Comparative in vivo evaluation of restoring severely mutilated primary anterior teeth with biological post and crown preparation and reinforced composite restoration

Restorative strategies for deciduous anterior teeth: A systematic review and meta-analysis

AIM

Common causes of destruction in primary anterior teeth include dental caries and trauma. This systematic review evaluated the success rate of restorative techniques for these cases.

METHODS

Systematic searches were conducted in Medline (PubMed), Scopus, Web of Science, Cochrane, Embase, and ProQuest until February 2024. Randomized controlled trials and non-randomized studies of interventions with ≥12 months of follow-up were included. Exclusion criteria were: studies with >30% loss to follow-up, unclear evaluation criteria, management under general anesthesia, unhealthy patients, or lacking individual success data. A meta-analysis assessed success rates, with subgroup analyses. Risk of bias was evaluated using RoB 2 and ROBINS-I, and evidence certainty was assessed using the GRADE system.

RESULTS

Eight studies involving 852 teeth from 271 children aged 2-9 years, with follow-ups of 3-36 months, were included. The meta-analysis revealed a 71% success rate at 12 months for all techniques. Strip crowns (79%) and zirconia crowns (70%) had the highest success rates for teeth without endodontic treatment. Intracanal posts (resin or glass fiber) achieved an 83% success rate for teeth requiring endodontic treatment. Evidence certainty was low.

DISCUSSION

Strip crowns and zirconia crowns performed well for teeth without endodontic treatment, with strip crowns offering a simpler and less technique-sensitive option. Biological restorations had poorer outcomes due to their complexity, sensitivity, and the need for a tooth biobank, raising legal and logistical challenges. Although zirconia crowns require extensive subgingival preparation, they align less with minimally invasive principles compared to strip crowns. Intracanal posts showed high success rates for teeth needing endodontic treatment, regardless of the material used.

CONCLUSIONS

Strip crowns appear to be a suitable option for restoring primary anterior teeth that do not require endodontic treatment. For teeth requiring endodontic treatment, the use of intracanal posts combined with strip crowns seems to yield satisfactory results.

Comparative Evaluation of Two Esthetic Full Coronal Restorative Materials for Primary Incisors

Aim

This study was designed to compare the clinical efficacy of two esthetic restorative materials, nanoceramic (Magma NT®) and giomer (Beautifil II®), as full coronal restoration in primary maxillary incisors.

Materials and methods

A total of 15 patients aged 3-5 years presenting with mutilated primary maxillary incisors due to caries or trauma were selected for the study using randomized simple sampling. A total of 40 maxillary incisors were randomly divided into two equal groups, with 20 teeth in each group. Teeth in group I (GP I) were restored with nanoceramic (Magma NT®) and group II (GP II) with giomer (Beautifil II®). The full coronal restorations were done using strip crowns (3M ESPE). The restorations were evaluated for gross fracture, marginal integrity, and secondary caries according to modified Ryge's criteria [United States Public Health Service (USPHS)] at baseline (immediate postoperative), 3, 6, and 9 months. Parental satisfaction with each type of restoration was also evaluated using the Likert 5-point scale.

Results

The data obtained was statistically analyzed using the Chi-squared test, and the level of significance, that is, the p-value, was determined. The Chi-squared test showed no significant changes to all modified USPHS criteria for each material at baseline and 3-month evaluation period. The changes recorded were after a 3-month follow-up between the two materials; nanoceramic (Magma NT®) restoration demonstrated marginally better than giomer (Beautifil II®) in terms of gross fracture and marginal integrity; however, there was no statically significant difference between them (p > 0.05), while giomer (Beautifil II®) was better than nanoceramic in terms of secondary caries (p < 0.05). Parental satisfaction for both entities was comparable in terms of color and durability; however, they were cost-ineffective.

Conclusion

Nanoceramic restoration demonstrated better results in terms of gross fracture and marginal integrity, while giomer was better in terms of secondary caries.

Clinical significance

Nanoceramics and giomers can serve as an alternative to conventional restorative materials in primary anterior teeth because of their improved qualities.

How to cite this article

Dhaker KK, Tandon S, Rathore AS, et al. Comparative Evaluation of Two Esthetic Full Coronal Restorative Materials for Primary Incisors. Int J Clin Pediatr Dent 2024;17(3):321-327.

Clinical Performance of Composite Resin Restorations of Primary Incisors with Extensive Carious Lesions Retained by Glass Fiber Post or Biological Post

AIM

Intracanal posts enhance the resistance of the restoration to mechanical loads and masticatory forces in primary teeth with extensive carious breakdown. This study was done to investigate the clinical performance of composite resin restoration retained by either glass fiber post or biological post in the restoration of primary anterior teeth with extensive carious lesions.

MATERIALS AND METHODS

A total of 21 children (with 82 primary anterior teeth) who met the inclusion criteria were involved in the study. The 82 primary maxillary incisors were randomly allocated into two equal groups: groups I (glass fiber post) and II (biological post). All the teeth underwent pulpectomy, followed by glass fiber post or biological post, followed by celluloid strip crown restoration. Clinical analysis of all the teeth in the two groups was performed at 1, 3, 6, 9, and 12 months to assess the success of treatment procedures. Statistical Package for the Social Sciences (SPSS) software version "17" was used for statistical analysis. Pearson's Chi-squared test and Fisher's exact test were utilized to evaluate the success of both treatment procedures. The significance level was predetermined at p < 0.05.

RESULTS

At the end of the 12-month follow-up period, 89.4 and 84.2% of composite resin restorations of primary incisors with extensive carious lesions were retained by glass fiber and biological posts, respectively. The intergroup comparison revealed no statistically significant differences pertaining to retention loss, marginal discoloration, and marginal adaptation at all follow-up intervals (p > 0.05).

CONCLUSION AND CLINICAL SIGNIFICANCE

Since biological posts are inexpensive and economical, they may replace the commercial post systems available to pediatric dentists.

HOW TO CITE THIS ARTICLE

Jaiswal N, Garg N, Pathivada L, et al. Clinical Performance of Composite Resin Restorations of Primary Incisors with Extensive Carious Lesions Retained by Glass Fiber Post or Biological Post. Int J Clin Pediatr Dent 2023;16(6):850-857.

Comparison of Fracture Resistance of Primary Incisors Restored with Different Intracanal-Reinforcement Materials

Aim

To evaluate the effects of placing short posts made of different restorative materials on the fracture resistance of root canals in primary incisors of primary teeth.

Materials and Methods

The root canals of 40 extracted primary incisors were prepared and filled with Vitapex and randomly divided into five groups of 8 each. In Groups 1–4, a post space was created and filled with different restorative materials (Tetric^® N-Ceram Bulk Fill, AeliteFlo, Filtek Z250 XT, and GC Fuji II LC^® capsule), while Group 5 was kept filled with Vitapex as a control. Fracture resistance was measured using a universal testing machine at a 0.5-mm/min crosshead speed. The results were statistically analyzed and compared.

Results

The highest fracture resistance was recorded for GC Fuji II LC capsules [439.82 N] and control [423.37 N], while the lowest fracture resistance was recorded for Tetric^® N Ceram Bulk Fill (239.91 N). A multiple comparison test showed that the Tetric^® N-Ceram Bulk Fill had a significantly lower average value than AeliteFlo (P = 0.030), as well as a significantly lower average value than GC Fuji II LC^® capsule (P = 0.001), and a significantly lower average value than the control group (P = 0.002). Multiple comparison tests showed no significant difference between Tetric^® N-Ceram Bulk Fill and Filtek Z250 XT (P = 0.39).

Conclusion

The fracture resistance of primary incisor root canals differs according to the material used for the intracanal posts. Three-millimeter intracanal posts in the primary incisors showed the highest fracture resistance for the teeth restored with GC Fuji II LC capsules and the control.

Comparison of parental satisfaction with strip crowns and primary anterior zirconia crowns in 3-5 years old children over 1 year

BACKGROUND

During the past decade, parental involvement for the selection of full coronal restorations for the primary anterior teeth of their children has been increased. Two most common anterior aesthetic full coronal restorations, the strip crowns and the preformed zirconia crowns, are available options.

AIM

The aim of this study is to compare parental satisfaction with strip crowns and preformed primary anterior zirconia crowns over 1 year in 3-5 years old children.

MATERIALS AND METHODS

Forty maxillary primary incisors were restored by either strip crown or zirconia crown in 24 children. Permuted block randomization method was used for the allocation of participants. Twenty-four parents participated were recalled to fill the questionnaire over 1 year. One parent dropped out at the end of 1 year. Data were analyzed using the t-test and Chi-square test. P < 0.05 considered statistically significant.

RESULTS

Parents were satisfied with both types of restorations. Statistically significant relationship was found between overall satisfaction and durability (P = 0.004) with strip crowns and with the color (P = 0.043) in the zirconia crowns. The parents with the lower satisfaction levels with the durability of strip crowns and color of zirconia crowns rated high overall satisfaction.

CONCLUSION

Parental overall satisfaction was higher for preformed primary anterior zirconia crowns than strip crowns. Almost equal number of parents was satisfied with all other parameters except for durability, which was more for zirconia crowns.

Evaluation of the Clinical, Child, and Parental Satisfaction with Zirconia Crowns in Maxillary Primary Incisors: A Systematic Review

Background

With the increasing demand for aesthetics in children and their parents, the treatment of decayed primary anterior teeth is one of the biggest challenges in pediatric dentistry. Zirconia crowns have provided a treatment alternative to address the aesthetic concerns and ease of placement of extracoronal restorations on primary anterior teeth.

Methods

The electronic databases including PubMed, Scopus, Google Scholar, and Embase were searched on articles published between January 2010 and January 2021. Studies relating to evaluating the clinical success and satisfaction of both parents and children about zirconia crowns in maxillary primary incisors were reviewed.

Results

Nine studies met the criteria for final inclusion. Findings from these studies showed that parental and child satisfaction with zirconia crowns is high with clinically acceptable restorations in the maxillary primary incisors.

Conclusion

Parental and child satisfaction with zirconia crowns is high with clinically acceptable restorations in the maxillary primary incisors. In addition, larger sample sizes and longer follow-ups are required in future studies.

Clinical and radiographic comparative study to evaluate the efficacy of restoring destroyed primary incisors using two different techniques-A pilot study

Objective: The restoration of destroyed maxillary primary incisors is difficult because of the insufficient amount of coronal structure. This pilot study aimed to compare the efficacy of composite posts technique and glass fiber posts technique in restoring destroyed primary incisors.

Materials and Methods: Thirty‐six destroyed maxillary primary incisors in 11 children with early childhood caries were randomly assigned after endodontic treatment into two groups: glass fiber posts (n = 18) and composite resin posts (n = 18). Blinded clinical evaluation was made at 3, 6, 9, and 12 months and Blinded radiographic evaluation was made at 6 and 12 months. The evaluation was according to the FDI criteria. Data were analyzed with Fisher's exact test (α = .05).

Result: After 12 months post‐treatment, the success rates were 88.2% in glass fiber posts group and 70.6% in composite resin posts group. There was no statistically significant difference between the two groups according to the evaluation criteria (p‐value >.05).

Conclusion: Glass fiber posts technique and Composite posts technique may be used in the restoration of destroyed primary incisors.

Fracture Resistance of a Bulk-Fill and a Conventional Composite and the Combination of Both for Coronal Restoration of Severely Damaged Primary Anterior Teeth

Objectives:

This study aimed to compare the fracture resistance of a bulk-fill and a conventional composite and a combination of both for coronal restoration of severely damaged primary anterior teeth.

Materials and Methods:

In this in vitro experimental study, 45 primary anterior teeth were randomly divided into three groups. After root canal preparation, the canals were filled with Metapex paste such that after the application of 1 mm of light-cure liner, 3 mm of the coronal third of the canal remained empty for composite post fabrication. Filtek Z250 conventional composite was used in group 1, Sonic-Fill bulk-fill composite was used in group 2 and Sonic-Fill with one layer of Filtek Z250 as the veneering were used in group 3. Adper Single Bond 2 was used in all groups. The teeth were thermocycled, and fracture resistance was measured by a universal testing machine. The mode of fracture was categorized as repairable or irreparable. Data were analyzed using one-way ANOVA.

Results:

The mean fracture resistance was 307.00±74.72, 323.31±84.28 and 333.30±63.96 N in groups 1 to 3, respectively (P=0.55). The mean fracture strength was 14.53±2.98, 15.08±2.82 and 15.26±3.02 MPa in groups 1 to 3, respectively (P=0.77). The frequency of repairable mode of failure was 80% for the conventional, 73.6% for the bulk-fill and 80% for the bulk-fill plus conventional group, with no significant difference (P>0.05).

Conclusion:

Bulk-fill composites can be used for coronal reconstruction of severely damaged primary anterior teeth similar to conventional composites to decrease the treatment time in pediatric patients.

Clinical comparison of various esthetic restorative options for coronal build-up of primary anterior teeth

Background:

This study was designed to compare the clinical performance of composite, strip crowns, biological restoration, and composite with stainless steel band when used for the coronal build-up of anterior teeth.

Materials and Methods:

A total of 20 patients aged 3-6 years presenting with mutilated primary anterior teeth due to caries or trauma were selected for the study using randomized simple sampling. A total of 52 primary anterior teeth were randomly divided into four equal groups having 13 teeth in each group. Teeth in Group I were restored with composite, in Group II with strip crowns, in Group III with biologic restoration and with stainless steel band reinforced composite in group IV. The restorations were evaluated for color match, retention, surface texture, and anatomic form according to Ryge's Direct (US Public Health Service) evaluation criteria at baseline (immediate postoperative), after 48 h, 3, 6, and 9 months. The data obtained were statistically analyzed using Chi-square test, and level of significance, that is, P value was determined.

Results:

At baseline, none of the groups showed any color changes. Other than Group III all other groups showed highly significant changes (P < 0.05) in color after 3 months. Loss of retention was seen in both Groups I and IV after 3 months. After 6 months, retention loss was seen in all the groups except Group II, in which loss was seen after 9 months (P > 0.05). Deterioration in surface texture was exhibited maximum by restorations in Group IV followed by Group I at 3 months. Whereas, no surface changes were seen in Group II and III. Only Group I and IV showed discontinuity in anatomic form after 3 months. After 6 months, except in Group II, discontinuity in anatomic form was observed in all the groups. Discontinuity in anatomic form was seen in all the 4 groups after 9 months although the difference was not significant (P > 0.05).

Conclusion:

Biological restoration was found to be most satisfying esthetically owing to color compatibility with the patient's tooth. Thus, it has a great potential to be used as esthetic restorative option in primary anteriors.

Biologic Foundation Restoration: A Natural Post And Core For Management

Complicated crown fractures are a common outcome of dental trauma. Various treatment options are available for consideration. The preferred choice of treatment though, is determined by multiple factors associated with the nature of trauma itself. This case report highlights the management of a cervical crown fracture by modifying the clinical technique of an existing concept of the "Biologic Post and Core" and integrating it with current advances in adhesive technology, with an intention for preservation and reinforcement of residual tooth structure. The clinical success observed during subsequent patient recall has given reason for optimism in considering the employed method as a possible alternative to address this area of prosthetic concern.

Methods of Intracanal Reinforcement in Primary Anterior Teeth-Assessing the Outcomes through a Systematic Literature Review

AIM

To assess how the various methods of intracanal reinforcement (short root canal posts) performed in their clinical and radiographic outcomes for restoring grossly broken down primary anterior teeth after pulpectomy for 1 year or longer follow-up period.

MATERIALS AND METHODS

Literature search of electronic databases (Sept 2013) and various journals (1980-Sept 2013) using medical subject headings and free text terms was conducted. For inclusion in quality assessment, prespecified inclusion criteria were applied. Quality assessment was performed by using 'The Cochrane collaboration's tool for assessing risk of bias'.

RESULTS

Seven relevant papers were selected for full text evaluation. After applying the inclusion criteria, only two trials could be considered for quality assessment. Both of these were classified as having high risk of bias.

CONCLUSION

The evidence to support any method of intracanal reinforcement for restoring grossly broken down anterior teeth is presently lacking. Further trials with well-defined methodology are needed. How to cite this article: Mittal N, Bhatia HP, Haider K. Methods of Intracanal Reinforcement in Primary Anterior Teeth- Assessing the Outcomes through a Systematic Literature Review. Int J Clin Pediatr Dent 2015;8(1):48-54.

Biological restorations as an alternative to reconstructing posterior teeth: a case report

This article reports on a three-year follow-up of two biological restorations performed on a 15-year-old female patient. After clinical evaluation, tooth fragments from extracted permanent molars were obtained from a Human Teeth Bank and were autoclaved, adjusted to the prepared cavity, and bonded to the remaining tooth structure with dual resin cement. The technical aspects are described and the benefits and disadvantages of biological restorations as an alternative treatment for rehabilitation of severely destroyed permanent molars are discussed.

Retentive strength of different intracanal posts in restorations of anterior primary teeth: an in vitro study

Objectives

To determine the retentive strength and failure mode of undercut composite post, glass fiber post and polyethylene fiber post luted with flowable composite resin and resin-cement.

Materials and Methods

Coronal parts of 120 primary canine teeth were sectioned and specimens were treated endodontically. The teeth were randomly divided into 6 groups (n = 20). Prepared root canals received intracanal retainers with a short composite post, undercut composite post, glass fiber post luted with flowable resin or resin-cement, and polyethylene fiber post luted with flowable resin or resin-cement. After crown reconstruction, samples were tested for retentive strength and failure mode. Statistical analysis was done with one-way ANOVA and Tukey tests (p < 0.05).

Results

There were statistically significant differences between groups (p = 0.001). Mean bond strength in the undercut group was significantly greater than in the short composite post (p = 0.030), and the glass fiber post (p = 0.001) and the polyethylene fiber post group luted with resin-cement (p = 0.008). However, the differences between the undercut group and the groups with flowable composite as the luting agent were not significant (p = 0.068, p = 0.557). Adhesive failure was more frequent in the fiber post groups.

Conclusions

Although the composite post with undercutting showed the greatest resistance to dislodgement, fiber posts cemented with flowable composite resin provided acceptable results in terms of retentive strength and fracture mode.

Modified intracanal post for severely mutilated primary anterior teeth

Early childhood caries leads to early damage, discolouration and gross destruction of the maxillary anterior teeth. This leads to difficulty in speech, decreased masticatory efficiency, development of abnormal tongue thrust and subsequent malocclusion, psychological problems and problem with self-esteem, if aesthetics are compromised. Thus, restoration of severely mutilated primary anterior teeth is often considered as a special challenge, especially in an emotionally immature child. This case documents the restoration of severely mutilated incisors in a patient with early childhood caries.

A simple method for reconstruction of severely damaged primary anterior teeth

Restoration of severely decayed primary anterior teeth is often considered as a special challenge by pedodontists. This case report presents a 5-year-old boy with severely damaged maxillary right canine. Subsequent to root canal treatment, a reversed (upside-down) metal post was put into the canal and composite build-up was performed. This new method offers a simple, practical and effective procedure for reconstruction of severely decayed primary anterior teeth, which re-establishes function and esthetics for time the tooth should be present and functional in the child's mouth.