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CASE REPORT
Year : 2012  |  Volume : 30  |  Issue : 4  |  Page : 333-336
 

Esthetic-functional recovery of permanent posterior tooth using autogenous biological restoration


1 Department of Dentistry, Federal University of Vales of the Jequitinhonha and Mucuri, Diamantina, Brazil
2 Students of Dentistry, Federal University of Vales of the Jequitinhonha and Mucuri, Diamantina, Brazil

Date of Web Publication19-Mar-2013

Correspondence Address:
KTA Tavano
Rua da Glória, 187 - Centro, Diamantina - M.G CEP 39100 - 000
Brazil
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Source of Support: Autogenous biological restoration, Conflict of Interest: None


DOI: 10.4103/0970-4388.108934

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   Abstract 

Occlusal morphology and difficult access for cleaning permanent molars result in the buildup of bacterial plaque and the development of caries. One method known as biological restoration was carried out. This technique known as biological restoration, has as main restorative material a fragment obtained from a duly donated extracted human tooth. This case report describes the restoration of an extensively decayed molar through the bonding of a fragment obtained from a third molar extracted from the patient himself. Biological restoration is a low-cost option that offers satisfactory aesthetic, morphological and functional results.The morphological/functional reestablishment of posterior teeth can be obtained through biological restoration, which allows the recovery of properties inherent to the dental structure, offers satisfactory aesthetic results and low cost.


Keywords: Dental public health, dental restoration, esthetics, operative, restorative dentistry, tooth extraction


How to cite this article:
Botelho A M, Tavano K, Correa-Faria P, Morato L, Viana M R. Esthetic-functional recovery of permanent posterior tooth using autogenous biological restoration. J Indian Soc Pedod Prev Dent 2012;30:333-6

How to cite this URL:
Botelho A M, Tavano K, Correa-Faria P, Morato L, Viana M R. Esthetic-functional recovery of permanent posterior tooth using autogenous biological restoration. J Indian Soc Pedod Prev Dent [serial online] 2012 [cited 2019 Dec 13];30:333-6. Available from: http://www.jisppd.com/text.asp?2012/30/4/333/108934



   Introduction Top


Epidemiological studies carried out in Brazil reveal that 70% of 12-year-old children and 90% of adolescents between 15 and 19 years of age have at least one permanent tooth with a history of caries. [1] The lower molars are the most affected and the treatment of these teeth is routine in dentistry. [2]

The choice of treatment is partly determined by the degree of decay. Biological restoration is a treatment option that uses the adhesive capacity of restorative materials to bond fragments obtained from a duly donated, sterilized, extracted human tooth in order to reestablish anatomical shape and function and favor the esthetic aspects regarding the tooth in need of treatment. [3],[4],[5]

The aim of the present study was to report the 5-year clinical follow-up of a case involving the bonding of an autogenous tooth fragment (biological restoration) performed for the esthetic/functional treatment of an extensively decayed permanent molar.


   Case Report Top


An 18-year-old male visited the Dental Clinic of the School of Dentistry of the University Federal of Valleys of the Jequitinhonha and Mucuri in the city of Diamantina, Brazil, complaining of pain in the region of tooth 48. The clinical and radiographic exams revealed that the tooth in question was partially erupted and exhibited pericoronitis. Moreover, an extensive carious lesion was observed on tooth 47. After reduction of the pericoronitis, the third molar was surgically removed, cleaned, and stored in 10% formalin solution.

When the area around tooth 48 had healed, the patient returned to the clinic for the restoration of tooth 47. It was evident, however, that the cavity preparation could be maintained with its margins in the enamel [Figure 1]. The radiographic exam revealed reduction of the pulp chamber, thereby denoting a considerable possibility of the preservation of pulp vitality after the removal of the carious tissue.
Figure 1: Initial clinical aspect

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Based on the clinical and radiographic findings, the patient was informed as to the available techniques and materials. The decision was made to perform autogenous biological restoration using a fragment from the previously extracted and appropriately stored tooth 48. The patient was informed as to the ethical principles and sterilization of the tooth to be used, and he agreed to the procedure and signed a term of informed consent.

Initially caries was removed and morphological reconstruction with resin-modified glass ionomer cement was performed (Vitremer, 3M ESPE, St. Paul, MN, USA). The preparation of the cavity was performed with occlusal-vestibular wear in a slightly expelling conformation and cervical termination in the enamel [Figure 2]a. Functional molding was performed in the same session, and the prepared cavity received a temporary acrylic resin restoration.
Figure 2: (a) Occlusal-vestibular aspect of cavity preparation. (b) Articulated models

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The plaster casts were mounted on a semi-adjustable articulator [Figure 2]b. The third molar extracted from the patient exhibited similar coloration and size to that of tooth 47 [Figure 3]. The extracted tooth was initially autoclaved at a temperature of 121°C for 15 min [6] and prepared for the acquisition of the fragment. The following step consisted of the sectioning of this tooth, discarding the roots, and wearing down the interior of the clinical crown with high-speed diamond-tip drill bits under intense refrigeration until achieving a fragment that was appropriately adapted to the plaster cast [Figure 4].
Figure 3: (a) Vestibular view of extracted tooth. (b) Occlusal view of extracted tooth. (c) Mesial-distal measurement of selected tooth. (d) Mesial-distal measurement of remaining tooth

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Figure 4: Dental fragment obtained. (a) Occlusal-vestibular view. (b) Internal view. (c) Occlusal-vestibular aspect of fragment adapted to model. (d) Occlusal aspect of fragment adapted to model

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The second clinical session began verification of the adaptation of the fragment to tooth 47 [Figure 5], followed by the complete isolation of the operating field. Both the tooth and fragment were etched with 37% phosphoric acid (Acid Gel; Dentalville, Joinville, SC, Brazil) for 15 s on the dentin and 30 s on the enamel [Figure 6]a and b, then washed and dried. The bonding system (Adper Single Bond 2, 3M Espe, St. Paul, MN, USA) was applied to both prepared substrates [Figure 6]c and d. Following photopolymerization, the fragment was bonded with chemically activated resin cement (C and B Cement, Bisco, Illinois, USA) [Figure 7]. The isolation was removed and the occlusion was assessed and adjusted [Figure 8]. The patient received orientation regarding oral hygiene and the need for periodic evaluations. [Figure 9] illustrates the radiographic and clinical aspects of the resulting biological restoration in comparison to the initial clinical aspect.
Figure 5: Clinical adaptation of tooth fragment

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Figure 6: (a) Acid etching of fragment. (b) Acid etching of remaining tooth. (c) Application of primer/adhesive to fragment. (d) Application of primer/adhesive to remaining tooth

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Figure 7: (a) Application of bonding agent to interior of fragment. (b) Fragment cemented to remaining tooth

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Figure 8: (a) Occlusal adjustment. (b) Occlusal points marked

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Figure 9: (a) Initial clinical aspect. (b) Radiographic aspect after bonding; (c) Final occlusal-vestibular aspect; (d) final occlusal-lingual aspect

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The restoration was followed up for a 5-year period and remained with a satisfactory clinical and radiographic appearance [Figure 10].
Figure 10: 5-year clinical follow-up. (a) Occlusal– vestibular aspect. (b) Occlusal– lingual aspect. (c) Radiographic aspect

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   Discussion Top


The clinical case described an alternative restoration procedure in which a fragment obtained from an extracted human tooth is used to reestablish the shape and function of a decayed tooth. This technique allows natural results in terms of anatomic shape, surface shine, smoothness, and translucence of the enamel; it also enables an improvement in chewing function and the physiological wear of the tooth structure. [7],[8],[9]

However, biological restoration may have limitations related to the selection of extracted teeth with similar color and shape to the tooth to be restored. This is especially true with posterior teeth, which can exhibit more extensive decay and greater anatomic complexity, particularly when having undergone root canal treatment. [7] It is therefore fundamental to establish human tooth banks. [6] The difficulty in encountering an extracted tooth similar to the tooth to be restored did not constitute a limitation in the present case, as the fragment used for the restoration was acquired from the extracted third molar of the patient himself.

Another limitation of biological restoration is the possibility of fracturing the selected extracted tooth during its sectioning for the obtainment of the fragment, as well as the difference in color after bonding. In order to minimize such risks, the teeth used in biological restorations should be kept hydrated throughout all procedures. Dehydration of the fragment - whether due to prolonged handling or sterilization - can also negatively affect its adherence to the bonding agent. In the present case, previous sterilization of the tooth was performed mainly for the protection of the dental professional during the sectioning procedure, as the tooth was used on the same patient from whom it had been extracted.

The results of the case presented - both in the immediate postoperative period and after 5 years - demonstrate that the fragment bonding technique (biological restoration) using either an endogenous fragment (obtained from an extracted tooth from the patient himself/herself) or heterogeneous fragment (obtained from a donated extracted tooth) is a viable treatment option. However, further studies are needed to assess the long-term clinical behavior of such restorations.

 
   References Top

1.Brazil. Ministry of Health Department of Health CareDepartment of Primary Care. SB Brazil Project 2003:oral health status of the population 2002-2003:Main results. Brasilia: Ministry of Health, 2004  Back to cited text no. 1
    
2.Demirci M, Tuncer S, Yuceokur AA. Prevalence of caries on individual tooth surfaces and its distribution by age and gender in university clinic patients. Eur J Dent 2010;4:270-9.  Back to cited text no. 2
[PUBMED]    
3.Cetin AR, Unlu N. One-year clinical evaluation of direct nanofilled and indirect composite restorations in posterior teeth. Dent Mater J 2009;28:620  Back to cited text no. 3
    
4.Barcelos R, Neves AA, Primo L, de Souza IP. Biological restorations as an alternative treatment for primary posterior teeth. J Clin Pediatr Dent 2003;27:305-10.  Back to cited text no. 4
[PUBMED]    
5.Busato AL, Loguercio AD, Barbosa AN, Sanseverino Mdo C, Macedo RP, Baldissera RA. Biological restorations using tooth fragments. Am J Dent 1998;11:46-9.  Back to cited text no. 5
[PUBMED]    
6.Imparato JCP. Bank human teeth. Curitiba:Publisher May, 2003  Back to cited text no. 6
    
7.Botelho AM, KT Tavano, Souza LT, PT Cabral, MA Sales. crownTotal made ​​by the technique of biological restoration. int JBraz Dent 2009; 5:284-92.  Back to cited text no. 7
    
8.Tavano KT, Botelho AM, Motta TP, Paes TM. 'Biological restoration': Total crown anterior. Dent Traumatol 2009;25:535-40.  Back to cited text no. 8
    
9.Corrêa-Faria P, Pinto de Alcântara CE, Caldas-Diniz MV, Botelho AM, Tavano KT. Biological restoration: Root canal and coronal reconstruction. J Esthet Restor Dent 2010;22:168-8.  Back to cited text no. 9
    


    Figures

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


This article has been cited by
1 Biologic Foundation Restoration: A Natural Post And Core For Management
Pooja Kakkar,George P. John,Gaurav Sharma
The Journal of Indian Prosthodontic Society. 2013;
[Pubmed] | [DOI]



 

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