Full adhesive restoration of subgingivally fractured teeth
Adhesive dentistry has been a revolution 30 years ago and has changed the mindset of the clinician. We went from a mechanical approach which required to adapt the tooth to the material, to a biological approach in which the chosen material has to adapt at the biology.
Minimal invasive phylosophy started to lead and transform the clinical approach with a significant change in the preservation of the tooth structure. Biology became the most important pillar before esthetic and function.
Adhesion has changed not only the coronal reconstruction but the root anatomy as well. This is why fiber post reconstruction has become a perfect substitute of the metal post core esthetically and physically with a better stress distribution along the root. Combination of fiber glass and dual cure composite are the best dentin substitute.
If we think at the upper floor bonded glass ceramic restorations are the best enamel substitute esthetically and biomechanically speaking
As you can see in the picture, the fractures go pretty far beyond the gingival margin.
• dual cure adhesive (DMG LuxaBond – Total Etch)
• glass fiber post (DMG LuxaPost)
• core build up dual cure composite (DMG LuxaCore Z – Dual)
• Colibri mixer tip with metal tip to inject the composite precisely in the root anatomy (Pulpdent, Voco, Danville, Itena, Tokuyama, Bisco)
Note that a new type of smart universal all in one mixer tip are available too.
– Sandblasting (Aquacare Velopex, Dentoprep Ronvig) with 50 micron aluminum oxyde particles)
– Etching with orthophosphoric acid 37% for 25 sec
– Universal adhesive (DMG Ecosite Bulk Fill)
– Light curing for 45 sec
– Resin cement (DMG Vitique) B1 veneer
– n° 12 blade
You can note the gum inflammation due to the placement of the rubber dam to push the gum in order to have the clamp beyond the deep margin.
Also the papilla between 11 and 12 is not complete because of the compression of the temporaries during the last 2 months.
final view after the periodontal healing (3 months later)
ceramist (gerald UBASSY)
Thanks to adhesive dentistry the practitioner today has the choice, the protocol and the material to regenerate the tooth structure thanks to the mimicry of the material used.
The use of fiber post reconstruction is the ideal way to copy esthetically and biomechanically dentin body and offer the freedom to use a glass ceramic material to copy enamel body.
This approach is the real revolution in dentistry as it better distributes force thus reducing the risk of destructive failure of the residual tooth structure.
• Lamichhane A, Xu C, Zhang FQ. Dental fiber-post resin base material: a review. J Adv Prosthodont. 2014 Feb; 6(1): 60–65.
• Hattory M, Takemoto S, Yoshinari M, Kawada E, Oda Y. Durability of fiber-post and resin core build-up systems. Dent Mater J. 2010 Mar;29(2):224-8
• Ozcan M, Valandro LF. Fracture strength of endodontically-treated teeth restored with post and cores and composite cores only. Oper Dent. 2009 Jul-Aug;34(4):429-36