|Year : 2016 | Volume
| Issue : 3 | Page : 199-203
Management of grossly decayed primary anteriors using various intracanal post systems: A clinical study
Manjul Mehra1, Rashu Grover1, Inder Kumar Pandit2, Nikhil Srivastava3, Neeraj Gugnani2, Monika Gupta2
1 Department of Pedodontics and Preventive Dentistry, Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar, Punjab, India
2 Department of Pedodontics and Preventive Dentistry, DAV(C) Dental College and Hospital, Yamuna Nagar, Haryana, India
3 Department of Pedodontics and Preventive Dentistry, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India
|Date of Web Publication||25-Jul-2016|
Department of Pedodontics and Preventive Dentistry, Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar, Punjab
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Purpose: The aim of the present study was to clinically evaluate and compare the efficacy and retention of various types of intracanal posts in the restoration of grossly decayed deciduous anterior teeth. The various posts used were polyethylene post, glass post, and composite post. Materials and Methods: A total number of 16 patients with 45 grossly decayed primary anterior teeth were selected. After biomechanical preparation and obturation, patients were randomly divided on the basis of posts to be used into three groups (Group I: Polyethylene post; Group II: Glass post, and Group III: Composite post). Then, space was created in the obturated canal and posts were placed, followed by core build up. Results: After an interval of 12 months, 86.67% of the teeth exhibited complete retention of the post restored with polyethylene post (P > 0.005) and 93.3% of the teeth exhibited complete retention of the post that were restored with glass post (P > 0.005) whereas only 60% of the teeth exhibited complete retention of the post that were restored with composite post (P< 0.005). Only 20% of the teeth exhibited marginal discoloration in both Groups I and III and 13.33% in Group II and this was nonsignificant. Conclusion: Both glass post and polyethylene post proved to be effective. Glass post showed the maximum retention and marginal adaptation followed by polyethylene post. Thus, it appears to be of potential interest for use especially in clinical pediatric dentistry.
Keywords: Caries, intracanal posts, primary anteriors
|How to cite this article:|
Mehra M, Grover R, Pandit IK, Srivastava N, Gugnani N, Gupta M. Management of grossly decayed primary anteriors using various intracanal post systems: A clinical study. J Indian Soc Pedod Prev Dent 2016;34:199-203
|How to cite this URL:|
Mehra M, Grover R, Pandit IK, Srivastava N, Gugnani N, Gupta M. Management of grossly decayed primary anteriors using various intracanal post systems: A clinical study. J Indian Soc Pedod Prev Dent [serial online] 2016 [cited 2021 Jun 21];34:199-203. Available from: https://www.jisppd.com/text.asp?2016/34/3/199/186749
| Introduction|| |
The restoration of primary incisors which are severely broken down by dental caries is often a difficult procedure that presents a special challenge to dentists. The development of carious lesions in primary maxillary incisors is often related to night-time feeding (breast or baby bottle), poor oral hygiene habits, and the consumption of a cariogenic diet after weaning. Premature loss of carious primary incisors may affect the patterns of speech by interfering with the pronunciation of tongue-tip consonants (i.e., “t,” “d,”, “s,” “sh,” and “ch”) and the labial sounds of “f” and “v”. Other implications of the loss of primary incisors are decreased masticatory efficiency and the development of abnormal tongue habits and, potentially, subsequent malocclusion. The child may also suffer from psychological problems if esthetics are compromised.
For the reconstruction of these primary anterior teeth, the dentist needs to seek a material that rebuilds the coronal part of the tooth making use of intracanal retention so as to achieve core retention and coronal stability for resisting the great occlusal forces to which children teeth are exposed. The various root canal posts used in pediatric dentistry are orthodontic thread in the shape of alpha or gamma, metallic posts with macro retention, composites posts, and biological posts.
A custom-made “omega wire extension” placed inside the root cavity and fixed with a composite resin is another alternative. Although it is easier and inexpensive technique, it does not get an adequate adaptation to the canal wall, which may lead to radicular fracture on excessive masticatory forces.,
The biological posts use natural extracted teeth that are prepared in a post shape for cementation in the root canal. The natural crowns offer outstanding anatomy and esthetics, but it needs the creation of a tooth bank and secure methods of sterilization and storage to ensure the safety of teeth.,
The posts made with composite resin present a satisfactory esthetic result, but they have the risk of losing the retention due to polymerization contraction.,
Viera et al. used polyethylene ribbon fibers as root posts in the reconstruction of extremely destroyed primary anterior teeth. They are flexible, have a strong fracture resistance without generating stresses, and modulus of elasticity is also close to that of a dentin thus reducing the incidence of root fracture.
Glass fiber posts have also been introduced to repair grossly decayed teeth. These are composed of unidirectional glass fibers embedded in a resin matrix that strengthens the dowels without compromising the modulus of elasticity. Another advantage of glass fibers is that they distribute stresses over a broad surface area, increasing the load threshold.
The present study was undertaken to clinically evaluate and compare the efficacy and retention of various types of intracanal posts in the restoration of grossly decayed deciduous anterior teeth.
| Materials and Methods|| |
This study was approved by the Ethics Committee of the DAV Dental College and Hospital Yamuna Nagar, India. The procedure and its possible discomfort and benefits were explained fully to the parents of the children involved and their written consent was obtained before the investigation. Children <5 years of age exhibiting grossly carious primary anterior teeth, maxillary or mandibular with at least one-third of the root present were selected. The teeth with excessive pathologic root resorption involving more than one-third of the root or radiographically visible internal root resorption were not included. According to the inclusion and exclusion criteria, a total number of 16 patients with 45 grossly decayed primary anterior teeth were selected.
Endodontic treatment was accomplished in all the grossly decayed teeth and at the subsequent appointment, obturating material was removed 2-3 mm below the cementoenamel junction (CEJ) using a straight fissure bur. A length of at least 2 mm within the root or about one-third of the root length is needed for adequate retention for all posts placed in primary teeth and at least two-third of root length should be present below the post so that there is no interference in the process of eruption of the permanent teeth. We opted for doing relative isolation with the help of cotton rolls since the remaining tooth structure did not allow for absolute isolation with rubber dam. Then, the prepared cavity was acid etched for 15 s with a 37% phosphoric acid gel (3M), rinsed, dried and two coats of a dentin adhesive single bond (3M) were applied according to the manufacturer's instructions. The tip of flowable composite (3M) was placed 2-3 mm apical. The CEJ and the composite were injected. The teeth were then built up with respective intracanal posts and randomly divided into three groups each comprising 15 teeth.
The material of choice for this group was 3 mm polyethylene fiber (RIBBOND). The necessary length of fiber for each tooth was achieved by measuring the intracanal length of each prepared root canal using a Williams's periodontal probe. The fiber was cut to approximately twice the measured depth for each canal and twice the height of the future coronary restoration so as to have a double thickness polyethylene fiber in canal for better reinforcement and to reduce the amount of cementing material. The polyethylene fiber was immersed in a bonding agent (3M single bond) as they are highly susceptible to surface contamination. Clean, cotton plier was used to handle the ribbon before the resin was applied to avoid contamination from operator hand. Polyethylene fibers were inserted into the canal with the help of plugger. The tip of fiber was folded back into the canal so as to have a double thickness polyethylene fiber in canal. The loop emerging out from the canal was used to build a core with Z100 composite.
Glass post (GLASSIX) was selected for this group. The post was cut with a diamond bur under water cooling system to approximately equal the measured depth for each canal and equal the height of the future coronary restoration. Then, glass post was inserted into the canal with cotton pliers and light cured. The coronary portion of the fiber was completely restored using resin composite (ZI00).
Canal was filled with flowable composite only without the application of any specific post. It was placed in several steps into the root canal and cured in increments. The crown was then built up free hand with Z100 composite and was finally finished with diamond finishing burs and composites polishing discs.
Patients were recalled after 3, 6, 9, and 12 months for evaluation of retention, marginal discoloration, and marginal adaptation. They were evaluated using modified Ryge criteria [Table 1]. The data were statistically analyzed using Chi-square test.
| Observations and Results|| |
[Table 2] shows the percentage number of teeth exhibiting complete retention and marginal adaptation at various time intervals. The polyethylene posts exhibited 100% retention and marginal adaptation after 3 and 6 months. This value decreased to 86.66% during 9 months and remained same after 12 months. Although few posts got fractured at 9 months, the difference in retention and marginal adaptation from 0 day to 9 months and from 0 day to 12 months was found to be nonsignificant (P > 0.05) [Table 3]. In Group II, glass post exhibited 100% retention and marginal adaptation after 3 and 6 months post insertion operative evaluation. This value decreased to 93.33% during 9 months and remained same at 12 months of postoperative evaluation. Although few post got fractured after 9 months, the difference in retention and marginal adaptation from 0 day to 9 months and from 0 day to 12 months was found to be nonsignificant (P > 0.05).
|Table 2: Percentage number of teeth exhibiting complete retention and marginal adaptation at various time intervals|
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|Table 3: Intragroup comparison for retention and marginal adaptation of various types of post from 0 day (D0) to 9 months (M9) and from 0 day (Do) to 12 months (M12) using Chi-square test|
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When intergroup comparison was made for glass post and polyethylene post, nonsignificant difference (P > 0.005) was observed after 9 and 12 months [Table 4].
|Table 4: Intergroup comparison for retention of various type of post after 12 months (M12) using Chi-square test|
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In Group III, it was observed that composite posts exhibited 100% retention and marginal adaptation [Table 2] after 3 months and 86.67% during 6 months of postoperative evaluation. This value decreased to 73.33% during 9 months and after 12 months, further decreased to 60%. When 0 day values were compared with those of 9 months and of 12 months, significant alteration (P< 0.05) in the retention of posts was observed [Table 3].
When intergroup comparison was made for glass post and composite post after 9 months [Table 4], nonsignificant difference (P > 0.05) was observed. However, after 12 months, significant difference (P< 0.05) was observed whereas intergroup comparison between polyethylene post and composite post showed nonsignificant difference (P > 0.05).
When comparison for marginal discoloration was done, it was observed that no discolorations were observed among the three groups during 6 months interval [Table 5]. In both Groups I and III, only 13.33% of the teeth exhibited marginal discoloration and 6% in Group II after an interval of 9 months. After 12 months, 20% of the teeth exhibited marginal discoloration in both Groups I and III and 13.33% in Group II and this was nonsignificant according to Chi-square test [Table 6].
|Table 5: Comparison between three group for the marginal discoloration scores|
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|Table 6: Intragroup comparison for marginal discoloration of various type of post from 0 day (D0) to 9 months (M9) and from 0 day (D0) to 12 months (M12) using Chi-.square test|
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| Discussion|| |
Clinically, the application of both glass post and polyethylene post to restore grossly destroyed primary incisors is a valuable clinical treatment option as shown in this study. Glass post showed the maximum retention and marginal adaptation followed by polyethylene post, and composite post showed the least retention and marginal adaptation. Although decrease in retention of posts was observed at various time intervals for all groups, the decrease in retention was significant only for composite post. When intergroup comparisons were made for the retention of different post, significant difference (P< 0.05) was observed between glass post and composite post whereas nonsignificant difference (P > 0.005) was observed when retention values for polyethylene post were compared with either of the two. Both glass post and polyethylene post increase the surface area of tooth structure, i.e., intraradicularly, where adhesion of the bonding of tooth structure is enhanced. Again, the use of glass post and polyethylene post together with flowable composite and bonding agent offers an alternative where all components are bonded to form a firmly attached restoration unit., This technique utilizes the coronal portion of the root, which is the strongest part of the root to transmit any functional stresses and may add to success. The results were in accordance to Viera et al. They used the polyethylene fibers for the reconstruction of decayed upper anterior primary teeth. After 1 year, they found complete retention of all post. Similar results were observed by Rocha Rde et al. 2004.
Glass post was made of braided glass fibers in a multiaxial arrangement and resin bonding matrix (epoxy resin with approximately 65% glass fiber content) providing high resistance to bending and torsion forces. This combination creates a durable alternative to metal, with increased flexural strength. Also, during manufacturing, they were pretreated with organosilanes that act as chemical coupling agents between dental resin and the glass. The composite which surrounds the fibers combines chemically with the flowable composite and the composite used for the core build-up. This allows that the glass post, the composite and the root dentine are securely bonded together and they all offer similar levels of resilience and form a firmly attached restorative unit. As a result, shocks and stress are borne by the entire root and absorbed by the dentine just as they are in a normally healthy, nonrestored tooth. Sharaf  used the glass post for the reconstruction of decayed upper anterior primary teeth. After 1 year, they found complete retention of all post. Laboratory studies have also demonstrated that this technique significantly improved the fracture resistance of teeth.
The polyethylene fibers have a very good adaptation to the composite because during manufacturing, they are plasma treated to enhance their chemical bonding to any composite system. The plasma treatment of the fibers ablates (etches) and chemically activates the fibers to allow them to chemically bond to dental resins creating a polymeric hybrid that functions as a laminate.,
Despite the high overall success rate of both glass post and polyethylene post, one case showed loss of the restoration in Group I (14%) because of trauma and in Group II (7%) because of biting on hard foods such as sugar cane.
The composite post showed the least retention and marginal adaptation. This can be explained due to resin polymerization contraction, enhancing microleakage and leading to possible fractures. There were also some iatrogenic factors such as trauma, dietary habits which were responsible for the low retention rate. Another factor which can be attributed to failure was bonding between post and composite.
All of them exhibited superficial staining which could have been due to plaque accumulation or due to extrusive factor such as green stains due to chromogenic bacteria or yellow stains due to bile pigments from gingival crevicular fluid. They generally occur on the labial surface of incisors and canines in both upper and lower jaw. Refinishing and repolishing procedure could remove all the discoloration. Both glass post and polyethylene post are translucent, practically colorless, and disappear within the composite or acrylic without show-through. They offer excellent esthetics; its translucency also allows the use of light cured composites.
| Conclusion|| |
- Although there was decrease in retention of posts with time for all groups, the decrease in retention was significant only for composite post.
- Glass post showed the maximum retention and marginal adaptation followed by polyethylene post. Composite post showed the least retention and marginal adaptation.
- Teeth restored with glass post showed the least marginal discoloration whereas polyethylene post and composite post showed equal marginal discoloration scores.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Ripa LW. Nursing caries: A comprehensive review. Pediatr Dent 1988;10:268-82.
Ngan P, Fields H. Orthodontic diagnosis and treatment planning in the primary dentition. ASDC J Dent Child 1995;62:25-33.
Island G, White GE. Polyethylene ribbon fibers: A new alternative for restoring badly destroyed primary incisors. J Clin Pediatr Dent 2005;29:151-6.
Mortada A, King NM. A simplified technique for the restoration of severely mutilated primary anterior teeth. J Clin Pediatr Dent 2004;28:187-92.
Usha M, Deepak V, Venkat S, Gargi M. Treatment of severely mutilated incisors: A challenge to the pedodontist. J Indian Soc Pedod Prev Dent 2007;25 Issue 5 (Supplement):S34-6.
Ramires-Romito AC, Wanderley MT, Oliveira MD, Imparato JC, Corrêa MS. Biologic restoration of primary anterior teeth. Quintessence Int 2000;31:405-11.
Mandroli PS. Biologic restoration of primary anterior teeth: A case report. J Indian Soc Pedod Prev Dent 2003;21:95-7.
Shetty T, Bhat Sudhakar G, Shetty P. Aesthetic material. J Indian Prosthodont Soc 2005;5:122-5.
Viera CL, Ribeiro CC. Polyethylene fiber tape used as a post and core in decayed primary anterior teeth: A treatment option. J Clin Pediatr Dent 2001;26:1-4.
Subramaniam P, Babu KL, Sunny R. Glass fiber reinforced composite resin as an intracanal post – a clinical study. J Clin Pediatr Dent 2008;32:207-10.
Cohen BI, Pagnillo MK, Deutsch AS, Musikant BL. Fracture strengths of three core restorative materials supported with or without a prefabricated split-shank post. J Prosthet Dent 1997;78:560-5.
Sharaf AA. The application of fiber core post in restoring grossly destroyed primary incisors. J Clin Pediatr Dent 2002;26:217-24.
Goldberg AJ, Freilich MA. An innovative pre-impregnated glass fiber for reinforcing composites. Dent Clin North Am 1999;43:127-33, vi-vii.
Rocha Rde O, das Neves LT, Marotti NR, Wanderley MT, Corrêa MS. Intracanal reinforcement fiber in pediatric dentistry: A case report. Quintessence Int 2004;35:263-8.
Krasteva K. Clinical application of a fiber-reinforced post system. J Endod 2001;27:132-3.
Metha D, Gulati A, Basappa N, Raju OS. Esthetic rehabilitation of severely decayed primary incisors using glass fiber reinforced composite: A case report. J Dent Child (Chic) 2012;79:22-5.
Mehra M, Grover R. Glassfiber post: An alternative for restoring grossly decayed primary incisors. Int J Clin Pediatr Dent 2012;5:159-62.
Belvedere PC. Single-sitting, fiber-reinforced fixed bridges for the missing lateral or central incisors in adolescent patients. Dent Clin North Am 1998;42:665-82, ix.
Pithan S, Vieira Rde S, Chain MC. Tensile bond strength of intracanal posts in primary anterior teeth: An in vitro
study. J Clin Pediatr Dent 2002;27:35-9.
Finn SB. Periodontal Diseases in Children, Clinical Pedodontics. 4th
ed., Vol. 13. W.B. Saunders; 2004. p. 286-307.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]