Stress analysis of maxillary central incisors endodontically -treated with varying ferrule heights and three different post dowel materials - a finite element analysis / Análisis de tensión de los incisivos centrales superiores tratados endodónticamente con diferentes alturas de férula y tres materiales diferentes de clavija posterior: un análisis de elementos finitos

Statement of problem : fracture of endodontically treated teeth is reduced by the use of a post with ferrule, but the effect of different ferrule configurations and dowel materials is not clear. Purpose: to evaluate the effect of ferrules with different configurations and heights on the stress of endodontically treated teeth restored with three different post and dowel materials. Materials and Methods: fifteen models of maxillary central incisors restored with porcelain fused to metal crowns were obtained using pro engineer software. the models were divided into three groups, each consisting of five models with ferrule heights of 0mm, 2mm, 4mm, 2mm with oblique fracture, 4mm with oblique fracture, the models under group GFR were restored with fiberglass reinforced post (GFR) and composite core build-up, group NiCr with a custom cast post metal alloy (NiCr), and group Zr with zirconia post (Zr) and composite core build-up. an oblique load of 100N and 150N at an angle of 135 degrees was applied to the palatal surface of the tooth, a vertical load of 100N and 150N at an angle of 90 degrees was applied to the incisal tip of the tooth. The maximum principal stress and the von mises stress was calculated for the remaining tooth structure and post apex using the finite element analysis (FEA) software. Results: the maximum von misses stress was observed in the apex of the post (p<0.05). Group Zr showed the highest mean stress (6.39Mpa) followed by group NiCr (5.65Mpa). There was a significant difference between post and between NiCr and Zr post for 2mm and 4mm ferrule height, while for 0mm ferrule there was a significant difference between the GFR and NiCr groups (p<0.05). Under oblique load, the maximum mean stress was observed in remaining tooth structures while for vertical load, it was observed at the apex of the post. Regarding ferrule heights, there were significant differences between 0mm-2mm, and 0mm-4mm uniform ferrule in post apex in the case of NiCr posts (p<0.05). Absence of ferrule resulted in higher stress for the NiCr group. Conclusion: higher loads that led to fracture were observed only at the apex of the post. Zirconia posts (group Zr) had higher fracture loads, whereas absence of ferrule resulted in higher fracture load with custom cast posts (group NiCr). Fracture thresholds were high on the remaining tooth structure for all the dowel systems especially for composite core build up irrespective of ferrule height and configuration. Clinical implications: appropriate selection of post and dowel materials in different configurations of ferrule heights ensures clinical success.

Indicación del problema: la fractura de los dientes tratados endodónticamente se reduce mediante el uso de un poste con férula, pero el efecto de diferentes configuraciones de férula y materiales de clavija no está claro. Propósito: evaluar el efecto de los casquillos con diferentes configuraciones y alturas sobre el estrés de los dientes tratados endodónticamente restaurados con tres materiales diferentes de postes y tacos. materiales y métodos: quince modelos de incisivos centrales superiores restaurados con porcelana fundida a coronas de metal se obtuvieron con el software Pro Engineer. Los modelos se dividieron en tres grupos, cada uno de los cuales consta de cinco modelos con alturas de casquillo de 0mm, 2mm, 4mm, 2mm con fractura oblicua, 4mm con fractura oblicua. los modelos del grupo GFR fueron restaurados con poste reforzado con fibra de vidrio (GFR) y acumulación de núcleo compuesto, grupo nicr con una aleación de metal de poste fundido personalizado (NiCr) y grupo Zr con poste de zirconia (Zr) y acumulación de núcleo compuesto. se aplicó una carga oblicua de 100N y 150N en un ángulo de 135º a la superficie palatina del diente. se aplicó una carga vertical de 100N y 150N en un ángulo de 90º a la punta incisal del diente. la tensión principal máxima y la tensión de von mises se calcularon para la estructura dental restante y después del vértice utilizando el software de análisis de elementos finitos (FEA). Resultados: el estrés máximo de von falta se observó en el vértice de la publicación (p<0.05). El grupo Zr mostró el mayor estrés medio (6.39Mpa) seguido del grupo NiCr (5.65Mpa). Hubo una diferencia significativa entre la publicación NiCr y Zr para la altura de la férula de 2mm y 4mm, mientras que para la férula de 0mm hubo una diferencia significativa entre los grupos GFR y NiCr (p<0,05), bajo la carga oblicua, la tensión media máxima en las estructuras dentales restantes, mientras que para la carga vertical, se observó en el vértice del poste. En cuanto a las alturas de la férula, hubo diferencias significativas entre la férula uniforme de 0mm-2mm y de 0mm-4mm en el post-apex en el caso de los postes de NiCr (p<0.05), la ausencia de férula dio como resultado un mayor estrés para el grupo NiCr. Conclusión: las cargas más altas que llevaron a la fractura se observaron solo en el vértice del poste; Los postes de zirconia (grupo Zr) tuvieron mayores cargas de fractura, mientras que la ausencia de férula dio como resultado una mayor carga de fractura con postes moldeados personalizados (NiCr de grupo). Los umbrales de fractura fueron altos en la estructura dental restante para todos los sistemas de clavijas, especialmente para la acumulación de núcleos compuestos independientemente de la altura y configuración de la férula. Implicaciones clínicas: la selección adecuada de materiales de postes y tacos en diferentes configuraciones de alturas de férulas asegura el éxito clínico.

A Multidisciplinary Approach for Rehabilitation of Enucleated Sockets: Ocular Implants with Custom Ocular Prosthesis.

Interdisciplinary prosthodontics goes beyond our imagination into fields that have a direct effect on our total body health and quality of life. Removal of an eye has a detrimental effect on the psychology of the patient. Enucleation involves removal of the eyeball proper and leads to an enophthalmic socket with a shrunken eye, which has a crippling effect on patient's emotional and social life. Custom-made eye prosthesis simulates the characteristics of the companion eye and helps in restoring the normal facial appearance. Restoration of saccadic eye movements occurring during speech is desirable because this greatly contributes to a normal facial expression. This can be achieved by an orbital implant, which helps in orbital volume replacement and restoration of prosthesis movement and comfort. This article describes prosthodontic rehabilitation of enucleated eye sockets with orbital implants for two patients.

Pre-surgical Provisional Prosthesis for Immediate Non-occlusal-loaded Flapless Implant.

A 49-year-old patient reported for immediate replacement of missing maxillary anterior teeth with implant-retained prosthesis. Elevation of flap alters the mucosal level, causes discomfort, and delays the restorative procedure. To maintain the esthetics, flapless surgery was planned. Since placement of an implant is pre-planned in a predetermined site, fabrication of the prostheses before commencement of the surgery, especially when replacing the teeth in the anterior region, could be a viable option. This case report explains the method of fabrication of the provisional restoration for flapless surgery in the presurgical phase. The technique would avoid any micromotion and implant instability caused due to abutment preparation and impression procedure postsurgically.