Restoration Of A Fractured Tooth With Dental Glass Fiber And Composite Crown: A Case Report

摘要

Restoration of a fractured tooth is routinely performed in clinical practice. Many factors are considered in the effort to provide optimal mechanical properties, esthetics, and longevity. Improvements in bondable dental glass fiber systems have stimulated a trend toward more conservative techniques. The aim of this clinical report is to describe restoration of a fractured maxillary lateral incisor tooth with a dental glass fiber post and composite resin without additional crown coverage. The restoration made it possible to maintain the remaining tooth structure in a good occlusion and resulted in a high level of patient satisfaction. Introduction Glass fiber posts bonded to root canal dentine via resin cement are now very popular for the restoration of endodontically treated teeth (1,2,3). The similarity in modulus of elasticity of glass fiber posts and resin cement with that of dentine have been advantageous in improving the performance of these kinds of restorations, as compared with cast metal post and core restorations (1,4,5). It is thought that fiber posts can distribute stresses between the post and dentine by their flexibility under load, resulting in favorable clinical behavior (6,7). Thus if excessive loads are applied to the tooth, the post will be able to absorb stresses, reducing the possibility of root fracture (6). The use of a post–core crown to restore the tooth has been reported to play a significant role in resistance of the tooth (8).Improvements in composites and the development of dentine bonding systems have stimulated a trend toward more conservative techniques of tooth restoration, which afford increased opportunities to preserve badly broken permanent incisor teeth (9). Currently used glass fiber post systems are designed to be corrosion resistant, are able to bond to tooth structure, are esthetically pleasing, and allow retrieval when the post core system fails (6).Glass fiber is a biocompatible, inert, translucent, and durable material that includes free radicals that can form chemical connections. Fibers for reinforcement are silanized electrical glass (E-glass) fibers and are impregnated with polymer by the manufacturer. EverStick (continuous unidirectional E-glass fiber bis-GMA with PMMA–bis-GMA matrix, impregnated with light-polymerizing resin, Stick Tech Ltd, Turku, Finland) offers a long-term, easy-to-use, reliable, and cost-effective material with a scientifically documented background (6,10,11,12,13).The purpose of this study was to describe a glass fiber post–core and a direct composite crown strong enough to be used to restore an anterior tooth. The influence of fiber reinforcement, esthetics, conservation, and cementation technique on the resistance of the anterior composite post crown was also evaluated. Clinical Case An 28-year-old male patient was initially examined for acute pain in the maxillary right lateral incisor. Clinical examination revealed that her maxillary right lateral incisor tooth was fractured at the cementoenamel junction. The root of the tooth was treated endodontically and filled with gutta percha and resin sealer in the normal manner, followed by gingivectomy in the labial region (Fig. 1). Afterward, the gutta percha was removed with Gates drills (Antaeos, VDW GmbH, Munchen, Germany) without enlarging the canal. At least 3–5 mm of gutta percha was left at the apex of the root. The depth of the prepared canal was measured using a periodontal probe, and the root canal drilled according to general principles until it measured the estimated depth required for the post. The inside of the root was rinsed and dried carefully, and the working area was isolated from moisture by cotton plugs.The root canal walls were etched with 37% phosphoric acid for 15 seconds, washed with spray, and then air dried. The excess water was removed from the post space using paper points. Subsequently, two consecutive coats of bonding agent (Single Bond 2, 3M ESPE, St Paul, MN, USA) were applie