junior OB, et al. Biological restoration: A solution for restoring teeth with coronal fractures in young patients. Case Rep Sci J Dent 2015;2:37-41.  Back to cited text no. 4
    
5.
Grewal N, Seth R. Comparativein vivo evaluation of restoring severely mutilated primary anterior teeth with biological post and crown preparation and reinforced composite restoration. J Indian Soc Pedod Prev Dent 2008;26:141-8.  Back to cited text no. 5
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6.
Carvalho CA, Xavier AC, Valera MC, Jorge AO, Ferraz MM, Oliveira LD. Morphological and chemical changes of dentin after applying different sterilization methods. Rev Odontol UNESP 2015;44:131-6.  Back to cited text no. 6
    
7.
Estrela C, Holland R, Estrela CR, Alencar AH, Sousa-Neto MD, Pécora JD, et al. Characterization of successful root canal treatment. Braz Dent J 2014;25:3-11.  Back to cited text no. 7
    
8.
Thakur DA, Patil S, Mohkar S, Gade V. Dentin post: A new method for reinforcing the tooth. J Int Clin Dent Res Organ 2016;8:67.  Back to cited text no. 8
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9.
Wadhwani KK, Hasija M, Meena B, Wadhwa D, Yadav R. Biological restorations: Option of reincarnation for severely mutilated teeth. Eur J Gen Dent 2013;2:62.  Back to cited text no. 9
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Verma KG, Verma P, Goyal T. Recreation with biological restoration: A root canal reconstruction. J Health Spec 2014;2:31-3.  Back to cited text no. 10
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11.
Mishra N, Narang I. Bio-reconstruction of root canal using dentin post. Saudi Endod J 2013;3:87.  Back to cited text no. 11
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12.
Peixoto RF, de Almeida KT, Campos JP, Barbosa AV, dos Santos Calderón P, de Vasconcelos Gurgel BC. Tooth fragment re-attachment in fracture with biological width violation: Case. Revista clínica de periodoncia, implantología y rehabilitación oral 2017;10:80-3.  Back to cited text no. 12
    
13.
Durkan RK, Ozel MB, Celik D, Baǧiş B. The restoration of a maxillary central incisor fracture with the original crown fragment using a glass fiber-reinforced post: A clinical report. Dent Traumatol 2008;24:e71-5.  Back to cited text no. 13
    
14.
Rajput A, Ataide I, Fernandes M. Uncomplicated crown fracture, complicated crown-root fracture, and horizontal root fracture simultaneously treated in a patient during emergency visit: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:e48-52.  Back to cited text no. 14
    
15.
Bhatnagar A, Jindal MK, Khan SY. Biological post and Core: An innovative approach. Int J Oral Health Med Res 2016;3:75-8.  Back to cited text no. 15
    
16.
Ambica K, Mahendran K, Talwar S, Verma M, Padmini G, Periasamy R. Comparative evaluation of fracture resistance under static and fatigue loading of endodontically treated teeth restored with carbon fiber posts, glass fiber posts, and an experimental dentin post system: Anin vitro study. J Endod 2013;39:96-100.  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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