Article
This technique tip highlights the role of fibre-reinforced composite (FRC) posts in managing fractured teeth, as well as their specific application in children, with a case-based discussion and exploration of their advantages and disadvantages.
Dentists are frequently exposed to the management of fractured anterior teeth in children. Restoring extensively fractured permanent teeth in a child to maintain function and aesthetics can pose a significant clinical challenge. Conventional techniques to support coronal restorations of teeth with little supragingival tooth structure in children may not always be practicable. They may not conform to immature canal anatomy or may require an indirect restoration with laboratory input, which may necessitate multiple appointments.
In a growing child, FRC may provide a useful alternative to address the shortcomings of more traditional restorative techniques in restoring an extensively fractured anterior tooth. The everStick® POST (GC Europe NV, Leuven, Belgium) (Figures 1–3), a silanated E-glass fibre impregnated with a bis-GMA matrix and Polymethylmethacrylate (PMMA) polymer,1,2 is an example of such an alternative. It is an adaptable, soft and flexible post with a diameter of approximately 1.5 mm and similar composition to composite. The term ‘E-glass’ refers to fibres which are a variant of a FRC which has been found to have superior strength properties in varying conditions, good chemical resistance and sufficient imperviousness to moisture.3,4 Whilst we are focusing on its use as a post in a fractured anterior permanent central incisor, other uses of variants of everStick® POST (GC Europe NV, Leuven, Belgium) include a splinting material for periodontally compromised teeth or a minimally invasive composite bridge, which are discussed in greater detail in other literature.5,6
In using this type of post, it allows for less invasive canal preparation, helping to maintain dentine and reduce the likelihood of iatrogenic damage to the tooth, such as perforations. In paediatric patients, traumatized teeth can require operative treatment at an early age and may require further treatment in the future. This proved to be a useful choice for re-restoring a heavily fractured tooth with a guarded clinical prognosis. A low viscosity cement helps to ensure that the post can reach the full anatomy of the root canal, preventing voids and unpolymerized areas for leakage and a poor overall seal.7 Further advantages and disadvantages are summarized in Table 1.
| Advantages | Disadvantages |
|---|---|
| Improved aesthetics and shade to tooth colour | Canal preparation and dentine removal still required |
| Good flexibility, facilitating negotiation around curved canals, immature canal anatomy and larger canals | Radiolucent and reduced visibility on radiographs |
| Chairside fabrication and adjustments: can be adjusted for size through cutting and/or adding more posts to the canal based on anatomy and size | Technique sensitive – clinicians may find them difficult to handle and manipulate with tweezers |
| Ability to bond directly to composite | Still reliant on the child's co-operation and the ability of the child to tolerate root canal treatment and tooth isolation |
| Similar modulus of elasticity to dentine8 |
The use of everStick® POST (GC Europe NV, Leuven, Belgium), as a post to aid in the restoration of an UR1 in a child which had a history of a complicated crown fracture and previous failed root canal treatment with post, core and crown is highlighted.
Case report
A nine-year-old boy was seen in the Paediatric Dental Department at Birmingham Dental Hospital for assessment of his UR1, which was causing him pain. On presentation, the UR1 had a buccal sinus and mobile indirect crown. The UR1 had previously sustained a complicated crown fracture, which had been treated with root canal treatment and a metal post, core and crown. A pre-operative radiograph was taken of the UR1 revealing an open apex, suboptimal RCT and poorly fitting post, core and crown (Figure 4).
On removal of the restoration under dry dam and local anaesthetic, it was noted that there was a lack of coronal supragingival tooth structure. Following removal of GP using Hedstrom files, the UR1 underwent re-root canal treatment (Figure 5) and was dressed with calcium hydroxide and temporized with composite. Four weeks later, symptoms improved and the patient returned for removal of the temporary restoration and obturation with Mineral Trioxide Aggregate (MTA). Due to the lack of remaining supragingival tooth structure remaining (Figure 6), retraction cord with astringent was used to isolate the margins and a FRC post everStick® POST (GC Europe NV, Leuven, Belgium) was used (Figures 7 and 8), which was cemented using a low-viscosity dual curing resin cement (GRADIA®, GC). Finally, the tooth was restored using direct composite. Occlusion was checked prior to completion (Figure 9). A post-operative radiograph revealed a well-condensed post, following the patient's root canal anatomy (Figure 10).
Conclusion
Dentists may encounter difficulties in restoring severely fractured anterior permanent teeth in children due to insufficient supragingival tooth structure and large root canal anatomy. The use of FRC posts can provide an alternative, chairside solution to restore a child's dental function and aesthetics in these cases.