Q ui nt essenc e I nt erna t i on al 1 Resin composite restoration in primary anterior teeth using short-post technique and strip cro wns: A case report Fausto Medeiros Mendes, DDS, MSD 1 /Monique Saveriano de Benedetto, DDS, MSD 1 /Cristina Giovannetti del Conde Zardetto, DDS, MSD 1 /Marcia T urolla Wanderley , DDS, MSD 2 /Maria Salete Nahás Pires Corra, DDS, MSD, PhD 3 A case report using a technique for the restoration of endodontically treated primary maxillary incisors with resin composite short posts and celluloid strip crowns is described in a 3-year- old girl. The technique of- fers the advantages of using one restorative material, improving esthetics, and reducing chair time and costs. (Quintessence Int 2004;35:xxx–xxx) Key words: esthetics, pediatric dentistry , primary t eeth, strip crown, short post D espite considerable advances in the prevention ofdental caries, pediatric clinicians still deal with cases of total destruction of the primary teeth. In very young children, severe tooth destruction is often asso- ciated with frequent and prolonged exposure to cario- genic substances in the nursing bottle, compounded by lack of adequate hygiene habits. The teeth most often involved are the maxillary central and lateral incisors and the maxillary and mandibular primary first mo- lars, while the mandibular primary incisors are rela- tively unaffected. Maxillary incisors are the most se- verely involved, and the lesions can lead to total de- struction of the crowns. 1–4 Dental destruction may lead to development of para- functional habits (tongue thrusting, [Au: Speech prob- lems?] ), psychologic problems, reduced masticatory ef- ficiency, and loss of vertical dimension of occlusion. 5–10 It is important to restore crowns destroyed by caries to preserve the integrity of the primary dentition until its exfoliation and eruption of the permanent teeth. 5 In cases of severely carious teeth, endodontic treat- ment associated with the use of intracanal posts be- comes necessary prior to restoration of the crowns. In pri mary t ee th, i ntr aca nal r e tention can be a chieve d by several techniques: directly building up a resin com- posite post 11 ; preparing an “inverted mushroom- shaped” undercut in the root canal prior to resin com- posite short post [Au: placement?] 12 ; using alpha- or omeg a-s hape d ort hodonti c w ir e , 13,14 stainless steel pre- fabricated posts, 7,15 nickel-chromium (Ni-Cr) cast posts with macroretentive elements, 9 natural teeth from a tooth bank, 10 and reinfor cement fiber. 16 Casellato et al 1 7 reported in an in vitro study that threaded posts (FKG [Au: Is this the brand of threaded post? Or is this the manufacturer? Please specify] ), Ni-Cr posts with macroretentions, alpha- shaped orthodontic wire, biologic posts, and root 1 Graduate Student, Pediatric Dentistry , University of São Paulo, São Paulo, Brazil. 2 Professor of Pediatric Dentistry, Department of Orthodontics and Pediatric Dentistry , University of São Paulo, São Paulo, Brazil. 3 Professor of Pediatric Dentistry, Department of Orthodontics and Pediatric Dentistry, and Coordinator, Clinic of Pediatric Dentistry, University of São Paulo, São Paulo, Brazil. Reprint requests: Dr Fausto Medeiros Mendes, Faculdade de Odontologia da Universidade de São Paulo, Departamento de Ortodontia e Odontopediatria, Av. Prof. Lineu Prestes, 2227, CEP 05508-900 – São Paulo, Brasil. E-mail: medeirosmendes @uol.com.br [Au: Please provide a short clinical relevance state- ment] Pediatric Dentistry
Transcript
7/24/2019 Jurnal Asli (1)
http://slidepdf.com/reader/full/jurnal-asli-1 1/5
Q uintessence International 1
Resin composite restoration in primary anterior teeth usingshort-post technique and strip crowns: A case report
A case report using a technique for the restoration of endodontically treated primary maxillary incisors with
resin composite short posts and celluloid strip crowns is described in a 3-year-old girl. The technique of-
fers the advantages of using one restorative material, improving esthetics, and reducing chair time and
costs. (Quintessence Int 2004;35:xxx–xxx)
Key words: esthetics, pediatric dentistry, primary teeth, strip crown, short post
D espite considerable advances in the prevention of dental caries, pediatric clinicians still deal with
cases of total destruction of the primary teeth. In veryyoung children, severe tooth destruction is often asso-ciated with frequent and prolonged exposure to cario-genic substances in the nursing bottle, compounded bylack of adequate hygiene habits. The teeth most ofteninvolved are the maxillary central and lateral incisorsand the maxillary and mandibular primary first mo-
lars, while the mandibular primary incisors are rela-tively unaffected. Maxillary incisors are the most se-verely involved, and the lesions can lead to total de-struction of the crowns.1–4
Dental destruction may lead to development of para-functional habits (tongue thrusting, [Au: Speech prob-lems?] ), psychologic problems, reduced masticatory ef-ficiency, and loss of vertical dimension of occlusion.5–10
It is important to restore crowns destroyed by caries topreserve the integrity of the primary dentition until itsexfoliation and eruption of the permanent teeth.5
In cases of severely carious teeth, endodontic treat-ment associated with the use of intracanal posts be-comes necessary prior to restoration of the crowns. Inprimary teeth, i ntracanal retention can be achieved byseveral techniques: directly building up a resin com-posite post 11 ; preparing an “inverted mushroom-shaped” undercut in the root canal prior to resin com-posite short post [Au: placement?] 12; using alpha- or
omega-shaped orthodonti c w ire,13,14
stainless steel pre-fabricated posts,7,15 nickel-chromium (Ni-Cr) cast postswith macroretentive elements,9 natural teeth from atooth bank,10 and reinforcement fi ber.16
Casellato et al17 reported in an in vitro study thatthreaded posts (FKG [Au: Is th i s the brand o fthreaded post? Or is this the manufacturer? Please
specify] ), Ni-Cr posts with macroretentions, alpha-shaped orthodontic wire, biologic posts, and root
1Graduate Student, Pediatric Dentistry, University of São Paulo, São Paulo,
Brazil.2Professor of Pediatric Dentistry, Department of Orthodontics and PediatricDentistry, University of São Paulo, São Paulo, Brazil.
3Professor of Pediatric Dentistry, Department of Orthodontics and PediatricDentistry, and Coordinator, Clinic of Pediatric Dentistry, University of SãoPaulo, São Paulo, Brazil.
Reprint requests: Dr Fausto Medeiros Mendes, Faculdade deOdontologia da Universidade de São Paulo, Departamento de Ortodontia eOdontopediatria, Av. Prof. Lineu Prestes, 2227, CEP 05508-900 – SãoPaulo, Brasil. E-mail: medeirosmendes @uol.com.br
[Au: Please provide a short clinical relevance state-
ment]
Pediatric Dentistry
7/24/2019 Jurnal Asli (1)
http://slidepdf.com/reader/full/jurnal-asli-1 2/5
canal filled with resin composite showed similar frac-ture resistance values when submitted to shear bondstrength tests.
Perrela et al18 described that threaded posts (FKG)
and alpha-shaped orthodontic wire showed an aver-age success rate of 76.47% after 10 months of clinicaland radiographic follow-up when used in primary an-terior teeth [ Au: Edit s to pr evious sentence OK ?] .
Restorative modalities used to treat primary ante-rior crowns include stainless steel crowns,19,20 polycar-bonate crowns,5 resin composite,6 indirect resin com-posite crowns,9 and biologic restoration with naturaltooth.10 Resin composites, used directly or indirectly,have been an excellent choice for severely cariousteeth due to their adhesive bonding and esthetic ap-pearance.20,22 [Au: You did not cite reference 21.
Please do so or it will be deleted from the referencessection] Preformed, indirect resin composite crowns
have recently become available in the form of resincomposite shells for primary teeth.23 Preparation of ac-etate crown forms on a stone cast prior to the ap-pointment saves treatment time and produces desir-able results.11,12,15,20,22,24 In light of these advantages,techniques that save treatment time are favorable invery young chil dren.20
The purpose of this report was to demonstrate therehabilitation of primary anterior teeth in a 3-year-oldgirl with early-onset carious lesions. The endodonti-cally treated teeth were reinforced using a resin com-posite short-post technique12 and restored with cellu-loid strip crown formers.
PATIENT HISTORY AND ORAL HEALTH FINDINGS
A 3-year-old boy [Au: Is the patient a boy or a girl?You said it was a girl in the article abstract] pre-sented with nursing-bottle caries lesions on the oc-clusal surfaces of his primary molars [Au: Maxil laryor mandibular?] and incisal surfaces of the maxillary
incisors (Fig 1). The patient was submitted to clinicaland radiographic evaluation in order to establish atreatment plan.
TREATMENT
After restoring the primary molars with resin compos-ite, the maxillary primary central incisors were submit-ted to a pulpectomy technique (Fig 2). The root canalswere obturated with an iodoform-based paste to twothirds their length, and a thin layer of resin-modifiedglass-ionomer [Au: Cement?] (Vitremer, 3M) wasplaced to isolate the root canal filling material. Theteeth were then cleaned, etched for 15 seconds with a37% phosphoric acid solution (Fig 3), rinsed withwater, and air dried. A light–cured bonding agent(Single Bond, 3M) was brushed on the etched surfacesand thinned by a compressed air blast. N ext, light-cured
resin composite (Z250, 3M), shade B2, was placed inseveral steps into the root canal and in the crown re-gion to form the superstructure of the post (Fig 4).
During the next visit, celluloid strip crowns wereused to build up the teeth (Pedo-form Strip Crowns,3M). The celluloid crowns have been previously se-lected based on the mesial-distal width of the teeth(Fig 5). The crowns were trimmed with scissors toachieve a good fit gingivally to the prepared incisors(Fig 6). The resin composite posts were etched for 15seconds with a 37% phosphoric acid solution (Fig 7),rinsed with water, and air dried. The light–curedbonding agent (Single Bond, 3M) was brushed on theresin composite posts. A hole was punched in thepalatal surface of the strip crowns using a sharp ex-plorer point to act as a vent when placing the resincomposite–filled crown. The celluloid crown formswere filled with shade B1 resin composite resin (Z250, 3M) and inserted with pressure onto the incisorand post (Fig 8). After polymerization on the buccaland palatal surfaces, a sharp tip of the explorer was in-serted at the gingival margin between the celluloidcrown form and the polymerized resin composite toremove the crown form. (Fig 9) Finishing, polishing,and occlusal adjustments were performed using dia-mond burs (KG Sorensen), Sof Lex discs (3M), andpolishing strips (Figs 10 to13).
The lateral maxillary incisors were also restoredwith celluloid strip crowns but without endodontictherapy. In order to improve esthetics, a bevel at cavo-surface margins was done on the facial surface of these teeth.
The child and parents were once again instructedabout proper dietary and oral hygiene habits. The im-portance of periodic visits in order to preserve the pri-mary dentition was also emphasized.
2 Volum e 35, N um ber 9, 2004
M endes et al
Fig 1 Frontal view of carious m axillary in-cisors.
7/24/2019 Jurnal Asli (1)
http://slidepdf.com/reader/full/jurnal-asli-1 3/5
Q uintessence International 3
M endes et al
Fig 2 Preparation of root canals for resincom posite post after end od ontic treatm ent.
Fig 3 Etch ing of roo t ca na ls for 15 sec -onds w ith 37% phosphoric acid.
Fig 4 R esin com posite p laced on the coro-nary portion follow ing the resin com positepost.
Fig 5 D ifferent size s of strip crow ns(Ped oform Strip C row n).
Fig 6 Selection of the strip crow ns basedon the m esial-distal w idth of the teeth.
Fig 7 Etching of resin com posite p osts for15 second s w ith 37% phosphoric acid.
Fig 8 C row n filled w ith resin com positeand inserted onto the prep ared incisor. N otethe excess resin on the palatal surface ex-trud ing through the vent.
Fig 9 An explorer tip w as used to rem ovethe strip crow n from the incisor leaving theresin com posite crow n in p lace.
Fig 10 Prim ary incisors restored w ith stripcrow ns b efore finishing an d p olishing ,show ing the esthetic appearance of the re-stored teeth.
Fig 11 Finishing w ith d iam ond stone on ahigh-speed hand piece.
Fig 12 Polishing of proxim al areas. Fig 13 Final radiograph show ing end odon-tic treatm en t, resin com posite short posts,and prim ary inc isors restored . [Au: Theimage shows the complete filing of onecanal and two thirds of a second canal.This is not consistent with the statementin the text of two-thirds length. Pleasecorrect discrepancy]
7/24/2019 Jurnal Asli (1)
http://slidepdf.com/reader/full/jurnal-asli-1 4/5
TREATMENT RATIONALE
The technique described restored esthetics and func-tion while eliminating laboratory processing and re-ducing costs. Chairtime was greatly reduced as theresin composite posts were prepared directly in the
root canal as opposed to adapting prefabricated ordentin posts. Furthermore, the technique involvedusing one cohesive material in the canal and crown(resin composite), while eliminating the cementationof the post. Also, resin short posts offered better es-thetic results since they do not require a layer of opaque material as used in metal posts. This techniquerepresents an alternative to other pr osthodont icrestorations in children in the absence of occlusal in-terferences [ Au : Ok t o delete “...in t he absence of oc-clusal in terferences.” ?] .
The use of celluloid strip crowns with resin com-posite short posts reduces operatory chairtime. Thetechnique does require selection and adaptation of strip crowns on the cervical margins of the teeth andthe reduction of excess resin composite around thegingival margin.
The technique described can be used to restore se-verely carious primary anterior teeth in two appoint-ments. The celluloid crown is filled with a resin com-posite, which is the same material used in fabricatingthe post. In addition, the celluloid crown produces aglossy fi nish, thereby minimizing polishing.
The described technique is simple and can be usedto restore severely carious or fractured primary ante-rior teeth, reestablishing function, shape, and estheticsin young children (Figs 14 and 15).
[AU: PLEASE MAKE A PORTION OF THE TEXT INTOTHE CONCLUSION OR PLEASE PROVIDE A SHORT
CONCLUSION]
REFERENCES
1. Tinanof f N, O’Sul l i van DM . Ear ly chi ldhood car ies:Overview and recent findi ngs. Pediatr Dent 1997;19:12–16.2. Davies GN . Early childh ood caries—A synopsis. Communi ty
Dent Oral Epidemiol 1998;26:106–116.3. Seow WK . Biological mechanisms of early chil dhood caries.
Community Dent Oral Epidemiol 1998;26:8–27.4. Bowen WH . Response to Seow: Biological mechanisms of
early childhood caries. Community Dent Oral Epidemiol1998;26:28–31.
Filho LE. Primary anterior tooth restoration using postswith macroretentive elements. Quintessence Int 1999;30:432–436.
10. Ramires-Romito ACD, Wanderley MT, Oliveira MD M ,Imparato JCP, Correa MSNP. Biologic restoration of pri-mary anterior teeth. Q uint essence Int 2000;31:405–411.
11. Grosso FC. Primary anterior strip crowns: A new techniquefor severely decayed anterior primary teeth. J Pedod 1987;11:375–384.
12. Judd PL , Kenny DJ, Johnston D H , Yacobi R. Compositeresin short-post technique for primary anterior teeth. J AmDent Assoc 1990;14:553–555.
13. M athias RS, Kramer PF, Imparato JCP, Guedes-Pinto A C.Operative and restorative dentistry. In: Guedes-Pinto AC(ed). Pediatri c Dentistry. São Paulo: Santos, 1997:569–607.
14. Issáo M, Guedes-Pinto AC. Pediatric Dentistry M anual. SãoPaulo: Pancast, 1978:132–134.
15. Citron CI . Esthetics in pediatric dentistry. NY State Dent J1995;61:30–33.
16. Vieir a CL, Ribeiro CC. Polyethylene fiber tape used as apost and core in decayed primary anterior teeth: A treat-ment option. J Clin Pediatr Dent 2001;26:1–4.
4 Volum e 35, N um ber 9, 2004
M endes et al
Fig 14 (left) A nterior view of m axillary in-cisors before crow n rehabilitation.
Fig 15 (right)Final anterior view . Follow -upof the anterior rehabilitation after a p eriod of4 m onths.
7/24/2019 Jurnal Asli (1)
http://slidepdf.com/reader/full/jurnal-asli-1 5/5
17. Casellato C, Giometti CF, Wanderley MT, Rodrigues-Filh oLE, Rodrigues CRMD. Shear-bond strength of primaryteeth restored with different intra-canal retention. J DentRes 2002;81:B–120. [ Au : Please give corr ect page range]
18. Perrela A, Sagretti OM A, Guedes-Pinto A C. Estudo com-parativo de técnica de retenção intracanal para recon-
strução de dentes decíduos anteriores [Au : Th is i sPortuguese?] . (Comparative study of post and core tech-nique for primary anterior teeth reconstruction.) Rev BrasOdontol 1995;52:42–45.
20. Croll TP. Restorative dentistry for preschool chil dren. DentClin Nor th A m 1995;39:737–770.
21. Ell is RK, Donly K J, Wil d TW. In direct composite resincrowns as an esthetic approach to treating ectodermal dys-plasia: A case report. Quintessence Int 1992;23:727–729.
22. Pollard M A, Curzon JÁ, Fenlon WL . Restoration of decayedprimary incisors using strip crowns. Dent Update 1991;18:150–152.
23. Updyk e J, Sneed, WD. Placement of a preformed ind irectresin composite shell crown: A case report. Ped Dent 2001;23:243–244.
24. Croll TP. Bonded composite resin crown s for primary in-cisors: Technique update. Quintessence Int 1990;21:153–157.
