Author 1: DR.RAHUL NAGRATH, DR.MANESH LAHORI, DR.NITI MALIK.
KD Dental College, Mathura, India

 


INTRODUCTION:
The rehabilitation of dental structure lost by trauma or caries requires an adequate planning based on the clinical situation. The restoration of endodontically treated and severely damaged teeth has been a concern of the clinicians and the researchers still seek the most adequate technique and material to restore these teeth. Several materials and techniques have been proposed to restore severely damaged endodontically treated teeth, including various post and core systems that can be classified into two main types: metal posts and cores that are custom cast as a single piece, and two-element designs comprising a prefabricated post to which a composite core is subsequently adapted ¹. The restoration of damaged endodontically treated teeth with material that have physical and mechanical properties similar to those of dentin has become a major objective of dentistry. The use of materials that can bond to both dentin and core material can improve distribution of forces along the roots, contributing to the reinforcement of the tooth ².

CASE REPORT:
A female patient by name Dolly, of age 22 years, reported to the OPD of K.D. Dental College, with the chief complaint of restoration of a fractured tooth in upper left front tooth region. Patient’s dental history revealed that tooth was fractured due to trauma, and she had undergone root canal treatment for the concerned tooth two months back (fig.1 and fig.2).

Figure1: Pre-operative photograph	Figure 2: Pre-operative photograph	Figure 3: Pre-operative radiograph	Figure4: IOPA showing the post-space created

Patient was advised an intra-oral periapical radiograph in relation to the fractured tooth. The radiograph depicted that the tooth was horizontally fractured into two parts, with well- obturated canal. The radiograph also depicted that the seal was adequate and maintained in the apical region. The following treatment options were considered and explained to the patient:

1. Extraction of the tooth and placement of a fixed partial denture
2. Extraction of the tooth and placement of an implant- supported prosthesis
3. Post and core restoration in the concerned tooth to stabilize both the fractured fragments together.

Figure5: Application of bonding agent	Figure 6 : Placement of fibre post and subsequent core build up	Figure 7 : Tooth preparation	Figure 8 : Post operative

Since the patient had a time constraint and was not willing for extraction, post and core restoration was considered as the treatment option. Patient also could not afford the implant supported prosthesis, hence it was not considered as a treatment option.The whole procedure was explained to the patient before commencement. Working length of the obturated canal was measured from the IOPAR. Post space was prepared using Gates-Glliden drills and the drills corresponding with the post. Post space preparation was done in so that at least 3mm of the apical portion of the fractured root could be engaged with the post.

An intra-oral periapical radiograph was taken to confirm the post space, fit of the post and the engagement of the post with the apical half of the root (fig.4).

Fiber post was placed into the canal upto the measured space and the fit was verified. Non-rinse conditioner [ParaBond, Coltene, Whaledent] was applied into the prepared canal for 30 seconds, dried and rinsed. Chemical cured adhesive A and B [ParaBond, Coltene, Whaledent] were mixed and applied for 30 seconds, dried and rinsed. Bonding agent [ParaBond, Coltene, Whaledent] was applied into the canal and on the fiber post (fig.5). Fiber post was placed into the canal and cured using the light cure unit . Core build- up was done using ParaCore [Coltene, Whaledent] (fig.6). Post- operative IOPAR depicted that the post had successfully engaged the apical portion of the root . Tooth preparation done in relation to the concerned tooth (fig.7) and rubber base impressions were made. Complete coverage porcelain fused to metal crown was fabricated and cemented (fig.8).

DISCUSSION:
Posts are widely used for restoring endodontically treated teeth with insufficient coronal tooth structure to retain a core for the definitive restoration. Prefabricated post systems have recently become more popular because they can provide satisfactory results, while saving time and reducing costs. However, a prefabricated post should adequately adapt to the prepared root canal; otherwise, a cast post and core should be used. Passive, tapered posts have a shape that is congruent with the root canal configuration and allow for optimal preservation of tooth structure, especially inthe apical region ³. Glass-fiber posts are composed of glass fibers, inorganic filler, and a resin matrix.They are usually luted with a resin cement to increase their retention and improve the mechanical performance of the restored teeth. Materials used for core restoration after endodontic treatment include amalgam, visible light-polymerized (VLP) resin composite, autopolymerized titanium containing resin composite, polyacid modified resincomposite, resin-modified glass ionomer, and silver cermet cement ⁴

Amalgam remains one of the most commonly used core materials and can be used alone or in combination with a pin or a dowel. The primary disadvantages of amalgam are the long setting time and low initial compressive strength. Visible light polymerized resin composites are extensively used as a core material. Resin composites offer various advantages, including high compressive strength, ease of manipulation, and short polymerizing time as compared to amalgam. These attributes enable the clinician to complete a core preparation directly after placement of a prefabricated dowel ⁵. Prefabricated glass fiber post has been widely used and show a relatively success rate because their properties are similar to those of dentin. They are esthetic, more practical, less expensive, and less invasive than metal post and core systems ².

CONCLUSION:
Preservation of existing tooth structure while restoring the tooth is mandatory. An ideal post should provide retention & resistance to displacement of core coupled with esthetics. Posts made of tooth-colored material, such as glass fibers or zirconia ceramics, have become popular because they increase the transmission of light within the root and overlying gingival tissues. The low modulus of elasticity of fiber-reinforced epoxyresin posts has been reported to reduce the risk of root fracture. In addition, the restoration of endodontically treated teeth with metal-free materials eliminates the potential hazards of corrosion and allergic hypersensitivity. Fiber-reinforced posts also have the advantage of easy removal if endodontic retreatment is required².

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