Resin composite restoration in primary anterior teeth ...

Pédiatrie Dentistry

Resin composite restoration in primary anterior teeth usingshort-post technique and strip crowns: A case reportFausto Medeiros Mendes, DDS, MSDVMonique Saveriano De Benedetto, DDS. MSDVCristina Giovannetti del Conte Zardetto, DDS, MSDVMarciaTurolla Wanderley, DDS, MSD /̂Maria Sálete Nahás Pires Correa, DDS, MSD, PhD^

A case report describing a technique lor the restoration of endodontically treated primary maxillary in-cisors with resin composite short posts and celluloid strip crowns in a 3-year-old boy is presented. Thetechnique otters the advantages ot using one restorative material, improving esthetics, and reducing chair-time and costs. (Quintessence Int 2004:35:689-692)

Key words: esthetics, pédiatrie dentistry, primary teeth, short post, strip crown

CLINICAL RELEVANCE: Oral rehabilitation of young chil-dren is a challenge due to lack of cooperation during den-tal visits. Therefore, the use of a restorative technique thatreduces ohairtime has great value in pédiatrie dentistry.

Despite considerable advances in the prevention ofdental caries, pédiatrie clinicians still deal with

cases of total destruction of the primary teeth. In veryyoung children, severe tooth destruction is often asso-ciated with frequent and prolonged exposure to cario-genie substances in the nursing bottle, compounded bylack of adequate hygiene habits. The teeth most ofteninvolved are the maxillary central and lateral ineisorsand the maxillary and mandibular primary first mo-

'Graduale Student, Pedjatrrc Dentistry, LIniversity of Sao Paulo, Sao Paulo,Brazii.

^Professor of Pédiatrie Denlistry, Department of Orthodontics and PédiatrieDentistry, university of Sao Paulo, Sao Pauio, Brazil.

^Professor of Pédiatrie Dentistry, Department of Orthodontics and PédiatrieDentistry, and Coordinator, Clinic of Pédiatrie Dentistry, tJniversity of SaoPauio, Sio Pauio, Brazil.

Reprint requests: Dr Pausto Medeiros Mendes, Faculdade deOdontoiogia da Universidade de Sao Paule, Departamento de Ortodontia eOdontopediatria, Av. Prof. Lineu Prestes, 2227, CEP 05508-900 - SaoPaulo. Brasii. E-maJi: medeirosmendes ©uol.com.br

lars, while the mandibular primary incisors are rela-tively unaffected. Maxillary incisors are the most se-verely involved, and lésions can lead to total destruc-tion of the crowns.̂ -"

Dental destruction may lead to development of para-functional habits (tongue thrusting, speech problems),psychologic problems, reduced masticatory efficiency,and loss of vertical dimension of occlusion.̂ -'" It is im-portant to restore crowns destroyed by caries to pre-serve the integrity of the primary dentition until its ex-foliation and eruption of the permanent teeth.'

In cases of severely carious teetb, endodontic treat-ment associated with the use of intracanal posts be-comes necessary prior to restoration of the crowns. Inprimary teeth, intracanal retention can he achievedusing several techniques: directly building up a resincomposite post"; preparing an "inverted mushroom-shaped" undercut in the root canal prior to resin com-posite short-post placement'^; and using alpba- oromega-shaped orthodontic wire,'^" stainless steel pre-fabricated posts,̂ ^^ nickel-cbromium (Ni-Cr) cast postswith macroretentive elements,' natural teeth from atooth bank/" or reinforcement fíher.^^

Casellato et aF reported in an in vitro study thatthreaded posts (FKG, FKG Dentaire}, Ni-Cr postswith macroretentions, alpha-shaped orthodontic wire,biologic posts, and root canal filled with resin com-posite showed similar fracture resistance values whensubmitted to shear bond strength tests.

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Fig 1 Frental view cf carious maxiliary in-cisors.

Perrela et al'* reported that threaded posts and alpha-shaped orthodontic wire showed an average successrate of 76.47% after 10 months of clinical and radio-graphic follow-up when used in primary anterior teeth.

Restorative modalities used to treat primary ante-rior crowns include stainless steel crowns/^^" polycar-bonate crowns,' resin composite crowns,'' indirectresin composite crowns,^ and biologic restoration witbnatural tooth.'" Resin composites, used directly or in-directly, have been an excellent choice for severelycarious teeth due to their adhesive bonding and es-thetic appearance.̂ *'-̂ ^ Preformed, indirect resin com-posite crowns have recently become available in tbeform of resin composite sbells for primary teetb.^^Preparation of acetate crown forms on a stone castprior to the appointment saves treatment time andproduces desirable results."-^ '̂'̂ '̂''̂ ^ '̂' In light of theseadvantages, techniques that save treatment time arefavorable in very young children.^"

The purpose of this report was to demonstrate therehabilitation of primary anterior teetb in a 3-year-oldboy with early-onset carious lesions. Tbe endodonti-cally treated teeth were reinforced using a resin com-posite sbort-post tecbnique'' and restored with cellu-loid strip crown formers.

PATIENT HISTORY AND ORAL HEALTH FINDINGS

A 3-year-old boy presented witb nursing-bottle carieslesions on tbe occlusal surfaces of the maxillary andmandibular primary molars and incisai surfaces of tbemaxillary incisors {Fig 1). Tbe patient was submittedto clinical and radiograpbic evaluation in order to es-tablish a treatment plan.

TREATMENT

After restoring the primary molars with resin compos-ite, the maxiUary primary central incisors were submit-ted to a pulpectomy technique (Fig 2). All except the

cervical thirds of the root canals were obturated withan iodoform-based paste, and a tbin layer oí resin-mod-ified glass-ionomer cement (Vitremer, 3M) was placedto isolate tbe root canal filling material. Tbe teetb werethen cleaned, etcbed for 15 seconds with a 37% phos-phoric acid solution (Fig 3), rinsed with water, and airdried. A light-cured bonding agent (Single Bond, 3M)was brusbed on tbe etcbed surfaces and tbinned by acompressed air blast. Next, ligbt-cured resin composite(sbade B2; Z250, 3M}, was placed in several steps intothe root canal and crown region to form the superstruc-ture of the post (Fig 4),

During the next visit, celluloid strip crowns wereused to build up tbe teetb (Pedoform Strip Crowns,3M). Tbe celluloid crowns bave been previously se-lected based on the mesial-distal width of the teeth{Fig 5). The crowns were trimmed with scissors toachieve a good fit gingivally to the prepared incisors(Fig 6). The resin composite posts were etched for 15seconds with a 37% phosphoric acid solution (Fig 7),rinsed with water, and air dried. The light-curedbonding agent (Single Bond, 3M) was brusbed on tberesin composite posts. A bole was punched in thepalatal surface of the strip crowns using a sharp ex-plorer point to act as a vent when placing the resincomposite-filled crown. The celluloid crown formswere filled with shade Bl resin composite resin (Z250,3M} and inserted with pressure onto the incisor andpost (Fig 8). After polymerization on the buccal andpalatal surfaces, a sharp tip of the explorer was in-serted at the gingival margin between the celluloidcrown form and the polymerized resin composite toremove the crown form {Fig 9). Finishing, polishing,and occlusal adjustments were performed using dia-mond burs (KG Sorensen), Sof Lex discs (3M), andpolisbing strips (Figs 10 tol3).

Tbe lateral maxillary incisors were also restoredwitb celluloid strip crowns but without endodontictherapy. In order to improve esthetics, a bevel at cavo-surface margins was done on tbe facial surface oftbese teetb.

Tbe cbild and parents were once again instructedabout proper dietary and oral hygiene habits. The im-portance of periodic visits in order to presei^e tbe pri-mary dentition was also emphasized.

TREATMENT RATIONALE

The technique described restored estbetics and func-tion while eliminating laboratory processing and reduc-ing costs. Cbairtime was greatly reduced as the resincomposite posts were prepared directly in tbe rootcanal as opposed to adapting prefabricated or dentinposts. Furthermore, the technique involved using one

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Fig 2 Preparation of root canals tor resin Fig 3 Etctiing ot root canals for 15 sec- Fig 4 Resin composite piaced on ttie coro-composite post after endodontic treatment. onds with 37% phospiioric acid nary portion following ttie resin composite

post.

Fig S Ditterent sizes ot strip crowns Fig 6 Seiection ot the strip crowns baseö Fig 7 Etching ot resin composite posts for(Pedoform Strip Crown), on the mesiai-distal width of the teetti, 15 seconds with 37% phosptioric acid

Fig 8 Crown lilied with resin composite Fig 9 An expiorer tip was used to remove Fig 10 Primary incisors restored with stripand inserted onto the prepared incisor. Note Itie strip crown from Itie incisor leaving the crowns betcre finishing and polishing,the excess resin on the paiatai surface ex- resin composite crown in piace shewing the esthetic appearance of the re-trudtng thrcugh the • e' i stored teeth.

Fig 11 Í i .au

higti-speed handpiece.diamond stone in a Fig 12 Polishing cf proximai areas. Fig 13 Finai radiograph showing endodcn-

tic treatment, resin composite short posts,and restored primary incisors.

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Fig 14 (left) Anterior view of maxillary in-cisors before orown rehabilitation.

Fig 15 fr/g/vij Final anterior view. Follow-upof the anterior rehabilitation after a period ot4 months.

cohesive tnaterial in the canal and crown [resin com-posite), while eliminating the cementation of the post.Also, resin short posts offered hetter esthetic resultssince they do not require a layer of opaque material asused in metal posts. This technique represents an alter-native to other prosthodontic restorations in children.

The use of celluloid strip crowns with resin com-posite short posts reduces operatory chairtime. Thetechnique requires selection and adaptation of stripcrowns on the cervical margins of the teeth and thereduction of excess resin composite around the gingi-val margin.

The technique descrihed can he used to restore se-verely carious primary anterior teeth in two appoint-ments. The celluloid crown is filled with a resin com-posite, which is the same material used in fabricatingthe post. In addition, the celluloid crown produces aglossy finish, thereby minimizing polishing.

CONCLUSION

The described technique is simple and can be usedto restore severely carious or fractured primary ante-rior teeth, reestablishing function, shape, and estheticsin young children (Figs 14 and 15).

REFERENCES

1. Tinanoff N, O'SulUvan DM, Early childhood caries:Overview and recent findings, Pediatr Dent 1997;19:12-16.

2. Davies GN, Early childhood caries-A synopsis. CommunityDent Oral Epidemiol 1998;26:106-116.

3. Seow WK. Biological mechanisms of early childhood caries.Community Dent Oral Epidemiol 1998;26:8-27.

4. Bowen WH, Response to Seow: Biological mechanisms ofearly childhood caries. Community Dent Oral Epidemiol1998;26:28-31,

5. Snawder KD, Gonzalez WE. iManagement of severely dis-eased primary anterior teeth. J Dent Child 1975;42:181-185,

6. Joho JP, Maréchaux SC, Aesthetics in the primary dentition:A clinical presentation. J Dent Child 1981;48:21-24,

7. Rifkin AJ. Composite post-crowns in anterior primary teeth.J Dent Assoc S Afr 1983;38:225-227.

8, Davis LG, Ashworth PD, Spriggs LS. Psychological effectsof aesthetic dental treatment, J Dent 1998;26:547-554,

9. Wanderley MT, Ferreira SLM, Rodrigues CRMD, RodriguesFilho LE, Primary anterior tooth restoration using posts withmacroretentive elements. Quintessence Int 1999;30:432,-436.

10. Ramires-Romito ACD, Wanderley MT, Oliveira MDM,Imparato JCP, Correa MSNP, Biologic restoration of pri-mary anterior teeth. Quintessence Int 2000;31:405-411.

11. Grosso FC. Primary anterior strip crowns: A new techniquefor severely decayed anterior primary teeth. J Pedod 1987;11:375-384,

12. Judd PL, Kenny DJ, Johnston DH, Yacohi R, Compositeresin short-post technique for primary anterior teeth, J AmDent Assoc 1990; 14:553-555.

13. Mathias RS, ICramer PF, Imparato JCP, Guedes-Pinto AC.Operative and restorative dentistry. In: Guedes-Pinto AC(ed]. Pédiatrie Dentistry. Sao Paulo; Santos, 1997:569-607.

14. Issáo M, Guedes-Pinto AC, Pédiatrie Dentistry Manual. SaoPaulo: Pancast, 1978:132-134.

15. Citron CI. Esthetics in pédiatrie dentistry. NY State Dent J1995;61:30-33.

16. Vieira CL, Riheiro CC. Polyethylene fiber tape used as apost and core in decayed primary anterior teeth: A treat-ment option. J Clin Pediatr Dent 2001;26;l-4.

17. Casellato C, Giometti CF, Wanderley MT, Rodrigues-FilhoLE, Rodrigues CRMD, Shear-hond strength of primaryteeth restored with different intra-canal retention [abstract635]. J Dent Res 2002 ;81;B-120.

18. Perrela A, Sagretti OMA, Guedes-Pinto AC. Comparativestudy of post and core technique for primary anterior teethreconstruction [in Portuguese]. Rev Bras Odontol 1995;52:42-45.

19. Wiedenfeld KR, Draughn RA, Welford JB. An esthetic tech-nique for veneering anterior stainless steel crowns withcomposite resin. J Dent Child 1994;61:321-326.

20. Croli TP. Restorative dentistry for preschool children. DentClin North Am 1995;39:737-770.

21. Ellis RK, Donly KJ, Wild TW. Indirect composite resincrowns as an esthetic approach to treating ectodermal dys-plasia: A case report. Quintessence Int 1992;23;727-729.

22. Pollard MA, Curzon JÁ, Fenlon WL. Restoration of decayedprimary incisors using strip crowns. Dent Update 1991;18:150-152.

23. Updyke J, Sneed WD, Placement of a preformed indirectresin composite shell crown: A case report. Pediatr Dent2001;23;243-244.

24. Croll TP, Bonded composite resin crowns for primary in-cisors: Technique update. Quintessence Int I990;21:153-157.

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