Journal of Indira Gandhi Institute Of Medical Sciences

CASE REPORT
Year
: 2019  |  Volume : 5  |  Issue : 2  |  Page : 182--184

Fracture reattachment of crown with glass fiber reinforced post


Krishna Prasad Biswas1, Drishti Kaushal2, Naveen Mishra3,  
1 Senior Resident, Dept. of Dental and Oral surgery, Lady Harding Medical College, Delhi, India
2 MDS Pedodontics, UCMS (University of Delhi) & GTB Hospital, Delhi, India
3 Assistant professor, Dept. of Dentistry, IGIMS, Patna, India

Correspondence Address:
Drishti Kaushal
MDS Pedodontics UCMS (University of Delhi) & GTB Hospital, DELHI-95
India

Abstract

Traumatic injuries of teeth are common among young children. However when traumatic injuries involves a permanent tooth, its different scenario all together. From esthetic and functional management to complete makeover as that of natural appearance gives a challenge to the dentist. This paper describes the clinical sequence of rehabilitation of fractured crown of right side of maxillary central incisor. Follow up visits were regularly scheduled and both clinical and radiographic examinations were done to evaluate the prognosis of the treatment done.



How to cite this article:
Biswas KP, Kaushal D, Mishra N. Fracture reattachment of crown with glass fiber reinforced post.J Indira Gandhi Inst Med Sci 2019;5:182-184


How to cite this URL:
Biswas KP, Kaushal D, Mishra N. Fracture reattachment of crown with glass fiber reinforced post. J Indira Gandhi Inst Med Sci [serial online] 2019 [cited 2022 Aug 12 ];5:182-184
Available from: http://www.jigims.co.in/text.asp?2019/5/2/182/301109


Full Text



 Introduction :



Trauma due to fall or while playing outdoor games or due to accident not only affect the aesthetic and functional aspect of the hard and soft tissue, also causes social embarrassment due to sudden loss of anterior maxillary tooth. Approximately 25% of population including children and adolescent has fractured anterior teeth due to trauma[1]. According to Elli’s and Davey classification the nature of injury is Elli’s class IV as there was exposure of pulp. It has been reported that the incidence of complicated crown fractures ranges from 2 to 13% of all dental injuries and most commonly affected teeth are maxillary central incisor because of its position in upper arch whereby the direct impact is often taken by it during fall[2]. Loss of crown especially in upper anterior region leads to social discomfort, functional inability and disturbance in phonetics as well as may affect psychologically the patient. Trauma in children and adolescents require greater attention due to the physical and emotional characteristics of both the patient and family members. When the permanent teeth are involved, it poses a challenge for the child, the parents, and the dentist, to save these teeth[2]. The prime focus of dentist at this stage is to rehabilitate the fractured segment in such a way that it should be naturally pleasing as well as restores the functional ability. However there are several factors which may influence the rehabilitation of crown factures such as extent of the fracture, pattern of the fracture, and the restorability of the tooth, as also the presence or absence of the fractured tooth fragment, occlusion, and esthetics[3]. Due to esthetic as one of the prime concern it is advisable to use a metal free post. In recent years, various types of fiber reinforcement have come into widespread use as an alternative to cast or prefabricated metal posts. The advantages of using reinforced fiber to construct an intra canal post include resin composite crown reinforcement, translucency, and relative ease of manipulation[4]. The lower flexural modulus of fiber reinforced posts measures closer to that of dentin and can decrease the incidence of root fracture.

This case presents the management of complicated crown fracture of 18 year old girl with the use of glass fiber reinforced resin post and core.

 Case Report :



An 18 year old girl presented to Department of Dental and Oral Surgery, Lady Harding Medical College, Delhi, India with a chief complaint of broken upper right central incisor and fractured left central incisor. The patient did not report any medical condition or any systemic condition. The trauma happened due to fall on ground while playing about 2 hours ago. Intraoral examination revealed no lacerations or evidence of alveolar bone fracture or gingival inflammation; however horizontal fracture of crown was evident [Figure 1], [Figure 2]. On electric pulp test, teeth responded to the electric pulp test and vitality test came as vital. Radiology showed completed root development with fracture of crown in case of right side central incisor (Elli’s class IV) and fracture of coronal third of crown of left central incisor. (Elli’s class III) [Figure 3]. As the patient had to go out of station and as esthetic was her prime concern therefore it was decided that to place glass fiber post and to modify the natural crown so that it can be reattached successfully.{Figure 1}{Figure 2}{Figure 3}

Parents were informed about the whole procedure and informed consent was taken prior starting of the treatment. Patch test was done with 2% adrenaline with 1:100000 lignocaine and no evidence of hypersensitivity were recorded. The patient was given local anesthesia and biomechanical preparation was done with hand and rotary files. Obturation was done with calcium hydroxide based sealer and lateral condensation of gutta percha was done. The gutta percha was partly removed by peeso reamers leaving the apical 4 mm of the filling to maintain a good seal. The canals were prepared with standardized burs. Electrocautery of palatal aspect of gingival tissue was done in consideration of biological width of tooth [Figure 4].{Figure 4}

Then close fittng posts were selected and evaluated radiographically. After etching of the coronal fragment with a 37% phosphoric acid gel for 20 seconds, the area was rinsed for 20 seconds then dried gently with air. A glass fiber reinforced root canal posts were cemented using dual curing resin system (kerr maxcem elite) according to the manufacturer’s instructions [Figure 5].{Figure 5}

Modification of fractured crown was done with slot type of preparation such that the post fits in the crown like lock and key mechanism [Figure 6]. The fractured crown was also etched with 37% phosphoric acid gel for 20 seconds, the area was rinsed for 20 seconds then dried gently with air. Bonding of fractured crown was done with 7th generation bonding agent. The fractured crown was then inserted over the post along with resin cement and was subsequently cured with ultraviolet light for 20 seconds [Figure 7]. Radiograph was taken to confirm for the successful reattachment of fractured crown with the glass fiber post [Figure 8]. Follow up after 6 months was done both clinically and radiographically to evaluate the prognosis and it was found that using glass fiber resin post was a successful treatment [Figure 9], [Figure 10].{Figure 6}{Figure 7}{Figure 8}{Figure 9}{Figure 10}

 Discussion :



Management of traumatic injuries of tooth is a complex procedure and requires skills to make the outcome better. Prevalence of traumatic injuries ranges from 6% to 37% [2] . Maxillary incisors are most commonly involved followed by upper and lower lateral incisors and the upper canines. Traumatized anterior teeth require quick functional and esthetic repair. In the beginning custom made cast post were used which was made out of various alloy but at latter stage due to esthetic reason and other advantages of glass fiber post it became more popular. The modulus of elasticity of glass fiber post is closer to dentin as compared to metal post[5]. When an endodontically treated teeth is rehabilitated it is to be kept in mind that the post which is being used should have mechanical properties similar to those of the tooth substance as it creates a homogenous system consisting of the post, luting cement and the core material along with the tooth substance. This results in distribution of forces and stresses to the root and thus there is less chances of root fracture.

Various reasons such as high tensile strength, increased fatigue resistance and inherent rigidity, increased resistance to corrosion, biocompatibility to different core materials, good chemical bonding to Bis-GMA resins, and the fact that they can be easily removed by using special drills to allow endodontic re-treatment makes it the material of choice[6]. Also modification in post were made such as translucency which allows the ultraviolet light to pass through and helps in curing of dual cure resin cement[7].

In the current case we have used glass fiber post system with dual cure resin cement to retain the natural fractured crown as the patient wanted quick result as well it should be esthetically pleasing. Retention, resistance to fracture, and esthetics are the three important factors that must be achieved with post- and core-retained restorations for maxillary anterior teeth.[8] The most critical aspect is that it can be done instantly, thus saving both chair-side time[9] and a reduction in the number of appointments and thus at the end a good favorable prognosis is obtained.

 Conclusion :



The esthetics and functional ability of the patient can be rehabilitated quickly with the help of glass fiber reinforced post which not only brings the patient smile quickly but gives the patient confidence against the social stigma which one goes through due to trauma to upper anterior region. In this case the glass fiber reinforced post was luted with dual cure resin based cement and subsequently follow up was done periodically and suggested favorable prognosis.

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