JICDRO is a UGC approved journal (Journal no. 63927)

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CASE REPORT
Year : 2016  |  Volume : 8  |  Issue : 1  |  Page : 67-69

Dentin post: A new method for reinforcing the tooth


Department of Conservative Dentistry and Endodontics, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India

Date of Web Publication12-Feb-2016

Correspondence Address:
Dr. Deepa A Thakur
Plot No. 18, Narmada Society, Bhupesh Nagar, Nagpur - 440 013, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2231-0754.176260

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   Abstract 

Ideal coronal reconstruction of a fractured tooth is still a challenge for restorative dentistry. Many post systems are available but none of them have all the ideal biological and mechanical properties. In this case report a "dentin post" was used for the reinforcement of fractured endodontically treated tooth by virtue of its biomimetic property. Following root canal treatment, a post space was prepared. A direct wax impression was made of the post space. A freshly extracted maxillary cuspid was used to prepare a dentin post, which was then verified in the post space. The dentin post was then luted with dual-cure resin in the canal. Biological dentin posts are considered a good alternative to conventional post systems as they preserve internal dentin walls and provide excellent adhesion and resilience, similar to the natural tooth structure.

Keywords: Biomimetic property, dentin post, post space


How to cite this article:
Thakur DA, Patil S, Mohkar S, Gade V. Dentin post: A new method for reinforcing the tooth. J Int Clin Dent Res Organ 2016;8:67-9

How to cite this URL:
Thakur DA, Patil S, Mohkar S, Gade V. Dentin post: A new method for reinforcing the tooth. J Int Clin Dent Res Organ [serial online] 2016 [cited 2020 Sep 22];8:67-9. Available from: http://www.jicdro.org/text.asp?2016/8/1/67/176260


   Introduction Top


Many endodontically treated teeth are grossly destructed with insufficient coronal structure, and in these teeth posts are needed to retain the core. [1] Post material plays a crucial role in the biomechanical performance of endodontically treated teeth. Ideally, the post material should have physical properties, such as modulus of elasticity, compressive strength, and thermal expansion, and esthetics that are similar to those of dentin; in addition it should bond predictably to the root dentin. To achieve intraradicular retention and stability in severely compromised anterior teeth, various post systems can be used, such as custom-made or prefabricated post of materials such as fiber glass, carbon fiber, metal, or ceramics. However, no commercially available posts fulfill all the mechanical and biological requirements. [2] The only material that can have all these properties is none other than the dentin itself. A few reported cases utilizing dentin as the post material have shown successful outcomes. [3],[4]

This case report describes the use of a dentin post made from a natural, extracted sterilized tooth for the management of compromised anterior tooth.


   Case Report Top


A 24-year-old male patient was referred to the Department of Conservative Dentistry and Endodontics with the complaint of a fractured left maxillary lateral incisor. Clinical examination revealed Ellis class III fracture in tooth #22 involving more than half of the coronal structure, with no fistulae or edema [Figure 1]. There was no tenderness to percussion and palpation, and the mobility of the tooth was within normal physiological limits. Thermal testing elicited no response in tooth #22. Intraoral periapical radiograph revealed slight widening of the periodontal ligament space with respect to tooth #22. The diagnosis of pulpal necrosis with asymptomatic apical periodontitis was made. All treatment options were explained, and the patient gave consent to restore tooth #22 with a biological post made from a freshly extracted canine. Ethical Committee permission was taken prior to the initiation of treatment procedures. Endodontic treatment was initiated and obturation was done using gutta percha and a Resino Seal (Amrith Chemicals and Mineral Agency, Punjab, India) sealer. The post space was prepared using Peeso reamers (Mani, Prime dental products, Mumbai, Maharashtra) and 5 mm of apical seal was preserved. A direct wax impression of the post space was taken. A freshly extracted, intact maxillary canine tooth was chosen and subjected to autoclaving at 121°C, 103421.35 Pa or N/m 2 for 15 min. The extracted tooth was then sectioned buccolingually along the long axis using a diamond disk without involving pulp space. The direct wax impression of the prepared post space served as a guide for the shape, thickness, and length of the dentin post. Using the wax impression, further contouring of the sectioned tooth into a dentin post and core was done with the help of a tapered fissure bur [Figure 2].
Figure 1: preoperative (a) labial view (b) palatal view (c) radiographic view

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Figure 2: intraoperative (a) post obturation (b) post space preparation (c) direct wax impression of the canal (d) contouring of freshly extracted tooth maxillary canine: same as wax impression (e) verification of dentin post in the root canal

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The dentin post was periodically verified in the prepared post space of the lateral incisor throughout the process of contouring. Following satisfactory adaptation of the biological post clinically and radiographically, the dentin post was again autoclaved at 121°C, 15 lbs psi for 15 min, and then cemented in the root canal using a dual-cure resin Calibra® (Dentsply, Konstanz, Germany). The core was further modified using Filtek™ Z250 Universal Dental Restorative (3M ESPE, St. Paul, MN, USA).

Following this, tooth preparation was done for the patient to receive a full veneer crown. Gingival tissue retraction was done and a rubber base impression was made. The full veneer crown was fabricated and cemented with dual-cure resin [Figure 3].
Figure 3: postoperative (a) postoperative after cementation of dentin post clinically (b) postoperative after cementation of dentin post radiographically (c and d) recall after 12 months

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The patient was made aware of the postoperative instructions and maintenance. The case was followed up for a period of 12 months, which revealed satisfactory functional, esthetical, and structural performance of the tooth, with normal clinical and radiographic findings.


   Discussion Top


Case report presents an effective management of fractured tooth with a dentin post. Faria et al. [5] have reported successful management of extensively damaged maxillary central incisors through the preparation and adhesive cementation of biological posts and crowns in a young patient. The technique used by them for the fabrication of a dentin post involved the retrieval of an acrylic resin pattern of the canals from a plaster model, which was then used as a reference for contouring the dentin post.

In this case, a direct wax impression of the canal was used as a guide for shaping the dentin post. Although the technique is simple, it requires professional expertise to prepare and adapt the dentin intracanal posts.

The extracted tooth for preparation of the dentin post was selected from a patient scheduled for extraction of an intact maxillary canine due to periodontal disease. The donor was subjected to a thorough review of medical history and routine blood investigations including human immunodeficiency virus (HIV) and hepatitis B surface antigen (HB s Ag) before the initiation of the procedure. Following extraction, the tooth was properly cleaned, stored, and sterilized by autoclaving at 121°C, 15 lbs psi for 15 min, ensuring all biosecurity standards. The tooth was autoclaved twice, after extraction and before cementation of the post. [6] As a freshly extracted tooth was used, the biomechanical properties of the dentin were well preserved. Autoclaving of teeth may cause a slight reduction in dentin microhardness, but it does not alter physical properties sufficiently to compromise on the strength. [7],[8]

The dentin post closely resembles root dentin in all its physical properties, such as modulus of elasticity, viscoelastic behavior, [9] compressive strength, [10] and thermal expansion. [11] Moreover, the fracture toughness of dentin has been found to be better than most of the current restorative materials. [12] A dentin post forms a micromechanical homogenous unit with the root dentin that results in uniform stress distribution. [13] The similarity in the elasticity of a dentin post to that of root dentin may allow post flexion to mimic tooth flexion so that the post acts as a shock absorber, transmitting only a fraction of the stresses placed on the tooth to the dentinal walls. [14] A dentin post being less expensive makes this practice a feasible option within dental institutions that attend mostly to people from the lower economic strata.

Ambica et al. [15] and Kathuria et al. [16] in their study reported that dentin posts demonstrated higher fracture resistance than carbon fiber posts and glass fiber posts. Hence, the use of a dentin post is considered a novel technique for the restoration of endodontically treated teeth.


   Conclusion Top


The use of a dentin post is justified as it provides excellent adhesion, strength to the remaining tooth structure, and retention to the crown.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Sorensen JA, Martinoff JT. Intracoronal reinforcement and coronal coverage: A study of endodontically treated teeth. J Prosthet Dent 1984;51:780-4.  Back to cited text no. 1
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2.
Cheung W. A review of the management of endodontically treated teeth. Post, core and the final restoration. J Am Dent Assoc 2005;136:611-9.   Back to cited text no. 2
    
3.
de Alcântara CE, Corrêa-Faria P, Vasconcellos WA, Ramos-Jorge ML. Combined technique with dentin post reinforcement and original fragment reattachment for the esthetic recovery of a fractured anterior tooth: A case report. Dent Traumatol 2010;26:447-50.  Back to cited text no. 3
    
4.
Remires-Romito AC, Wanderley MT, Oliveira MD, Imparato JC, Corrêa MS. Biologic restoration of primary anterior teeth. Quintessence Int 2000;31:405-11.   Back to cited text no. 4
    
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.
Lolayekar NV, Bhat SV, Bhat SS. Disinfection methods of extracted human teeth. J Oral Health Comm Dent 2007;27:27-9.   Back to cited text no. 6
    
7.
Pantera EA Jr, Schuster GS. Sterilization of extracted human teeth. J Dent Educ 1990;54:283-5.  Back to cited text no. 7
    
8.
Parsell DE, Stewart BM, Barker JR, Nick TG, Karns L, Johnson RB. The effect of steam sterilization on the physical properties and perceived cutting characteristics of extracted teeth. J Dent Educ 1998;62:260-3.  Back to cited text no. 8
    
9.
Kinney JH, Marshall SJ, Marshall GW. The mechanical properties of human dentin: A critical review and re-evaluation of the dental literature. Crit Rev Oral Biol Med 2003;14:13-29.  Back to cited text no. 9
    
10.
Jantarat J, Palamara JE, Lindner C, Messer HH. Time-dependent properties of human root dentin. Dent Mater 2002;18:486-93.  Back to cited text no. 10
    
11.
Kishen A, Asundi A. Investigations of thermal property gradients in the human dentine. J Biomed Mater Res 2001;55:121-30.  Back to cited text no. 11
    
12.
El Mowafy OM, Watts DC. Fracture toughness of human dentin. J Dent Res 1986;65:677-81.  Back to cited text no. 12
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13.
Newman MP, Yaman P, Dennison J, Rafter M, Billy E. Fracture resistance of endodontically treated teeth restored with composite posts. J Prosthet Dent 2003;89:360-7.  Back to cited text no. 13
    
14.
Martelli R. Fourth-generation intraradicular posts for the aesthetic restoration of anterior teeth. Pract Periodontics Aesthet Dent 2000;12:579-84; quiz 586-8.  Back to cited text no. 14
    
15.
Ambica K, Mahendran K, Talwar S, Verma M, Padmini G, Periasamy R. Comparative evaluation of fracture resistance under static and fatigue loading of endodontically treated teeth restored with carbon fiber posts, glass fiber posts, and an experimental dentin post system: An in vitro study. J Endod 2013;39:96-100.  Back to cited text no. 15
    
16.
Kathuria A, Kavitha M, Khetarpal S. Ex vivo fracture resistance of endodontically treated maxillary central incisors restored with fiber-reinforced composite posts and experimental dentin posts. J Conserv Dent 2011;14:401-5.  Back to cited text no. 16
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