The effect of ferrule and core material on fracture resistance of endodontically treated anterior teeth restored with ceramic crowns after artificial aging.

OBJECTIVES: To assess the influence of ferrule and core type on the fracture strength of endodontically treated anterior teeth (ETAT) and identify the failure mode type and distribution across different core types and ferrule conditions. METHODS: Sixty extracted human central incisors were endodontically treated, decoronated and divided into two main groups (F=with ferrule, NF=no ferrule). Each main group was further subdivided into three subgroups according to the core material used: direct composite cores (DC), Ribbond fibre-reinforced composite cores (RIB-DC), and glass fibre post (GFP) with direct composite cores (GFP-DC). All specimens received E.max crowns and underwent thermal cycling and cyclic loading. Subsequently, the fracture resistance was tested with static loads applied to the crown restoration. Two-Way ANOVA and Chi square tests identified significant differences among the groups (p < 0.05). RESULTS: The means and standard deviations (SD) of fracture loads in Newtons (N) for specimens in the F subgroups were RIB-DC: 465.0 (104.20), GFP-DC: 367.6 (79.59), DC: 275.8 (68.48), and in NF subgroups were RIB-DC: 110.8 (24.33), GFP-DC: 95.6 (25.47), DC: 67.4 (7.46). Specimens with ferrule yielded significantly higher fracture loads than those without ferrule (p = 0.0054). In the F groups, fracture loads of specimens with RIB-DC cores were significantly higher than those with GFP-DC (p = 0.0019) and those with DC (p = 0.0001). Moreover, fracture loads for the GFP-DC were significantly higher than those for the DC (p = 0.0026). The GFP-DC specimens showed the highest incidence of catastrophic failures (p = 0.0420). CONCLUSIONS: Using fibre-reinforced composite (FRC) cores significantly increased fracture resistance in ETAT with ferrule. The failure modes repairable and possibly repairable were dominant in most specimens. CLINICAL SIGNIFICANCE: When restoring ETAT with insufficient coronal tooth structure, preserving 2 mm of tooth structure ferrule and preparing cores with FRC can increase fracture resistance and reduce the incidence of non-repairable catastrophic fractures of teeth.

Comparative evaluation of marginal adaptation and fatigue resistance of endodontically treated premolars restored with direct and indirect coronal restorations: an in vitro study.

BACKGROUND: An optimum restoration for reconstructing endodontically treated teeth should provide excellent marginal adaptation, high fracture resistance as well as maximum tooth structure conservation. The purpose of this study was to evaluate the marginal adaptation and fatigue resistance of different coronal restorations in endodontically treated premolars. METHODS: Thirty sound maxillary first premolars were endodontically treated and received MOD cavities. Teeth were randomly allocated into three groups (n = 10) according to the type of coronal restoration: Group R: polyethylene fibers (ribbond), fibers-reinforced composite (everX posterior) and final layer of nano-hybrid composite. Group O: indirect lithium disilicate overlay and Group C: fiber-post, resin composite restoration, and lithium disilicate crown. Marginal gap assessment was performed before and after thermocycling (5000 cycles) using stereomicroscope. Samples were subjected to stepwise-stress loading starting at 200 N, and increased by 100 N in each step until failure occurred. Statistical analysis was done by One-way ANOVA followed Tukey`s Post Hoc test for multiple comparison. Paired t test was used to compare the marginal adaptation before and after thermocycling. Survival probability was evaluated by Life table survival analysis. Failure mode analysis was performed with Chi-square test. RESULTS: Marginal gap was significantly the lowest in group R (37.49 ± 5.05) and (42.68 ± 2.38), while being the highest in group C (59.78 ± 5.67) and (71.52 ± 5.18) in before and after thermocycling respectively (P < 0.0001). Fatigue resistance was the highest for group O (1310.8 ± 196.7), and the lowest for group R (905.4 ± 170.51) with a significant difference between groups (P < 0.0001). Crown group had the highest percentage (80%) of catastrophic failure, while, overlay group exhibited the lowest (20%). CONCLUSIONS: Direct restoration without cuspal coverage using ribbon fibers with short FRC provided better marginal adaptation than indirect overlays and crowns, but fatigue resistance wasn't significantly improved. Adhesive ceramic overlays showed the best fatigue performance and the least catastrophic failure rate compared to both direct fiber-reinforced composite and indirect ceramic full coverage restorations. CLINICAL SIGNIFICANCE: Indirect adhesive overlays are a suitable, more conservative restorative option for endodontically treated teeth than full coverage restorations, especially when tooth structure is severely compromised.

Cuspal deflection of teeth restored with bulk fill flowable composite resins, with and without fiber-reinforcement and evaluated by Micro-computed Tomography.

Polymerisation shrinkage of composite resins is a clinical challenge which has been well documented in the literature. Many studies investigating polymerisation shrinkage stress measure cuspal deflection, which is a manifestation of this stress. The introduction of flowable bulk-fill composite (BFRBC) materials has streamlined the restorative process, though the shrinkage and cuspal deflection from these BFRBCs has not been compared with regards to its use with polyethylene fibers (Ribbond fibers). The authors describe a method to measure the cuspal deflection of flowable BFRBCs placed in cavities of standardised dimensions at distinct steps of the restorative process, with and without fiber-reinforcement and using x-ray micro-computed tomography. Co-ordinate points are established on the buccal and lingual aspects of scanned specimens using the Volume Graphics VG Studio max 3.2.5 (Hiedelberg, Germany 2018) software. The system allows for these landmarks to be established across each scan (of the same tooth), ensuring standardization of each specimen. Further anatomical points are used to enable analysis. Comparison of angles generated across these points determines the extent of cuspal deflection.•A method of measuring the cuspal deflection of composite resins is proposed.•Experimental procedures are provided.•Data analysis methods are outlined.

Fracture Load of Mesio-Occluso-Distal Composite Restorations Performed with Different Reinforcement Techniques: An In Vitro Study.

BACKGROUND: Mesio-occluso-distal (MOD) cavity preparations are often fragile due to the amount of tooth and carious structure removed. MOD cavities can often fracture if left unsupported. AIM: The study investigated the maximum fracture load of mesi-occluso-distal cavities restored using direct composite resin restorations with various reinforcement techniques. METHOD: Seventy-two freshly extracted, intact human posterior teeth were disinfected, checked, and prepared according to predetermined standards for mesio-occluso-distal cavity design (MOD). The teeth were assigned randomly into six groups. The first group was the control group restored conventionally with a nanohybrid composite resin (Group I). The other five groups were restored with a nanohybrid composite resin reinforced with different techniques: the ACTIVA BioACTIVE-Restorative and -Liner as a dentin substitute and layered with a nanohybrid composite (Group II); the everX Posterior composite resin layered with a nanohybrid composite (Group III); polyethylene fibers called "Ribbond" placed on both axial walls and the floor of the cavity, and layered with a nanohybrid composite (Group IV); polyethylene fibers placed on both axial walls and the floor of the cavity, and layered with the ACTIVA BioACTIVE-Restorative and -Liner as a dentin substitute and nanohybrid composite (Group V); and polyethylene fibers placed on both axial walls and the floor of the cavity and layered with the everX posterior composite resin and nanohybrid composite (Group VI). All teeth were subjected to thermocycling to simulate the oral environment. The maximum load was measured using a universal testing machine. RESULTS: The highest maximum load was exhibited by Group III with the everX posterior composite resin, followed by Group IV, Group VI, Group I, Group II, and Group V. A statistically significant difference was demonstrated between groups (p = 0.0023). When adjusting for multiple comparisons, there were statistical differences specific to comparisons between Group III versus I, Group III versus II, Group IV versus II, and Group V versus III. CONCLUSIONS: Within the limitations of the current study, it can be concluded that a higher maximum load resistance can be achieved (statistically significant) when reinforcing nanohybrid composite resin MOD restorations with everX Posterior.

Evaluation of Fracture Strength of Fiber-Reinforced Direct Composite Resin Restorations: An In Vitro Study.

This in vitro study aimed to compare the fracture strength of direct non-reinforced class II composite resin restorations and polyethylene fiber-reinforced restorations, and also to investigate the influence of the locations of polyethylene fibers within the cavity on the fracture strength. Sixty freshly extracted human teeth were disinfected and prepared (class II cavity design). The teeth were assigned randomly into four groups (n = 13). Group I (control) was restored with nano-hybrid composite resin. The other three experimental groups were restored with the same composite resin material reinforced by polyethylene fibers (Ribbond) at different locations. Fibers were placed either on the axial wall (Group II), on the gingival floor (Group III), or on the axial wall and pulpal/gingival floor (Group IV) of the proximal cavity. All the teeth were subjected to thermocycling to simulate the oral environment. The fracture strength was measured using a universal testing machine. Group IV had the highest mean fracture strength at maximum load (148.74 MPa), followed by Group II (140.73 MPa), Group III (136.34 MPa), and Group I (130.08 MPa), with a statistically significant difference from the control group (p = 0.008) but not between groups II and III.

Corono-radicular reinforcement with minimal invasion: A novel case report.

Maxillary premolar with an oval-shaped canal always poses a challenge while reconstruction using the post and core system. Fiber-post has many advantages over metallic-post and so fiber-post is becoming more popular and particularly widely used than metallic-post nowadays. Fiber-post has benefits of esthetic and strength, and its combination with flexible material, Ribbond has provided it with a high rise in the field of dentistry. The purpose of this case report was to show an innovative technique to place both glass fiber-post and Ribbond as a single assembly into the canal which gives a monoblock effect. This technique is feasible and may eradicate some of the problems associated with the cementation of ill-fitted fiber-post in an oval-shaped canal with widened canal space.

Comparison of Ribbond and Everstick Post in Reinforcing the Re-attached Maxillary Incisors Having Two Oblique Fracture Patterns: An In Vitro Study.

AIM AND OBJECTIVE: This study aims to compare the resistance to fracture in maxillary incisors which were fractured in two different oblique patterns and then were re-attached and reinforced using anatomic fiber-reinforced composite (FRC) post. MATERIALS AND METHODS: Sixty extracted and intact human maxillary incisors were obtained and divided into two groups (A and B; n = 30). "Labiopalatal" and "palatolabial" fractures were induced in group A and group B, respectively. These two groups were further subdivided into two subgroups (n = 15). In subgroup I Ribbond fiber (Ribbond Inc., Seattle, WA, USA) and in subgroup II Everstick post (everStick Post™, GC Corporation, Tokyo, Japan) were used. Fractured fragments were re-attached using resin and tested for fracture resistance in universal testing machine. Statistical analysis was done with ANOVA one-way test and post hoc test. RESULTS: The labiopalatal fracture pattern of group A showed significantly increased resistance to fracture than the palatolabial fracture pattern of group B in both the subgroups. Similarly, subgroup II with Everstick post exhibited significantly higher fracture resistance than subgroup I with Ribbond in both groups A and B (p value < 0.05). CLINICAL SIGNIFICANCE: The study simulates a clinical scenario of coronal fracture of a tooth and focuses on the techniques and materials which can be used for successful management of such cases. HOW TO CITE THIS ARTICLE: Khurana D, Prasad AB, Raisingani D, et al. Comparison of Ribbond and Everstick Post in Reinforcing the Re-attached Maxillary Incisors Having Two Oblique Fracture Patterns: An In Vitro Study. Int J Clin Pediatr Dent 2021;14(5):689-692.

In vitro Study Comparing Fracture Resistance of Nanocomposites with and without Fiber Reinforcement with Different Cavity Designs Used for Obliquely Fractured Incisal Edge Restoration.

AIM: The aim of the study is to evaluate fracture resistance of nanocomposites with and without fiber reinforcement with different cavity designs used for obliquely fractured incisal edge restoration. MATERIALS AND METHODS: In the present study, 60 sound extracted maxillary central incisors were mounted on autopolymerizable acrylic resin up to the cementoenamel junction, out of which, 10 intact teeth were kept as control (group 1) and the remaining 50 samples were reduced incisally in an oblique manner up to 3 mm. All incisally reduced samples were divided into five groups (n = 10) based on the restoration techniques as follows: group 2 (conventional bevel), group 3 (single central palatal slot on the incisal edge), group 4 (single palatal slot with central 2 mm fiber), group 5 (two palatal slots on the incisal edge with a distance of 0.5 mm to 1 mm between them), and group 6 (two slots on the incisal edge with two 2 mm fibers). All samples were built incrementally with nanocomposites followed by finishing and polishing. All samples including control were then stored in distilled water before their fracture resistance was measured using a universal testing machine. Failure modes were visually examined and the results were subjected to statistical analysis. RESULTS: The mean fracture resistance among the experimental groups was observed, group 4 with single fiber in the central position had the highest (832.68 N) followed by group 3 (490.84 N), group 5 (446.175), and group 2 (270.1359), and the least in group 6 (223.443). The mean fracture resistance of group 4 is comparable to intact teeth, i.e., group 1 (1096.40). The mean of all samples was compared using the one-way Anova test, and it was found that there is statistically significant difference in fracture resistance among groups (p < 0.001**). CONCLUSION: Fibers certainly have the reinforcing effect and the position of fibers determines their reinforcing effects. A single central slot with fiber (Ribbond) showed maximum fracture resistance almost equivalent to natural teeth. Modifying conventional beveled cavity design with an additional slot in the center also increases the fractural strength of restoration. CLINICAL SIGNIFICANCE: Nanocomposites reinforced with single fiber in the central palatal slot used for restoring fractured incisors provide strength almost equivalent to natural teeth. In case when the fiber is not available for preparing a single palatal slot also, we can increase the fracture resistance.

Lining prefabricated dowel(s) with fibre reinforced resin composite.

The study evaluated the adaptation and push-out bond force of two different lined fibre dowels in oval canals. Dowel spaces were prepared in 30 obturated mandibular premolars with oval roots. The samples were divided into three groups (n = 10). The first group received non-lined fibre dowels (NL). The fibre dowels in the second group were lined with a resin composite (PL). The fibre dowels in third group were lined with resin composite reinforced with polyethylene fibre ribbon (PFL). The proportion of surface area (PSA) occupied by the dowel and push-out bond force were analysed. The data were statistically analysed using two-way anova with post-hoc Holm-Sidak and Tukey tests. The PSA was higher in lined dowels. Highest push-out bond forces were recorded in PFL. Fibre reinforced composite lining improves the adaptation and push-out bond force of fibre dowel in oval canals.

Efficacy of Ribbond and a fibre post on the fracture resistance of reattached maxillary central incisors with two fracture patterns: a comparative in vitro study.

AIM: To compare the fracture resistance of maxillary central incisor fragments having two different fracture patterns and re-attached using two different posts - fibre post and Ribbond. MATERIALS AND METHODS: Sixty extracted human maxillary central incisors were randomly divided into two groups of thirty samples each. Group A consisted of samples with 'labio-palatal' fracture pattern and Group B with a 'palato-labial' fracture pattern. The crowns of all the samples were sectioned using safe-sided diamond discs. Following cleaning and shaping and sectional obturation, the samples were randomly subdivided into two subgroups of 15 samples each. Prefabricated fibre post (Reforpost, Angelus, Londrina, PR, Brazil) was placed in all samples of Subgroup I, and Ribbond (Ribbond Inc., Seattle, WA, USA) was placed in all samples of Subgroup II. The fragments were re-attached, fracture resistance was tested using Instron Universal Testing Machine, and the failure modes were assessed using a stereomicroscope. RESULTS: Group A with a labio-palatal fracture pattern exhibited higher fracture resistance as compared to Group B (palato-labial) in both subgroups. The fibre post (Subgroup I) exhibited higher fracture resistance as compared to Ribbond (Subgroup II). The Ribbond group exhibited significantly more number of repairable failures as compared to fibre post group. CONCLUSION: The labio-palatal pattern of fracture is a favourable type of fracture on palatal load application. The fragments re-attached using the fibre post (Reforpost) had a higher resistance to fracture. However, teeth restored with Ribbond posts exhibited 100% repairable failures upon load application. The fracture pattern had no influence on the failure modes.

Comparison of compressive strength among three different intracanal post materials in primary anterior teeth: An in vitro study.

OBJECTIVE: The objective of our study was to compare the fracture resistance and the mode of failure among three different post materials in primary anterior teeth. MATERIALS AND METHODS: A total of sixty extracted primary anterior teeth were selected for the study. The samples were divided into three groups of twenty teeth each: Group I (Ribbond), Group II (Omega loop), and Group III (Glass fiber post). Pulp therapy was followed by intracanal post and crown buildup. The samples were mounted in self-cure acrylic and subjected to compressive strength test using universal testing machine (Instron). The maximum force at which the tooth fractured was recorded. RESULTS: The values were subjected to one-way analysis of variance. The mean compressive strength values of Ribbond, omega loop, and glass fiber post were found to be 83.25 N, 61.60 N, and 75.55 N, respectively. The P value was found to be 0.220. CONCLUSION: Group I (Ribbond) showed the highest fracture resistance values followed by Group III (Glass fiber post) and Group II (Omega loop). Although there is difference in mean values, they were nonsignificant.

Evaluation of fracture resistance of endodontically treated teeth restored with composite resin along with fibre insertion in different positions in vitro.

This study was carried out to compare the different techniques of placement of polyethylene fibre (Ribbond) on reinforcement of endodontically treated teeth with MOD cavities in vitro. Forty extracted human premolars were randomly assigned to four groups (n = 10). Teeth in Groups I-IV received root canal treatment and a MOD cavity preparation, with gingival cavosurface margin 1.5 mm in coronal to cementoenamel junction. Group I served as no fibre group, Group II as occlusal fibre group, Group III as base fibre group and Group IV as dual-fibre group (occlusal and base both). Subsequent to restoring with composite resin and thermocycling, a vertical compressive force was applied at a cross-head speed of 0.5 mm min(-1) using universal testing machine until fracture. Data were analysed using one-way analysis of variance and Tukey's post hoc tests. Fracture resistance was significantly highest in dual-fibre group (P < 0.001) as compared with other groups. The highest favourable fracture rate was observed in the base fibre group (70%). This study concluded that the use of polyethylene fibre inserted over or under the restoration significantly increased the fracture strength of the root canal-treated teeth and maximum fracture resistance was observed when cavity was restored using dual-fibre technique.

Preservative management of traumatized maxillary central incisor using fiber reinforced composite and mineral trioxide aggregate: Report of a case.

The myriads of technological advancements in dentistry in last two decades have led to a dramatic shift from conventional invasive procedures to more conservative biomimetic therapies. In this series, management of traumatic dental injuries has taken a big leap in that now it is possible to conserve many of these teeth which were otherwise doomed to extraction. Depending on the extent of injury, esthetic and functional requirements, traumatic dental injuries can be managed by a variety of clinical procedures including composite resin restorations, reattachment of fractured fragment, endodontic therapy with or without post and core or lastly extraction. Reattaching natural tooth structure offers an advantage over the others in that it is instant, provides superior esthetics, preserves the natural tooth structure and is best accepted by the patient. This paper describes the comprehensive management of traumatized maxillary central incisor involving pulp exposure while maintaining pulp vitality and natural appearance of a tooth.

Fiber-reinforced Composite Resin Bridge: A Treatment Option in Children.

A number of treatment options, ranging from Maryland bridges to implants, are available for the replacement of congenitally or traumatically missing permanent anterior teeth. But, there are several limitations of these therapeutic options when they have to be used before the completion of the growth, particularly in children. Reinforcement of composite resins with polyethylene fibers significantly improves their mechanical properties. Fiber-reinforced composite (FRC) bridge can offer a good alternative to conventional treatment options in replacing a missing permanent anterior tooth until a more definitive prosthesis can be provided at the end of the growth period. The purpose of this article is to present a clinical case of a single tooth replacement utilizing noninvasive and metal free fixed FRC bridge in a 13 years old child as an interim treatment option. How to cite this article: Gupta A, Yelluri RK, Munshi AK. Fiber-reinforced Composite Resin Bridge: A Treatment Option in Children. Int J Clin Pediatr Dent 2015;8(1):62-65.

Survival of post-treatment canine-to-canine lingual retainers with fiber-reinforced composite resin: a retrospective study.

The aim of the study is to evaluate the long term results of ribbond retainer after orthodontic treatment. One hundred and thirty patients who were orthodontically treated satisfied the inclusion criteria of having received a semipermanent retention were treated with FRC lingual retainers (Ribbond (®)). It was performed a follow up evaluation after 2 years average from the retainer application and any complication or failure was recorded. Data from 119 remaining patients that met the inclusion criteria were analyzed and no instances of loosening were observed. It may be concluded that orthodontic canine-to-canine FRC retainers provide aneffective means of retaining realigned anterior teeth for at least two years.

Banded vs Bonded Space Maintainers: Finding Better Way Out.

OBJECTIVES: Of this in vivo study was to evaluate various space maintainers in terms of survival rate, gingival health and presence of caries. DESIGN: A total of 60 extraction sites in the age group of 4 to 9 years were divided into four groups and different space maintainers were placed in them viz (conventional band and loop, prefabricated band with custom made loop, Ribbond, Super splint). RESULTS: Prefabricated bands with custom made loop showed maximum success rates (84.6%), while super splint (33.33%) was found to be least successful. In terms of gingival health, prefabricated band with custom made loop reported minimum cases with poor gingival health (27.2%), while maximum cases with poor gingival health (50%) were reported with Super splint. None of the space maintainers developed caries at the end of 9 months. How to cite this article: Setia v, Pandit IK, Srivastava N, Gugnani N, Gupta M. Banded vs Bonded Space Maintainers: Finding Better Way Out. Int J Clin Pediatr Dent 2014;7(2):97-104.

Fibre reinforced composite: post and core material in a pediatric patient - an alternative to usual.

Fractured teeth are always a challenge to the dentist. The root canal therapy today can retain even very badly broken teeth. One of the most accepted techniques involve restoration of extensively carious or badly fractured teeth by the fabrication of a post and core while utilizing the root canal space for anchorage. So far, the only materials that are available to the dentist for this procedure have been a variety of metallic alloys. These materials are hard and need to be cast precisely so that they can fit the canals. Today materials are available which usually eliminates all the intermediate steps which are done in laboratories and the total control is rendered in the hands of the dentist, to fabricate on the chair, a resilient, aesthetic and bonded post and core. One such material is discussed here in a pediatric permanent anterior tooth.

Space maintainers in dentistry: past to present.

Early orthodontic interventions are often initiated in the developing dentition to promote favourable developmental changes. Interceptive orthodontic can eliminate or reduce the severity of a developing malocclusion, the complexity of orthodontic treatment, overall treatment time and cost. The safest way to prevent future malocclusions from tooth loss is to place a space maintainer that is effective and durable. An appropriate use of space maintainer is advocated to hold the space until the eruption of permanent teeth. This case report describes the various changing trends in use of space maintainers: conventional band and loop, prefabricated band with custom made loop and glass fibre reinforced composite resins as space maintainers.

Puente adhesivo en paciente con labio leporino y fisura velopalatina: una solución temporal con compromiso estético / Adhesive bridge in a patient with cleft lip and palate: a temporary solution with esthetic commitment

En la actualidad el aumento de la demanda estética y la necesidad de procedimientos mínimamente invasivos ha llevado a un aumento de la técnica adhesiva. Ribbond® es una marca de fibra de polietileno que permite un eficiente traspaso de fuerzas, es virtualmente plegable y se adapta fácilmente a la morfología dentaria y al contorno del arco dentario. Dentro de sus principales características podemos encontrar: Biocompatibilidad, inerte, translúcido y durable. Dentro de la odontología se le han dado distintos usos para esta fibra, ya sea como mantenedor de espacio, puente adhesivo, poste y núcleo endodóntico, ferulización, restauraciones tipo inlay y estabilización postortodóncica. En el caso de los pacientes fisurados se ha hecho relevante el uso de Ribbond® como puente adhesivo ya que permite mejorar la estética y rehabilitar temporalmente los espacios desdentados causados por la ausencia de un incisivo, principalmente una vez terminado el tratamiento de ortodoncia y en espera de una rehabilitación definitiva, aún más cuando el paciente no ha terminado su crecimiento y desarrollo. En este artículo se presenta un caso clínico de un paciente con labio leporino y fisura velopalatina operado demostrativo de la técnica de rehabilitación con Ribbond®.

Today the increasing demand of aesthetic and minimally invasive procedures has led to a boom of the adhesive technique. Ribbond® is a polyethylene fiber that allows an efficient transfer of forces, is virtually foldable and is easily adapted to tooth morphology and dental arch contour. Among its main features we can find: Biocompatibility, inert, translucent and durable. In dentistry, different uses have been given to this fiber, whether as space maintainer, adhesive bridge, endodontic post and core, splinting, inlay type restorations and postorthodontic stabilization. In the case of cleft lip and palate patients the use of Ribbond® as an adhesive bridge has become relevant, as it improves aesthetics and temporarily rehabilitates the edentulous spaces caused by the absence of an incisor. It is used especially after completion of the orthodontic treatment and waiting for a final rehabilitation, even when the patient has not completed their growth and development. This article presents a clinical case of a patient with lip and cleft palate operated with the rehabilitation technique using Ribbond®.

Fiber reinforced composite loop space maintainer: An alternative to the conventional band and loop.

The stainless steel band and loop appliance is the most commonly used fixed space maintainer in pediatric dentistry. But there are several disadvantages with this appliance such as the need for a cast or a working model, decalcification of the abutment tooth, loosening because of breakage or dissolution of the luting agent, tendency to get embedded in the soft tissue and the possibility of metal allergy. The purpose of this article is to present a simple, laboratory design of a "Fiber Reinforced Composite" (FRC) loop space maintainer and discuss the advantages over the traditional band and loop space maintainers.