|Year : 2013 | Volume
| Issue : 4 | Page : 282-285
Biological restoration: A 4/5 crown
Monize Ferreira Figueiredo de Carvalho1, Adriana M Botelho2, Karine T. A. Tavano2, Vanessa C. S. fernandes1
1 MSc student, Department of Operative Dentistry, School of Dentistry, Federal University of Vales of the Jequitinhonha and Mucuri, Diamantina, Brazil
2 Professor, Department of Operative Dentistry, School of Dentistry, Federal University of Vales of the Jequitinhonha and Mucuri, Diamantina, Brazil
|Date of Web Publication||21-Nov-2013|
Monize Ferreira Figueiredo de Carvalho
Figueiredo de Carvalho, Rua da Glória, 187, Centro, MG, CEP 39100-000, Diamantina
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Dental caries is one of the most prevalent conditions in humans; the purpose of restorative dentistry is to recreate the anatomy of the affected tooth thus the use of fragments from natural teeth as an effective restorative method. A maxillary first premolar left was prepared for an inverted 4/5 crown due to involvement of the vestibular face, after prepared received an allogeneic collage with similar color and dimension. Follow-up after 12 months indicated a stable restoration. Clinically, the site was without signs of caries, migration of the fragment or marginal infiltration. Biological restoration is a viable alternative for reestablishing function and esthetics to damaged/decayed teeth and therefore, biological restoration as an alternative to other restorative options.
Keywords: Biological restorations, dental esthetic, tooth
|How to cite this article:|
de Carvalho MF, Botelho AM, Tavano KT, fernandes VC. Biological restoration: A 4/5 crown. J Indian Soc Pedod Prev Dent 2013;31:282-5
| Introduction|| |
Dental caries (tooth decay) is one of the most prevalent conditions in humans throughout the world, especially in childhood.  The aim of restorative dentistry is to recreate the anatomy of the affected tooth through the replacement of the lost tissue, thereby reestablishing shape, chewing function, speech and esthetics. ,
A variety of materials have been employed in the restoration of teeth with considerable decay, such as amalgam, composite resin, ceramic, metalloplastic, metalloceramic and forged metal.  However, no synthetic material is capable of replicating the esthetic characteristics or color stability of natural teeth.  Thus, a number of researchers have suggested the use of fragments from the natural teeth as an effective restorative method.  This procedure is known as "biological restoration."
The concept of biological restoration is based on the use of material from a tooth bank or a duly donated tooth for the purposes of reconstruction. The aim is to ensure the best physical and mechanical properties, such as shape, surface texture, biocompatibility, resistance to wear and a linear thermal expansion coefficient similar to that of the sound dental tissue as well as an excellent emotional response on the part of the patient to the resulting esthetics.  Nonetheless, a number of limitations are inherent to this technique, such as the difficulty in finding a tooth with a similar color and shape to the damaged tooth and the patient's refusal to accept a tooth from another individual. 
This paper describes a clinical case demonstrating the quality and functionality of a biological restoration performed to reestablish function and esthetics to a posterior tooth.
| Case Report|| |
A 26-years-old female patient visited the dental clinic of the Universidade Federal dos Vales do Jequitinhonha e Mucuri (Brazil) seeking treatment for an esthetically compromised tooth (#24). The clinical exam revealed fracture of the entire vestibular face, terminating in the enamel of the cervical face [Figure 1]. The radiographic exam revealed that the tooth in question exhibited satisfactory endodontic treatment. The treatment options were then presented to the patient and biological restoration was selected the procedure of choice. The patient then signed a statement of informed consent.
The technique consisted of the regularization of the tooth and the subsequent creation of a filling nucleus with photopolymerizable composite resin. The cavity was then prepared for an inverted 4/5 crown due to the involvement of the vestibular face [Figure 1]. A cast was made of the arches and the position of the maxilla in maximum intercuspation was recorded to facilitate the cutting and adjustment of the tooth fragment. A temporary restoration was then performed.
A duly donated extracted tooth 24 with similar color and dimensions to the damaged tooth was then selected [Figure 2] and sterilized in an autoclave at 121°C for 15 min.  With the aid of a thickness gauge, a number of cuts were made to donated tooth with diamond-tip burs under intense refrigeration until achieving a fragment similar in shape to the prepared cavity. Once the fragment was adequately adapted to the cast [Figure 3], the initial occlusal adjustments were made on the articulated model to facilitate the procedure [Figure 4].
The dental fragment was then tested on the prepared tooth in the oral cavity [Figure 4]. Following absolute isolation of the operating field, the tooth and fragment were both etched with a 37% phosphoric acid solution for 30 s on the enamel and 15 s on the dentin. The etched regions were then rinsed and dried. The primer was applied to both substrates and photopolymerized for 20 s. The fragment was then bonded using a duo resin cement. Prior to photopolymerization, the excess cement was removed and the final occlusal adjustments were made. [Figure 5] illustrates the final clinical and radiographic aspects of the restoration.
Further clinical and radiographic exams were performed after a 12 months period [Figure 6]. The restoration was stable, with no signs of caries, migration of the fragment or marginal infiltration.
| Discussion|| |
The use of donated a tooth fragment for biological restorations is often viable for teeth with extensive crown damage.  This method replaces the lost dental tissue and reestablishes function, natural anatomic characteristics and esthetics.  Moreover, the low cost allows the use of this technique in public oral health-care.  Biological restoration is an alternative to complex restorations with amalgam, composite resin and porcelain.  Although the literature points out those synthetic restorative materials have achieved a high degree of development and stability, none completely satisfies the requirements for the replacement of the lost dental tissue in terms of function and esthetics.  As biological restoration is a homogeneous technique, changes are not expected as those found in composite resin restorations, such as discoloration of the restorative material over time in comparison to the surrounding tooth. 
The main difficulty regarding biological restoration consists of selecting a tooth with comparable color, shape and size to the tooth to be restored. Compatible teeth can be acquired from a tooth bank or a legally donated extracted tooth that has been appropriately stored.  The donated tooth should be submitted to a rigorous sterilization process to completely eliminate the risk of contamination and the transmission of diseases.  A number of safe sterilization and storage methods are currently available. Sterilization can be performed with the use of an autoclave, 10% formalin, thymol, ethylene oxide and radiation and the tooth can be stored in 10% formalin, thymol, sodium hypochlorite, glutaraldehide or sodium azide. ,
For the execution of a biological restoration in posterior teeth, the cavity to be prepared must be expulsive and must terminate in the enamel. Casting is necessary after the preparation of the cavity. As with any indirect restoration, the laboratory phase is a critical step. The cutting of the fragment requires professional experience for the adequate adaptation to the plaster model and subsequent placement on the tooth to be restored.
The use of fragments from extracted natural teeth is viable for situations in which restorative materials with adequate physical properties are desired for the reestablishment of function and esthetics in teeth having lost a large amount of tissue.  While, biological restorations have considerable clinical applicability and offer the advantages of a superior esthetic outcome as well as indisputable psychological and social impacts, such restorations do not replace existing restorative techniques. Thus, biological restoration cannot be considered the best option, only the most biological option  and should be well planned considering each case on an individual basis.
| Conclusion|| |
The purpose of this case report was to show readers that biological restoration is a viable alternative for reestablishing function and esthetics to damaged/decayed teeth.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]