The effect of ultrasonic vibration protocols for cast post removal on the incidence of root dentin defects.

PURPOSE: To investigate the effects of two ultrasonic vibration protocols for cast post removal (single or double ultrasound units) on the development of defects in root dentin. METHODS: Sixty bovine incisors were selected. Fifteen roots were left unprepared (control). Forty-five roots were instrumented and filled. A 10-mm post space was prepared using #1-4 Largo drills. Fifteen teeth were prepared for post space and received no further procedure. Thirty roots had cast posts cemented and were submitted to ultrasonic vibration protocols for removal. The time necessary to remove each post was recorded. Roots were sectioned 3, 6, 9, and 12 mm from the coronal portion and viewed through a 25× magnification in a stereomicroscope. The presence of root fractures, partial cracks, and craze lines was registered. Chi-square and Fisher's exact tests were performed to compare the incidence of dentin defects. The Kruskal-Wallis test was performed to explore the difference between the time needed for post removal. The significance level was set at P = 0.05. RESULTS: Root defects were observed in all experimental groups. There were no statistical differences comparing previous root canal treatment and post removal steps, either with 1 or 2 ultrasonic units, in the formation of defects (P = 0.544) or fractures (P = 0.679). CONCLUSION: Ultrasonic vibration protocols for removing cast posts did not increase the number of dentin defects compared to root canal preparation and obturation and post space preparation steps.

Retratamiento y reparación de una perforación radicular. Informe clínico, radiográfico e histológico / Retreatment and healing of a case of root perforation. Clinical, radiographic and histological report

Objetivo: Describir los aspectos clínicos, radiográfi- cos e histológicos del retratamiento realizado en un segundo molar superior en el que se había producido previamente una perforación radicular durante el tratamiento original. Caso clínico: Un paciente masculino de 50 años con- currió a la consulta para realizar un retratamiento endodóntico en un segundo molar superior derecho. El examen radiográfi- co reveló la presencia de un tratamiento incompleto, un área radiolúcida periapical y una perforación radicular producida por un poste roscado insertado fuera del espacio del conducto mesio vestibular. Una vez retirado el poste, se selló la perfo- ración con Biodentine y se realizó el retratamiento. Luego de dos años, el paciente regresó a la consulta con dolor a la mas- ticación, localizado en el área correspondiente al segundo mo- lar superior derecho previamente tratado. Durante el examen clínico y radiográfico se detectó la presencia de una fractura vertical en la raíz palatina. A causa del severo compromiso radicular el molar fue extraído y derivado para su análisis his- tológico. El informe del laboratorio reveló que la perforación había sido reparada por medio de la aposición de un nuevo tejido calcificado y que el remanente periodontal adherido a la raíz se encontraba dentro de los límites normales. El presente caso clínico resalta la importancia que tiene el conocimiento cabal de la anatomía del sistema de conductos radiculares con el objeto de evitar errores de procedimiento que puedan influir negativamente en el pronóstico del tratamiento (AU)

Aim: To describe the clinical, radiographic and histo- logical aspects of the retreatment of a second upper molar in which root perforation had occurred during the original treatment. Clinical case: A 50-year old male was referred for endo- dontic retreatment of the right second maxillary molar. Radi- ographic examination revealed the presence of an incomplete root canal treatment, a radiolucent periapical area and a root perforation produced by a threaded post placed outside of the mesiobuccal root canal. After post removal, the root perfo- ration was sealed with Biodentine and the root canals were retreated. Two years later, the patient returned to the office com- plaining of severe pain during mastication, in the area of the previously retreated right second maxillary molar. Clinical and radiographic examination revealed the presence of a ver- tical fracture on the palatal root. Since this kind of root dam- age non-restorable, the tooth was extracted and submitted to histologic analysis. The laboratory report revealed that the perforation site had healed by the apposition of new calci- fied tissue, and that the remnants of periodontal tissue which persisted attached to the root were within normal limits. This clinical case highlights the importance of thorough knowl- edge of the anatomy of the root canal system in order to avoid procedural errors which may compromise the prognosis of the treatment (AU)

Fracture Resistance of Titanium and Fiber Dental Posts: A Systematic Review and Meta-Analysis.

PURPOSE: The fracture resistance of dental post systems is influenced by the material of the post. The purpose of this systematic review and meta-analysis was to assess if there is a difference in fracture resistance between prefabricated dental titanium posts and fiber posts. METHODS: An online electronic search was performed using the PubMed, Scopus, and Web of Science databases for in vitro studies published from 2010 to 2020 in English. The retrieved eligible studies that compared the fracture resistance of titanium and fiber posts on human teeth were selected. The pooled standardized mean difference (SMD) with a 95% confidence interval was calculated. In addition, the trial sequential analysis (TSA) was performed to test if the available studies are sufficient to make conclusive evidence. RESULTS: Of the 1165 retrieved studies, 17 studies were included in the qualitative analysis, while 16 studies were included in the quantitative analysis. Because of the high heterogeneity among studies, data from 10 studies were pooled and submitted to TSA. A total of 852 teeth were evaluated for fracture of the posts in 27 independent comparison groups. The pooled effect of the residual studies revealed no significant difference between titanium and fiber posts (SMD = -0.12; 95% CI = -0.30, 0.06; p = 0.20). Results of the TSA revealed no conclusive evidence. CONCLUSIONS: The results of the current evidence revealed no significant difference between fiber and titanium posts. The evidence is insufficient, and more standardized in vitro studies are required.

Coronal Microleakage of Teeth Restored with Cast Posts and Cores Cemented with Four Different Luting Agents after Thermocycling.

PURPOSE: The apical seal provided by a root canal filling may be breached via coronal leakage. This study aimed to compare the teeth restored with custom-made cast metal posts and cores cemented with different luting agents in terms of coronal microleakage after thermocycling. MATERIALS AND METHODS: This in vitro study was conducted on 32 extracted single-canal teeth. Root canals were prepared by step-back technique and filled with gutta percha and sealer. The coronal 7 mm of gutta percha was removed, and post space was prepared using peeso reamers #2 and #3 consecutively. After fabricating the acrylic resin patterns of the posts and cores, they were cast using Ni-Cr metal alloy. The specimens were divided into 4 groups in which the castings were cemented using one of the following luting agents: zinc phosphate (ZP), glass ionomer (GI), Panavia F 2.0, and Speed CEM. After cementation, the teeth were immersed in distilled water and incubated for 7 days. Then, the teeth were subjected to thermocycling, immersed in silver nitrate for 6 hours, and finally sectioned. The degree of dye penetration into the coronal part of the specimens was measured using a stereomicroscope. Data were analyzed using Kruskal-Wallis and Mann-Whitey U tests with significance level of 0.05. RESULTS: The median microleakage in ZP, Speed CEM, GI, and Panavia were 171.89, 114.76, 26.51, and 20.02 µm, respectively. Pairwise comparisons among GI and ZP, GI, and Speed CEM, ZP and Panavia, ZP and Speed CEM, and Panavia and Speed CEM groups yielded significant differences (p < 0.05). CONCLUSION: Complete coronal seal was not achieved with any of the luting agents. The highest and the lowest degree of microleakage was yielded by ZP and Panavia luting agents, respectively.

Clinical Characteristics of Abutment Teeth with Gingival Discoloration.

PURPOSE: The grey-bluish discoloration of gingiva (known as "amalgam tattoo") does not appear only in the presence of amalgam restorations. It may also be seen in cases of teeth restored with cast dowels and porcelain-fused-to-metal (PFM) restorations. The aim of this article was to determine the clinical characteristics of abutment teeth with gingival discoloration. MATERIALS AND METHODS: This research was conducted on 25 patients referred for cast dowel and PFM restorations. These restorations were manufactured from Ni-Cr alloys. Ninety days after cementing the fixed prosthodontic restorations, the abutment teeth (n = 61) were divided into a group with gingival discoloration (GD) (n = 25) and without gingival discoloration (NGD) (n = 36). The control group (CG) comprised the contralateral teeth (n = 61). Plaque index, gingival index, clinical attachment level, and probing depth were assessed before fabrication and also 90 days after cementation of the PFM restorations. RESULTS: The gingival index, clinical attachment level, and probing depths of the abutment teeth that had GD were statistically higher before restoration, in comparison with the abutment teeth in the NGD and control groups. Ninety days after cementation, the abutment teeth with GD had significantly lower gingival indexes and probing depths, compared to the abutment teeth in the NGD group. Both abutment teeth groups (GD and NGD) had significantly higher values of clinical attachment levels when compared to the control group. There were no statistically significant differences in plaque index values between the study groups. CONCLUSIONS: The results of this study indicated that impairment of periodontal status of abutment teeth seemed to be related to the presence of gingival discolorations. Therefore, fabrication of fixed prosthodontic restorations requires careful planning and abutment teeth preparation to minimize the occurrence of gingival discolorations. CLINICAL RELEVANCE: With careful preparation of abutment teeth for cast dowels and crown restorations it may be possible to decrease the frequency of gingival discolorations adjacent to abutment teeth.

The Influence of Post System Design and Material on the Biomechanical Behavior of Teeth with Little Remaining Coronal Structure.

PURPOSE: To evaluate the influence of different post systems on the biomechanical behavior of teeth with a severe loss of remaining coronal structure. MATERIALS AND METHODS: Fifty standardized bovine teeth (n = 10 per group) were restored with: cast post-and-core (CPC), prefabricated metallic post (PFM), parallel glass-fiber post (P-FP), conical glass-fiber post (C-FP), or composite core (no post, CC). The survival rate during thermomechanical challenging (TC), the fracture strength (FS), and failure patterns (FP) were evaluated. Finite element models evaluated the stress distribution after the application of 100 N. RESULTS: All specimens survived TC. Similar FS was observed among post-containing groups. Groups P-FP and CC presented 100% repairable fractures. The von Mises analysis showed the maximum stresses into the root canal in groups restored with metallic posts. Glass-fiber posts and CC presented the maximum stresses at the load contact point. Glass-fiber groups showed lower stresses in the analysis of maximal contact pressure; CPC led to the highest values of contact pressure. The modified von Mises (mvM) stress in dentin did not show differences among groups. Moreover, mvM values did not reach the dentin fracture limit for any group. CONCLUSIONS: The type of intracanal post had a relevant influence on the biomechanical behavior of teeth with little remaining coronal structure.

Influência da presença e do tipo de retentor intrarradicular no comportamento em fadiga de incisivos centrais restaurados com coroas totais / Influence of the presence and type of post-and-core on the fatigue behavior of crowned central incisors

Este estudo avalia a influência da presença e tipo de pinos e núcleos na sobrevivência à fadiga de incisivos centrais restaurados com coroas totais. As coroas de 69 incisivos bovinos foram cortadas e as raízes tratadas endodonticamente. As raízes foram distribuídas aleatoriamente em três grupos (n = 23): núcleo de resina composta (NRC), núcleo de resina composta retido por pino de fibra de vidro (PFV) e núcleo metálico fundido (NMF). Todos receberam preparo de coroa total com férula de 2 mm, e então, uma coroa de cerâmica reforçada com leucita foi adesivamente cimentada. Três amostras de cada grupo foram testadas para determinação da carga máxima até a falha. As amostras restantes foram carregadas pelo teste acelerado de fadiga stepwise stress até a fratura ou suspensão após o término de 1,5 x 106 ciclos. A carga e o degrau em que cada espécime falhou foram analisadas pela estatística de Kaplan-Meier e Mantel-Cox (Log Rank test), seguidas por comparação múltipla aos pares, com nível de significância de 5%. O modo de falha foi analisado com estéreomicrocópio. Não houve diferença estatística entre os tratamentos quanto à carga (Mantel-Cox Log-Rank test for trend, X2=0,015, df=1, p=0,901), nem para o número de ciclos (Mantel-Cox Log-Rank test for trend, X2 =3,171, df=1, p=0,995). O modo de falha predominante foi a trinca da coroa. Fratura obliqua da raiz só foi observado nos grupos retidos por pinos. Nos incisivos tratados endodonticamente com férula de 2 mm, a presença e o tipo de pino e núcleo não influenciaram na sobrevida em fadiga. Fraturas não restauráveis ocorreram somente em dentes restaurados com pinos(AU)

This study evaluates the influence of presence and type of post-and-core systems on fatigue survival of non-vital central incisors restored with all-ceramic crowns. The crowns of 69 bovine incisors were cut and endodontically treated. The roots were randomly assigned into three groups (n=23): composite resin build-up (NRC), glass fiber post-retained-composite build-up (PFV) and cast post-and-core (NMF). All specimens received crown preparation with a 2 mm ferrule, and then a leucite-reinforced ceramic crown was adhesively cemented. Three samples from each group were tested for the determination of the maximum load to failure. The remaining samples were loaded by the accelerated fatigue stepwise stress test until fracture or suspension after the end of 1.5 x 106 cycles. The load and the step on which each specimen failed were analyzed by the Kaplan-Meier and Mantel-Cox (Log Rank test) statistics, followed by multiple paired comparisons, with a significance level of 5%. The failure mode was analyzed with stereomicroscope. There was no statistically significant difference between the treatments (Mantel-Cox Log-Rank test for trend, X2=0.015, df=1, p=0.901), nor for the number of cycles (Mantel-Cox Log-Rank test for trend, X2=3.171, df=1, p=0.995). The predominant failure mode was the crown crack. Oblique root fracture was observed only in groups retained by posts. The presence and type of post system did not influence the fatigue survival of the endodontically treated incisors with a 2 mm ferrule. Non-restorable fractures only occurred on teeth restored with post(AU)

Comparative Clinical Evaluation of Composite Overcast Gold Post and Core Buildups in Endodontically Treated Teeth.

BACKGROUND: The management of non-vital teeth includes endodontic treatment and restoration followed by post and core restoration in selected cases. The present study was conducted to compare the indirect cast post, and core buildup with direct composite post build up in patients. MATERIALS AND METHODS: The present study was conducted on 128 teeth of 82 patients. The success rate over 3 years was evaluated clinically and radiographically by observing caries, tooth mobility, probing depth, periapical pathology, and root fractures. RESULTS: Group I consisted of 16 incisors, 20 canines, 22 premolars, and six molars while group II had 17 incisors, 14 canines, 25 premolars, and eight molars. The difference was statistical non-significant (p-0.1). Forty-four teeth in group I and 42 teeth in group II utilized composite cement, whereas 18 teeth in group I and 16 teeth in group II used GIC and zinc phosphate was used in two teeth in group I and six teeth in group II. The difference was statistical ly significant (p< 0.05). Four teeth in group I and 8 in group II were lost. One tooth in group I and two teeth in group II showed root fracture and three teeth in group I and six teeth in group II showed periapical pathology. The difference was statistically significant (p-0.01). Most common type of complication was probing depth > 4 mm, caries, tooth mobility, and root fracture. The difference was non- significant (p-0.31). CONCLUSION: Both composite post buildup and cast gold post and core build-up exhibited similar properties. CLINICAL SIGNIFICANCE: Both composite post buildup and cast gold post and core build-up exhibited similar properties hence either of the methods can be used in post core build up.

Failure loads of all-ceramic cantilever fixed dental prostheses on post-restored abutment teeth: influence of the post presence and post position.

The influence of a fiber post-restored abutment tooth on the load capability of a three-unit zirconia framework cantilever fixed dental prosthesis (cFDP) was evaluated after simulated clinical function. Human lower sound premolars (n = 64) were distributed, in equal numbers, to four experimental groups: two vital abutment teeth (group I; control); mesial abutment tooth post-restored (group II); distal abutment tooth post-restored (group III); and mesial and distal abutment teeth post-restored (group IV). All specimens received an adhesively luted three-unit cFDP of veneered zirconia. Simulated clinical function was performed by two subsequent sequences of thermal-cycling (2 × 3,000 cycles) and mechanical loading (1.2 × 106 load cycles from 0 to 50 N) (TCML). Four specimens failed during TCML (one in each of groups I and IV and two in group II). The maximum load capability ranged from 365 to 538 N and was not significantly different between groups. Specimens with post-restored abutments failed mainly because of abutment tooth fracture of the distal abutment. The presence or position of post-restored abutment teeth has no significant impact on load capability of all-ceramic three-unit cFDPs. The risk of tooth fracture of the distal abutment teeth of a cFDP was significantly increased when one abutment tooth, irrespective of its position, was post-and-core restored.

Are fibre posts associated with the occurrence of prosthetic complications?

Data sourcesThe Pubmed, Evidence-Based Dentistry, BMJ Clinical Evidence, EmbaseDynamed, and www.opengrey.eu databases and manual search of reference lists.Study selectionRandomised clinical trials (RCTs) were accepted if they had: participants with no periodontal disease and teeth restored with SCs or FDPs and compared fibre posts and other prosthetic systems and evaluated the prosthetic complications with a minimum observational period of 36 months.Data extraction and synthesisTitles and abstracts were evaluated independently by two reviewers, any disagreement was discussed with a third reviewer. The agreement for the two reviewers was 97%. The quality and the risk of bias of the studies included was assessed following the Cochrane Handbook considering the domains of randomisation, sample size, inclusion and exclusion criteria, follow-up achieved, blinding, withdrawing and groups' compatibility for quality assessment, and for the risk of bias the domains evaluated were allocation concealment, blinding of outcome assessor and follow-up.ResultsThe database search yielded 4,230 records; after duplications removal, 3,670 records were reviewed independently by the authors, and four articles were chosen to include in the systematic review.The most frequently reported failures in the available studies were as follows: fibre post debonding, loss of retention of single crowns and marginal gaps. Less frequently, chippings and fractures were recorded in SCs. No studies about complications related to FDPs were found.The failure rate ranged from 0 to 28.2%.ConclusionsA correlation between the failure rates of fibre posts and the type of prosthetic restoration (SCs or FDPs ) cannot be found. Further RCTs are required to achieve evidence-based conclusions, particularly about the use of fibre posts with FDPs.

The feasibility of characterising the effects of dental post-operative discomfort and sensitivity over time.

OBJECTIVES: To assess the feasibility of using short message service text messages to solicit dental patients' experiences of post-operative dental discomfort and sensitivity (PODDS) and whether responses characterise change in PODDS over time. METHODS: Patients were recruited from clinics following routine dental procedures, such as simple restorations or root surface debridement. They completed a short questionnaire collecting information on socio-economic circumstances, their recent experience of PODDS, the acceptability of receiving text message questions and their telephone number. Participants received a short question by text to their telephone for five consecutive days that asked them to respond with an indication (on a 1 to 10 scale) of their experience of PODDS at that time. RESULTS: Questionnaires were completed by 34 participants, of whom text message responses were received from an average of 23.4 participants (min 20, max 26) across the five follow-up days. Regression analyses indicated that PODDS decreased over time (ß = -0.24, 95% CI -0.36 to -0.12). CONCLUSIONS: Text messaging to solicit PODDS is feasible and can potentially be used to assess the efficacy of treatments designed to minimise or reduce PODDS.

Survival Rates of Teeth with Primary Endodontic Treatment after Core/Post and Crown Placement.

INTRODUCTION: The objective of this study was to determine the effect of delayed placement of the core/post and crown on the outcomes of nonsurgical root canal therapy (NSRCT). METHODS: According to the Delta Dental of Wisconsin claims database, 160,040 NSRCTs were completed with a core/post and a crown placed before the end of the continuous coverage period or occurrence of an untoward event. Untoward events were defined as a retreatment, apicoectomy, or extraction as defined by the Code on Dental Procedures and Nomenclature. Statistical analysis was performed by using a multivariable Cox proportional hazards model. RESULTS: The survival rate from the time of crown placement to an untoward event was 99.1% at 1 year, 96.0% at 3 years, 92.3% at 5 years, and 83.8% at 10 years. Failure rates were greater when a core/post was placed more than 60 days after the NSRCT (adjusted hazard ratio, 1.08) and when the crown was placed more than 60 days after the core/post placement (adjusted hazard ratio, 1.14). Overall, the survival rates of NSRCT were greater when performed by an endodontist versus other providers. CONCLUSIONS: On the basis of the information available from insurance claims data, this study shows that the long-term survival rates of initial endodontic therapy are adversely affected by the delayed placement of the final restoration and full coverage crown.

Stress Distribution, Tooth Remaining Strain, and Fracture Resistance of Endodontically Treated Molars Restored Without or With One or Two Fiberglass Posts And Direct Composite Resin.

OBJECTIVES: To evaluate the effects of direct composite resin without a post or with one or two fiberglass posts on the restoration of severely compromised endodontically treated molars. METHODS AND MATERIALS: Forty-five molars with 2 mm of "remaining tooth structure" were divided into three groups: Wfgp, restored with Filtek Z350XT without a fiberglass post; 1fgp, restored with Z350XT with one fiberglass post in the distal root canal; and 2fgp, restored with Z350XT with two fiberglass posts, one in the distal root canal and the other in the mesial-buccal root canal. The teeth were load cycled. Tooth remaining strain was measured using strain gauges (n=10) at two moments: TrSt-100 N, during 100 N occlusal loading, and TrSt-Fr, at fracture load. Fracture resistance was calculated, and fracture mode was classified. The elastic modulus and Vickers hardness were calculated using dynamic indentation (n=5). Stress distribution was analyzed by three-dimensional finite element analysis. RESULTS: The use of two fiberglass posts resulted in lower fracture resistance than was noted in the groups with one fiberglass post and without fiberglass posts. The lingual surface of the remaining tooth had higher strain values than the buccal surface, regardless of the restorative technique and moment of evaluation. The absence of a fiberglass post resulted in significantly higher strain values and more irreparable fracture modes than were noted in the other groups. The use of one fiberglass post had a better strain/fracture resistance ratio. Stresses were concentrated in the occlusal portion of the post and in the furcation region. The presence of one fiberglass post resulted in better stress distribution in the entire distal root dentin, reducing stress on the critical areas. CONCLUSIONS: The use of one fiberglass post for restoring molars with direct composite resin resulted in higher fracture resistance than did the use of two fiberglass posts; it also resulted in better tooth remaining strain and stress distribution and more reparable fracture modes than were seen in the group without a fiberglass post.

Influence of glass fibre post length and remaining dentine thickness on the fracture resistance of root filled teeth.

AIM: To evaluate, ex vivo, the influence of glass fibre post length and remaining thickness of dentine on the fracture resistance of bovine roots, after thermomechanical ageing. METHODOLOGY: Ninety bovine roots of the same size were root filled and randomly distributed into nine groups (n = 10), according to the root weakening protocol (NW - nonweakened; MW - medium weakened; HW - highly weakened) and post length (7 mm; 9 mm and 12 mm). The weakening of roots was performed using diamond burs, resulting in different thicknesses of remaining dentine. The post spaces were prepared, and in the weakened roots, the glass fibre posts were customized with composite resin, to create posts matching the canal size. Chemically activated resin cement was used to lute the posts. After luting, full crowns made of composite resin were attached to a silicon matrix. To reproduce physiological mobility, the roots were covered with polyether and embedded in polyurethane. The thermomechanical cycling was performed (1 200 000 cycles; 88N; 3,8 Hz; 5 ± 1 °C to 55 ± 1 °C). Then, the specimens were subjected to compressive force in a universal testing machine (1 mm min-1 ; 100 kgf) to analyse the fracture resistance. The specimens were analysed through a stereomicroscope to classify the failure mode (repairable/catastrophic). The values were subjected to statistical analysis (two-way anova and Tukey's test at 5%). The frequencies of failure mode were compared using chi-square test. RESULTS: The association between length and dentine thickness was significant (P > 0.05). The difference was between NW and HW roots for posts of 12 mm in length. There was an association between failure mode and the length and remaining dentine thickness. CONCLUSIONS: Reduced dentine thickness in roots with longer posts had lower fracture resistance values, as catastrophic failure was more predominant.

Long-term Clinical Outcomes of Endodontically Treated Teeth Restored with or without Fiber Post-retained Single-unit Restorations.

INTRODUCTION: The aim of the present study was to evaluate both survival and failure rates of endodontically treated teeth restored with or without fiber post-retained restorations after a mean observation period of at least 5 years. METHODS: A total of 144 single-rooted and multirooted teeth in 100 subjects were endodontically treated following a predetermined aseptic protocol and restored with either a fiber post and a composite core or a composite filling without intraradicular retention. A fiber post was cemented when the teeth presented with only 1 wall and/or less than one third of the remaining height of the clinical crown. After a comprehensive treatment plan, the teeth were restored with either a direct composite restoration or a single-unit crown. Endodontically treated teeth supporting fixed and removable dental prostheses and telescopic crowns were excluded from the analysis. Success was defined as tooth survival without any treatment of biological and/or technical complications. RESULTS: The overall tooth survival rate was 89.6% after a mean observation time of 8.8 ± 2.3 years. The survival rate of teeth with a fiber post amounted to 94.3%, and for teeth without a post, it was 76.3% (P < .001). The main reason for tooth loss was root fracture (9.7%). No loss of post retention was observed. Successfully treated teeth without any biological and/or technical complications and requiring no additional treatment during the entire observation period amounted to 79.9%. CONCLUSIONS: Endodontically treated teeth restored with fiber posts and either a direct composite restoration or a single-unit crown yielded higher survival and success rates compared with teeth restored without fiber posts. Vertical fractures of roots not containing a post represented a frequently encountered and serious problem.

Cánula rígida, alternativa en el tratamiento estético-funcional de la apicoformación por fractura complicada de corona / Rigid stems, an alternative in the esthetic-functional treatment of apex formation due to complicated crown fracture

Las edades más afectadas, por la presencia de fracturas complicadas de corona, son la niñez y la adolescencia. En la mayoría de los pacientes se afectan los incisivos centrales superiores permanentes de incompleta formación apical. Esto implica una disminución de las capacidades de masticación, dicción y trae consigo implicaciones psicológicas en la adolescencia. El tratamiento consiste en la aplicación de una técnica de apicoformación que dificulta lograr al unísono la resolución de la afección estética. Nuestro propósito es describir un caso de apicoformación en incisivo central superior izquierdo, con cementación de cánula rígida, conformación de muñón y restauración estético-funcional definitiva. Un paciente de 8 años, masculino acude a consulta tras sufrir traumatismo dentoalveolar consistente en fractura complicada de corona. Los rayos X muestran ligero ensanchamiento periodontal y ápice inmaduro. Se le aplicó anestesia local, se realizó la extirpación pulpar total del diente afectado, y se colocó medicamento intraconducto. La culminación del tratamiento de restauración total coronaria se realizó con la cementación con ionómero de vidrio tipo II de una cánula rígida No. 22 hasta las dos terceras partes de la longitud de trabajo; alrededor de esta se conformó un muñón y corona de nano composite híbrido fotopolimerizable. Se controló evolución cada 24 días, durante tres meses para comprobar el estado de maduración apical. La cementación de la cánula rígida, consituye una alternativa para el tratamiento funcional de la apicoformación por fractura complicada de corona. Supone una rápida recuperación de las funciones bucodentales y psicológico-sociales integrales del paciente(AU)

The life periods most commonly affected by complicated crown fractures are childhood and adolescence. The teeth most frequently affected are permanent upper central incisors of incomplete apical formation, resulting in limitations in chewing and speech, as well as psychological effects in adolescence. The treatment consists in the application of an apex formation technique which makes it difficult to also solve the esthetic effect. It was our purpose to describe a case of apex formation in the upper left central incisor, with rigid stem cementation, stump conformation and definitive esthetic and functional restoration. An 8-year-old male patient attends consultation after undergoing dentoalveolar trauma consisting in complicated crown fracture. Radiography revealed slight periodontal expansion and an immature apex. A local anesthetic was applied to perform total pulpal removal of the affected tooth and place intracanal medicament. At the end of the total crown restoration treatment, cementation of a No. 22 rigid stem was performed with type II glass ionomer up to two thirds of the working length, and a hybrid photopolymerizable nanocomposite crown and stump were shaped around it. Evolution was checked every 24 days for three months to verify apical maturation status until total formation was achieved. Rigid stem cementation is an alternative for the functional treatment of apex formation due to complicated crown fracture. It is characterized by a fast, complete recovery of the patients oral-dental and psycho-social functions(AU)

Cánula rígida, alternativa en el tratamiento estético-funcional de la apicoformación por fractura complicada de corona / Rigid stems, an alternative in the esthetic-functional treatment of apex formation due to complicated crown fracture

Las edades más afectadas, por la presencia de fracturas complicadas de corona, son la niñez y la adolescencia. En la mayoría de los pacientes se afectan los incisivos centrales superiores permanentes de incompleta formación apical. Esto implica una disminución de las capacidades de masticación, dicción y trae consigo implicaciones psicológicas en la adolescencia. El tratamiento consiste en la aplicación de una técnica de apicoformación que dificulta lograr al unísono la resolución de la afección estética. Nuestro propósito es describir un caso de apicoformación en incisivo central superior izquierdo, con cementación de cánula rígida, conformación de muñón y restauración estético-funcional definitiva. Un paciente de 8 años, masculino acude a consulta tras sufrir traumatismo dentoalveolar consistente en fractura complicada de corona. Los rayos X muestran ligero ensanchamiento periodontal y ápice inmaduro. Se le aplicó anestesia local, se realizó la extirpación pulpar total del diente afectado, y se colocó medicamento intraconducto. La culminación del tratamiento de restauración total coronaria se realizó con la cementación con ionómero de vidrio tipo II de una cánula rígida No. 22 hasta las dos terceras partes de la longitud de trabajo; alrededor de esta se conformó un muñón y corona de nano composite híbrido fotopolimerizable. Se controló evolución cada 24 días, durante tres meses para comprobar el estado de maduración apical. La cementación de la cánula rígida, consituye una alternativa para el tratamiento funcional de la apicoformación por fractura complicada de corona. Supone una rápida recuperación de las funciones bucodentales y psicológico-sociales integrales del paciente(AU)

The life periods most commonly affected by complicated crown fractures are childhood and adolescence. The teeth most frequently affected are permanent upper central incisors of incomplete apical formation, resulting in limitations in chewing and speech, as well as psychological effects in adolescence. The treatment consists in the application of an apex formation technique which makes it difficult to also solve the esthetic effect. It was our purpose to describe a case of apex formation in the upper left central incisor, with rigid stem cementation, stump conformation and definitive esthetic and functional restoration. An 8-year-old male patient attends consultation after undergoing dentoalveolar trauma consisting in complicated crown fracture. Radiography revealed slight periodontal expansion and an immature apex. A local anesthetic was applied to perform total pulpal removal of the affected tooth and place intracanal medicament. At the end of the total crown restoration treatment, cementation of a No. 22 rigid stem was performed with type II glass ionomer up to two thirds of the working length, and a hybrid photopolymerizable nanocomposite crown and stump were shaped around it. Evolution was checked every 24 days for three months to verify apical maturation status until total formation was achieved. Rigid stem cementation is an alternative for the functional treatment of apex formation due to complicated crown fracture. It is characterized by a fast, complete recovery of the patients oral-dental and psycho-social functions(AU)

Changing the gingival color discrepancy induced by pigmented root using subepithelial connective tissue graft: a case report.

Metallic alloys can suffer corrosion, and metallic posts and cores used for restorative procedures may develop a blue-gray pigmentation in root dentin, which in turn changes the color of gingival tissues. Removing posts and cores may lead to root fracture, and bleaching agents have a limited effect on staining from alloy corrosion. Surgical techniques for correcting undesirable esthetic deficiencies have been investigated in the literature. This article describes the case of a patient with gingival discoloration caused by root pigmentation in the maxillary area. A subepithelial connective graft harvested from the palate was used to treat the gingival color discrepancy.