|Year : 2013 | Volume
| Issue : 2 | Page : 87-89
Bio-reconstruction of root canal using dentin post
Navin Mishra1, Isha Narang2
1 All India Institute of Medical Sciences, New Delhi, India
2 Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
|Date of Web Publication||13-Sep-2013|
All India Institute of Medical Sciences, New Delhi
Source of Support: None, Conflict of Interest: None
This case report describes the successful management of complicated crown fracture of left maxillary central incisor (#21) of 23-year-old male using dentin (biological) post made from human tooth. Endodontic treatment was initiated and sectional obturation was done using ProTaper gutta-percha and AH Plus sealer. The coronal space was modified to receive a human dentin post. A two-step procedure comprising direct and indirect technique of post fabrication was done to achieve the accuracy of biological post. A maxillary cuspid from an institutional tooth bank was taken, sectioned mesiodistally using a diamond disc simulating the length and thickness of mock post. Dentin post was first verified on the plaster model and then cemented in tooth #21. Core build up was done with composite and porcelain fused to metal (PFM) crown was luted. On the follow-up visits, patient was asymptomatic and radiographic evaluation revealed normal periradicular architecture. Biological posts may be good alternatives to conventional post systems as they preserve internal dentin walls, provide excellent adhesion, and resilience similar to natural tooth structure.
Keywords: Biological restoration, bio-reconstruction, dentin post
|How to cite this article:|
Mishra N, Narang I. Bio-reconstruction of root canal using dentin post. Saudi Endod J 2013;3:87-9
| Introduction|| |
Traumatic injuries to anterior teeth are quite common in children aged 6-13 years. The prevalence rate of these dental injuries to permanent incisor teeth is 15.1% in South Indian population.  Moreover, it has been reported that one out of every four persons under the age of 18 years sustains such injuries. These traumatic dental morbidities result in functional, social, and psychological disturbances. ,, Thus, restorative approach plays a key role in maintenance of aesthetics as well as functional occlusion. A satisfactory smile can be achieved with wide variety of aesthetic materials such as resin, porcelain, etc., But, up to date no restorative material has gained the aesthetics and smoothness of natural dental structures.  Several studies have reported the successful reattachment of natural tooth fragments after complicated or uncomplicated crown fractures,  but to achieve intraradicular retention and stability in severely compromised anterior teeth, the custom made or prefabricated posts such as fiber glass, carbon fiber, metal, or ceramics are used. However, no commercially available posts fulfill all the mechanical and biological requirements. Thus, Kaizer et al.,  in 2008 utilized the posts made up of dentin to reconstruct the weakened roots. The use of such posts is a viable alternative as they have resilience of natural tooth structure, provides excellent adhesion, does not promote dentin stresses, preserves the internal dentin walls, biocompatible, and easily adapts to the configuration of root canal.  This case report describes the use of biological post made from sterilized natural extracted tooth from institutional tooth bank for management of compromised anterior tooth.
| Case Report|| |
A 23-year-old male reported to the Department of Conservative Dentistry and Endodontics, with chief complaint of fractured left upper front tooth [Figure 1]a and history of bicycle fall 1 month back. The patient's medical history was noncontributory. Extraoral examination did not reveal any significant changes. Clinical examination revealed Ellis class III fracture in tooth #21 involving more than half of the coronal structure with no fistulae or edema. Periodontal, endodontic, and occlusal evaluation of tooth #21 and adjacent teeth were done. There was no tenderness to percussion and palpation and the mobility of tooth was in normal physiological limits. Thermal testing elicited no response in tooth #21. Intraoral periapical radiograph revealed slight widening of periodontal ligament space with respect to tooth #21. The diagnosis of pulpal necrosis with asymptomatic apical periodontitis was made. All treatment options were explained and patient gave consent to restore tooth #21 with biological post made from tooth taken from institutional tooth bank. Endodontic treatment was initiated and sectional obturation was done using ProTaper gutta-percha and AH Plus sealer [Figure 1]b. Restorative technique initially consisted of crown preparation and slight modification of root canals to receive a biological post. A two-step procedure comprising direct and indirect technique of post fabrication was done. In the first step, the direct molding of post space was done with self-curing acrylic resin (Duralay, Reliance Dental Mfg. Co., Worth, IL, USA) to form a mock (resin) post [Figure 2]a. In the second step, the impression of post space was taken using light body impression material and stainless steel pin in the canal and two stage putty wash impression was taken (ADSIL, Vigodent SA, Rio de Janeiro, Brazil) and the plaster model was established. Mock post was placed in the plaster model to evaluate the adaptation. After confirming its adaptation at macroscopic level, it was used as a reference to establish the length, thickness, and shape of the biological post which was made from a maxillary cuspid derived from institutional tooth bank. The canine was sectioned mesiodistally using diamond disk and entire pulp canal space was removed, resulting in a thick section of dentin simulating the mock post [Figure 2]b. Biological post was then verified on the plaster model. In next appointment, the dentin post was sterilized in an autoclave at 134°C for 10 min under 30 psi pressure. The canal surface in tooth #21 and dentin post were etched. Self-adhesive dual cure resin cement (C and B Cement, Bisco, and Schaumburg, IL, USA) was applied on to the dentin post and canal walls. Dentin post was placed in the prepared space and photopolymerization was done for 40 s [Figure 3]a and b. Core build up was done with composite (Z250, 3M ESPE, USA) and temporary crown was cemented. Necessary occlusal adjustments were done. Patient was given postoperative instructions. After 1 week, patient was recalled for PFM crown [Figure 4]a. Patient was clinically asymptomatic after follow-up period of 6-months and 1 year. Intraoral periapical radiograph revealed the normal periodontal architecture in periapical region of tooth #21 [Figure 4]b.
|Figure 1: (a) Clinical view showing a fractured crown. (b) Periapical radiograph after sectional obturation|
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|Figure 4: (a) Crown cemented. (b) Intraoral periapical radiograph after 1 year|
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| Discussion|| |
Advancement in adhesive technology and restorative armamentarium has resulted in use of natural tooth fragments for management of fractured anterior teeth. These restorations are commonly known as biological restorations. When patient presents the fragment in good condition, the same fragment is used to provide optimal function and aesthetics called as autogenous bonding. , Homogenous bonding refers to the use of natural extracted teeth form tooth bank, if patient does not present the fragment or its use is not indicated. Corrêa-Faria et al.,  in 2010 used posts and crowns made from extracted teeth for reconstruction of compromised anterior teeth. 
A human tooth bank is a nonprofit institution that is associated with a college, university, or other such institution that provides the tooth for didactic, scientific, and clinical use.  Its purpose is to fulfill academic needs for research and laboratory training for students. It has strict control on separation and stocking of teeth and maintenance of donors' and beneficiaries records. The tooth bank functions within the framework of tissue banks' activity in terms of cryopreservation. , Human tooth banks work for the elimination of cross-infection caused by indiscriminate handling of extracted teeth. To further reduce the risk of contamination, dentin post was further sterilized in an autoclave.
In the present case, since the coronal destruction extended to the cervical third of tooth, the use of intraradicular retention was deemed necessary. This retention was achieved with biological posts as it provides the excellent adhesion to resin and canal walls, thus attaining the monoblock system. The coronal part of canal was slightly modified with files to achieve the molding with self-curing acrylic resin instead of Peaso reamers and Gates-Glidden drills, resulting in preservation of internal dentin walls.
Careful assessment of patient's occlusion should be done in terms of premature contacts Patient's consent is most important as use of extracted teeth form another person has a psychological impact.
Advantages include the excellent results in terms of its functional value as it preserves inner dentin and results in better distribution of forces along the root surface in compromised teeth. Another advantage is its low cost, thus it could be accepted as a useful technique in dental schools for the people of low socioeconomic status.
The present case study reported the successful use of dentin posts, however further studies are required to measure the adhesion, function, and long-term behavior of these biological posts. Use of advanced technology like computer-aided designing and machining (CAD-CAM) may be used in future research work to achieve the accurate dimensions of biological posts as that of post space.
| Conclusion|| |
The use of dentin post is justified as it provided the excellent adhesion, strength to remaining tooth structure, and retention to the crown.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]