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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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Year : 2013  |  Volume : 31  |  Issue : 4  |  Page : 282-285

Biological restoration: A 4/5 crown

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 Publication21-Nov-2013

Correspondence Address:
Monize Ferreira Figueiredo de Carvalho
Figueiredo de Carvalho, Rua da Glória, 187, Centro, MG, CEP 39100-000, Diamantina
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-4388.121834

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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

How to cite this URL:
de Carvalho MF, Botelho AM, Tavano KT, fernandes VC. Biological restoration: A 4/5 crown. J Indian Soc Pedod Prev Dent [serial online] 2013 [cited 2021 Jul 30];31:282-5. Available from: https://www.jisppd.com/text.asp?2013/31/4/282/121834

   Introduction Top

Dental caries (tooth decay) is one of the most prevalent conditions in humans throughout the world, especially in childhood. [1] 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. [1],[2]

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. [3] However, no synthetic material is capable of replicating the esthetic characteristics or color stability of natural teeth. [4] Thus, a number of researchers have suggested the use of fragments from the natural teeth as an effective restorative method. [5] 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. [6] 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. [7]

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 Top

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.
Figure 1: Clinical Exam and prepared 4/5 crown

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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. [5] 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].
Figure 2: Extracted tooth selected

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Figure 3: Tooth fragment adapted to the cast

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Figure 4: Occlusal adjustments on model and tested on oral cavity

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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.
Figure 5: Clinical and radiographic immediately aspect

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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.
Figure 6: Clinical and radiographic aspect after 12-months

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   Discussion Top

The use of donated a tooth fragment for biological restorations is often viable for teeth with extensive crown damage. [1] This method replaces the lost dental tissue and reestablishes function, natural anatomic characteristics and esthetics. [8] Moreover, the low cost allows the use of this technique in public oral health-care. [5] Biological restoration is an alternative to complex restorations with amalgam, composite resin and porcelain. [9] 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. [10] 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. [4]

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. [11] The donated tooth should be submitted to a rigorous sterilization process to completely eliminate the risk of contamination and the transmission of diseases. [12] 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. [13],[14]

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. [15] 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 [10] and should be well planned considering each case on an individual basis.

   Conclusion Top

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.

   References Top

1.Sanches K, de Carvalho FK, Nelson-Filho P, Assed S, Silva FW, de Queiroz AM. Biological restorations as a treatment option for primary molars with extensive coronal destruction - Report of two cases. Braz Dent J 2007;18:248-52.  Back to cited text no. 1
2.Raghu R, Srinivasan R. Optimizing tooth form with direct posterior composite restorations. J Conserv Dent 2011;14:330-6.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.Reis A, Lourguercio AD. Tooth fragment reattachment current treatment concepst. Pract Period Aesthet Dent 2004;16:739-40.  Back to cited text no. 3
4.Grewal N, Seth R. Comparative in 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. 4
[PUBMED]  Medknow Journal  
5.Corrêa-Faria P, Alcântara CE, Caldas-Diniz MV, Botelho AM, Tavano KT. "Biological restoration": Root canal and coronal reconstruction. J Esthet Restor Dent 2010;22:168-77.  Back to cited text no. 5
6.Tavano KT, Botelho AM, Motta TP, Paes TM. Biological restoration: Total crown anterior. Dent Traumatol 2009;25:535-40.  Back to cited text no. 6
7.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. 7
8.Kapur A, Chawla HS, Goyal A, Gaube K. An esthetic point of view in very young children. J Clin Pediatr Dent 2005;30:99-103.  Back to cited text no. 8
9.Santos JFF, Bianchi J. Restoration of severely damage teeth a with resin bonding systems: Case Report. Oper Dent 1999;22:611-15.  Back to cited text no. 9
10.Pegoraro CN, Domingues LA, Trassi PMMM. Biological onlay: An alternative technique for restoration of severely damaged posterior tooth. A case report. Rev Dent Press Estét 2006;3:114-5.  Back to cited text no. 10
11.Reis A, Kraul A, Francci C, Assis TGR, Crivelli DD, Oda M, Loguercio AD. Re-attachment of anterior fractured teeth: Fracture strength using different materials. Oper Dent 2002;27:621-7.  Back to cited text no. 11
12.Cru E, Carpenter WM. Extracted teeth - descontamination, disposal and use. J Cal Dent Assoc 1997;25:801-4.  Back to cited text no. 12
13.Kumar M, Sequeira P, Peter S, Bhat G. Sterilisation of extracted human teeth for educational use. Ind J of Med Microb 2005;23:256-8.  Back to cited text no. 13
14.Lolayekar NV, Bhat SS. Disinfection methods of extracted human teeth. J Oral Health Comm Dent 2007;1:27-9.  Back to cited text no. 14
15.Imparato JCP, Bonecker MJS, Duarte DA, Guedes Pinto AC. Restorations in anterior primary teeth: an alternative technique through gluing of natural crowns. J Bras Odontop Odont Bebe 1998;1:63-72.  Back to cited text no. 15


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]


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