Esthetic and Functional Rehabilitation of Maxillary Anterior Tooth by Polyethylene Fibre Post

Case Report

Austin J Clin Case Rep. 2016; 3(3): 1094.

Esthetic and Functional Rehabilitation of Maxillary Anterior Tooth by Polyethylene Fibre Post

Singh S¹*, Nagpal R¹, Singh P¹, Singh UP¹ and Manuja N²

¹Department of Conservative Dentistry and Endodontics, Kothiwal Dental College and Research Centre, India

²Department of Pedodontics, Kothiwal Dental College and Research Centre, India

*Corresponding author: Shipra Singh, Department of Conservative Dentistry and Endodontics, Kothiwal Dental College and Research Centre, Moradabad, India

Received: May 11, 2016; Accepted: August 31, 2016; Published: September 08, 2016

Abstract

The fracture resistance of endodontically treated tooth is highly dependent on the remaining dentine thickness around post and core systems. Flared root canals are more susceptible to fracture as the remaining walls are thin, and the restoration of these teeth requires techniques that will not compromise the integrity of the remaining radicular tooth structure. The introduction of materials that can bond to dentine has created an alternative option for the reconstruction and rehabilitation of root canals that have been severely damaged by caries, trauma, congenital disorders, or internal resorption. Ultra high molecular weight polyethylene (UHMWPE) fibre reinforcement systems are gaining in popularity. As bondable reinforcement fibres, they can be used to build up endodontic posts and cores; moreover, they adapt to the root canal walls without requiring additional enlargement of the root canal after endodontic treatment. This case report discusses the management of fractured non-vital anterior tooth using polyethylene fibre post-core.

Keywords: Esthetic; Rehabilitation; Polyethylene fibre

Introduction

The important role of anterior teeth in esthetics and function makes these teeth a significant component in dentition. Traumatic accidents are common in maxillary anterior teeth. Trauma and caries occurring before root completion can lead the tooth to a degenerative cycle which eventually causes necrosis and creation of large flared root canal. Root canal therapy (RCT) is often successfully done after apexification but compromised dentinal walls especially in cervical area, makes these teeth susceptible to fracture [1]. The fracture resistance of endodontically treated tooth is highly dependent on the remaining dentine thickness around post and core systems [2]. Flared root canals are more susceptible to fracture as the remaining walls are thin, and the restoration of these teeth requires techniques that will not compromise the integrity of the remaining radicular tooth structure.

As a rule, endodontically treated teeth are weaker than intact teeth due to loss of tooth structure, reduction in tooth flexural strength [3], change in the collagen cross-links and moisture content reduction and tooth dehydration [4]. Canal enlargement and cavity preparation can reduce the stiffness of the teeth [5] and brittleness could be a final result of a root canal treatment [6]. When most of the coronal structure of endodontically treated teeth has been lost, the use of post and core systems seems mandatory [7]. The decision regarding the treatment plan and post insertion should be based on three aspects: position of tooth in the arch [8], amount of remaining tooth structure [9] and esthetic requirements [10,11]. The main goal of the post insertion is to provide an optimum retention for the core which eventually supports the crown [12-14].

The introduction of materials that can bond to dentine has created an alternative option for the reconstruction and rehabilitation of root canals that have been severely damaged by caries, trauma, congenital disorders, or internal resorption [15-18]. In recent years, fibre reinforcement systems have been introduced in an attempt to increase resin-bonded composites durability and damage tolerance [19,20]. Ultra high molecular weight polyethylene (UHMWPE) fibre reinforcement systems are gaining in popularity. As bondable reinforcement fibres, they can be used to build up endodontic posts and cores; moreover, they adapt to the root canal walls without requiring additional enlargement of the root canal after endodontic treatment. These woven fibres have a modulus of elasticity similar to that of dentine and are supposed to create a mono-block dentine post- core system able to better distribute forces along the root [15,21,22]. Polyethylene fibres are used to improve the impact strength of composite materials, and they are nearly invisible in resinous matrices. For these reasons, polyethylene fibres seem to be the most appropriate and aesthetic strengtheners of composite materials [23,24].

Case Presentation

A sixteen years old male patient reported to the out-patient Department of Kothiwal Dental College and Research Centre with the chief complaint of broken tooth in the left upper front tooth region (Figure 1). On vitality testing, tooth 12 was found to be nonvital. Root canal treatment was completed in tooth 12 (Figure 2).