Radicular Reinforcement – An Endodontic Challenge

 

 

Article by

 

Jeanne Zara Monteiro

Rajan Lambhor

 

Abstract

There are many treatment modalities involved in restoring an endodontically treated tooth, but the aesthetic and functional restoration of a pulpless tooth is a demanding challenge. Teeth that need endodontic therapy may also have a significant loss of structure resulting from caries, trauma or resorptive lesions. This article presents case reports, which utilize a simplified treatment modality for the reinforcement of the post/core supporting dentinal structures and for enhanced resistance to functional fracture. Luminex post technology and the original Classic post is used in combination with composite to strengthen root canals and eliminate the compromises in strength and aesthetics created by an overflared root canal and pulp chamber in endodontically treated teeth.

 

Introduction

The aesthetic and functional restoration of a pulpless tooth is a demanding challenge. Endodontic treatment compromises the strength of a tooth. Teeth that need endodontic therapy may also have a significant loss of structure resulting from caries or trauma, developmental defects and anomalies or resorptive lesions.

In some cases, more conventional restorative treatments can be difficult to accomplish. Using a prefabricated post to restore this situation is undesirable, as the post does not fit the canal and these posts placed in an enlarged canal filled with cement often contribute to premature failure of the tooth/post/core/crown[1].

The Luminex Light – Transmitting Post System (Dentatus USA) uses light-transmitting technology with adhesives and composite resin to restore structurally compromised pulpless teeth. Case reports using this innovative system for restoring a thin-walled endodontically treated teeth have been presented in this article.

Case Reports

Case I

A 12 year old male patient reported with a fractured upper front tooth with a history of trauma 1 year ago. On examination 11 was fractured at the middle third of the crown. The tooth was asymptomatic. IOPA revealed a flared root canal with no periapical lesion. A diagnosis of chronic irreversible pulpitis was made. Access opening was done under rubber dam isolation. Working length was determined using Ingle’s technique. Cleaning and shaping of the canals was completed with hand k-files. Sodium hypochlorite was used for irrigation and obturation was done with gutta-percha and a non eugenol sealer (Sealapex, SybronEndo) using lateral condensation. Post space was prepared using Dentatus reamers.

The technique followed was using manufacturer procedure guidelines.

 

The canal was etched with an etching gel, rinsed using an endodontic syringe filled with sterile water and air dried. Solobond plus bonding agent (primer and adhesive) was used in the Dual Cure Composite (Rebuilda DC; VOCO), was canal with the help of a microbrush, plugged into the canal with a Buchanan plugger and it was cured in place with the help of Luminex burn out post for 2 minutes. Luminex post (Dentatus USA), was then removed from the newly created, centered post space with a predetermined size. A stainless steel parallel sided Classic Dentatus post was selected and tried in. The post was passively cemented in with a dual cure flowable composite. The remainder was restored with composite and crown cutting was done followed by delivery of an intermediary crown with 11.

TC- Dec 2015 - 019 - case1

Case II

A 15 year old female patient complained of a fractured grossly decayed upper front tooth. On examination 21 was fractured at the cervical third of the crown and the IOPA revealed a flared root canal. The tooth was asymptomatic. The same procedure as Case I was followed. The core was built up using a dual cure core build up material. This was followed by fabrication and cementation of a provisional restoration.

 

 TC- Dec 2015 - 020 - case2

 

Review of Literature:

  • Saupe et al showed that the Luminex resin reinforced dowel system was upto 50% more resistant to fracture than conventional cast post and core.
  • Lui, Strassler et al have demonstrated adequate depth of curing composite resin within the root canal.
  • Tajan and coworkers evaluated the retention of a Dentatus Classic Post in a Luminex created composite lined root canal. They found that using Luminex significantly improved the retention of the post within the canal.

 

Discussion

The sole purpose of the cast post is to replace missing coronal tooth structure and provide retention for the crown. The features of Luminex system and Surtex Classic Posts are discussed below.

 

Functions of Luminex (LTP)

  • Transilluminates the interior of the root canal, enabling polymerization of light cure adhesives and composite resin to the full depth of the canal.
  • Provides a new centered ‘canal’ surrounded by composite resin (adapted and bonded to the intraradicular dentin walls) providing root strengthening and reinforcement.
  • Creates a full length predetermined- sized canal for use with the Classic metal post.
  • Eliminates the problem of limited working time, associated with self cure composite resins.

 

ADVANTAGES OF LPS

  • Polymerization shrinkage does not occur within the root canal when the Luminex System is used.
  • The Luminex post does not chemically bond with dental composite resins, so it can be easily removed.
  • Reinforced Root Strength: Light-cured composites internally reinforce the root structure providing maximum sheer load support and retention.
  • Technique Versatility: Luminex smooth and grooved posts may be also used as an impression and castable post pattern in the direct and indirect fabrication of posts.

 

Features of SURTEX posts

  • Posts are 200% more retentive when surface texturized.
  • The SURTEX non-reflective interface is adequately masked with aesthetic composite and core materials without opaquers.
  • SURTEX posts perform amazingly well with bonding agents and composite restorative materials.

 

Conclusion:

Thin walled fragile roots are no longer condemned to poor prognosis. Intra radicular rehabilitation offers means to the  clinician to create an ideal post /channel geometry in such teeth. With this innovative technique, the compromises in strength and aesthetics created by an overflared root canal and pulp chamber in endodontically treated teeth can be overcome.

 

TC- Dec 2015 - 021 - Writers art pg 37

 

References:

 

  1. Strassler H, Mullen K, Buttaro L. An innovative technique for the Esthetic Restoration and Reinforcement of Endodontically treated teeth. Contemporary Esthetics and Restorative Practice. October 1997.
  2. Saupe WA, Gluskin AH, Radke RA: A Comparative study of fracture resistance between morphological dowel and cores and a resin reinforced dowel system in the intraradicular restoration of structurally compromised roots. Quintessence Int 1996; 27:483-491.
  3. Lui JL: Depth of composite polymerization within stimulated canals using light-transmitting posts. Oper Dent 1994;19: 165-168.
  4. Tjan AHL, Tjan AH, Sun JC: Retention of Luminex post system. Oral Health 1997; 878: 31-35.
  5. www.dentatus.com.