M Jain, S Singla, BAK Bhushan JISPPD - 2011 ; Vol 29 : Issue 4

Introduction
Despite the introduction of various novel techniques for restoring carious lesions in the primary incisors still it is a challenge for the clinician to satisfy the patient effectively. It is becoming a greater concern as more emphasis is being placed on esthetics

 Anterior primary teeth, when grossly decayed, lack a coronal structure, leading to decreased support and adhesion for a composite crown. Hence, use of a posts are preferred and the technique is referred to as the 'short post technique,' which requires root canal treatment followed by post.

Intra coronal restoration Luted

Full coronal restoration

Bonded

Direct

Indirect Stainless steel with facing Cheng crowns Kinder crowns Nu-smile Dura-crowns Whiter bite Pedo pearls Ceromo-basemetalcrowns

Polycarbonate Strip crowns Pedo jacket New millnium Glastech

Crown Build up (Restoration of Severely Decayed Tooth)

Direct

Indirect

1. Resin composite short post technique 2. Orthodontic wires shaped as Greek alphabets like alpha, omega, theta

1. Indirect composite resin crowns reinforced with a fibre glass,polyethylene fibres post 2. Biological posts & crowns 3. Metal posts

Crown build up using resin composite

This technique involves placement of light cured resin composite in the root canal and crown region in several steps where the cervical third of root is left unobturated. This eventually forms the superstructure of the post. in next visit celluloid crowns are used to build up the teeth. The celluloid crown is filled with same material used in fabricating the post

Orthodontic wires shaped as Greek alphabets like alpha, omega, theta

Mortada and King(2004) proposed this technique involving the placement of an omega shaped stainless steel wire extension into the entrance of the root canal prior to restoring the crown with an internal compomer core and an external composite restoration. Disadvantage : the wire is unable to adequately adapt to the canal form, because it is not the exact copy of the canal.

Biological posts and crowns

Biological restoration was introduced by Santos & Bianchi in 1991. teeth from the Human Tooth Bank are used as natural posts & crowns. The selected tooth from the tooth bank is reshaped, roots strengthened by retro filling with flowable composites and autoclaved before cementation

 Different fiber types have been added to composite materials such as carbon fibers kevlar fibers vectran fibers glass fibers polyethylene fibers

composite resin crowns reinforced with a fibre glass post

In this method glass fiber core posts are introduced into the root canals of primary incisors for a distance of 2 to 3 mm. It is retained in place by flowable composite, then the coronal part is reconstructed by a strip crown to restore the crown form. improve the impact strength of composite materials & have excellent esthetic properties but do not easily stick to resinous matrix.

Polyethylene fiber
Polyethylene fibers are routinely used in current restorative dentistry. These fibers improve the impact strength, modulus elasticity and flexural strength of composite material The fibers transparency makes it possible to use esthetic restorations for cases such as traumatized anterior tooth

 It is a spectrum of 215 fibers with a very high molecular weight high elasticity coefficient (117 GPa) that makes them highly resistant to stretch and distortion and high resistance to traction (3 GPa) that allows them to easily adapt to tooth morphology and dental-arch contours. It is biocompatible, esthetic, translucent, practically colorless and disappears within the composite there are characterized by an impact strength five times higher than that of iron.

 After pulpectomy cervical third of each tooth is prepared for the placement of an intra canal retainer The necessary length of tape is achieved by measuring internal length of each prepared root canal using millimeter periodontal probe. The fiber is cut approximately twice the height of future coronary core restoration. Acid etching of root canal - 37% of phosphoric acid and fiber is double inserted in to the canal after it is immersed in the dental adhesives system along with thin layer of flowable composite and light cured finally teeth restored with composite

Applications
as a space maintainer a fixed partial denture with a natural tooth pontic an endodontic post and cores as a splint material orthodontic fixed lingual retainers reattachment of Coronal Fragment

Case reports:
Case 1: four-year-old girl chief complaint - poor facial appearance due to discolored and worn out front teeth On examination multiple carious lesions with root stumps of 52, 53, 61, and 62

 The root stumps were found to be firm, with less than 2 mm of the crown above the gingival margin being intact. Radiographic examination - no signs of exfoliation, with normal development of a permanent successor.

Case 2
A four-and-a-half-year-old boy reported with a chief complaint of decayed teeth. On examination 51, 61, and 52 were grossly carious, to the extent that only 2 - 3 mm of the crown structure above the gingival margin was intact, with the presence of fenestration i.r.t 62 Radiographic examination revealed the presence of a fully formed root without any signs of early resorption of 51, 61, and 52.

Follow up
Clinical & radiographic examination after 1,3 & 6 months revealed presence of an intact crown & absence of periapical pathology

Review of literature

Polyethylene fibers: a new alternative for restoring badly destroyed primary incisors
J Clin Pediatr Dent 2005 Winter;29(2):151-6.

present study compared two different types of fibers and analyzed the fracture resistance between the two of them. Group I used non pre-impregnated resin fibers and group II used pre-impregnated resin fibers . results indicated that the mean fracture resistance for group I was 71.346 and for group II 97.952 (p = 0.004). Adhesive failures were noted for group I at the junction between the fiber and its core to the interior wall of the root canal. In group II, the fibers were dislodged out of the canal and the core part of the canal remained intact. It was concluded that pre-impregnated fibers offer a better fracture resistance when used as post in endodontically treated primary anterior teeth.

Use of polyethylene fiber in pediatric esthetics: clinical reports Of two cases

Santosh M Sholapurmath - J. Int Oral Health 2010

This article presented two cases of early child hood caries where Reinforcement fibers (poly ethylene fiber) had been used as an intra canal retainer . Polyethylene fibers appear to have best properties in elasticity, translucency, adaptability, tenaciousness, resistance to traction and to impact. Along with ease of application fiber can be used alternative to traditionally used materials in the management of early childhood caries

Restoration of crown fractures with a fiber post, polyethylene fiber and composite resin: a combined restorative technique with two case reports

two patients 23 and 19-year-old male presented with complex crown fractures. The treatment included a glass fiber reinforced root canal post, a fiber ribbon core and restoration with a resin composite. RESULTS AND CONCLUSION: The one-year follow-up examinations showed that the restorations were still in place and successful.

Different Clinical Applications of Bondable Reinforcement Ribbond in Pediatric Dentistry

Nuray Tuloglu Eur J Dent. 2009 October

Ribbond is a bondable, biocompatible, esthetic, translucent and easy-to-use reinforced ribbon. By virtue of its wide spectrum of intended properties, it enjoys various applications in clinical dentistry. This case report demonstrated usage of Ribbond as a space maintainer, a fixed partial denture with a natural tooth pontic, an endodontic post and cores and a splint material in children.

Success of Reinforced Fiber Material Space Maintainers

Zuhal Krzo, J Dent Child. 2004;71:158-162

This study used Splint-it a FRC, to prepare a newly developed space maintainer chairside in 1 appointment. A total of 40 space maintainers were applied to 29 children between 7 to 14 years old. Results: Twenty-nine (73%) space maintainers were dislodged at the end of the sixth month. The space maintainers placed on primary teeth (1 or both abutments) showed the highest failure rate (94%). Conclusions: Prolonged use of this material for space maintenance in children must be further evaluated.

Development and Testing of Fiber-reinforced Composite Space Maintainers

Gajanan Kulkarni J Dent Child 2009

Loops of fiber-reinforced composites were constructed using polyethylene fiber and glass fiber . The loops were bonded on extracted third molars and tested for flexural strength before and after thermocycling and following repair of the appliances after initial stress failure. Bacterial colonization on the appliances was also compared. Conventional stainless steel band and loop space maintainers were controls.

 Results: Ribbond samples demonstrated higher flexural strength than glass fiber and the control . The repaired Ribbond samples were statistically comparable in flexural strength to the initial samples. Thermocycling resulted in decreased flexural strength of both Ribbond and glass fiber. While all space maintainers allowed some bacterial adhesion, glass fiber showed higher Streptococcus mutans counts than Ribbond . Conclusions: The fiber-reinforced composite space maintainers may be a clinically acceptable and expedient alternative to the conventional bandloop apliance.

 Teeth lost in the anterior region infrequently require space maintenance, but demand rehabilitation from a psychological point of view. Technological advances in dental materials and new approaches in their use, such as polyethylene fibers used to reinforce the composite strip crown, have yielded convincing results in various studies. Further similar studies with increased follow-up time are required to establish the superiority of the polyethylene fibers in comparison to other fiber core posts