RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

NAME OF THE CANDIDATE AND ADDRESS

DR.JAYA PAUL POST GRADUATE COORG INSTITUTE OF DENTAL SCIENCES, VIRAJPET-571218.

2. NAME OF THE INSTITUTION

COORG INSTITUTE OF DENTAL SCIENCES, VIRAJPET-571218.

3. COURSE OF THE STUDY AND SUBJECT

MDS PEDODONTICS AND PREVENTIVE DENTISTRY

4. DATE OF ADMISSION TO THE COURSE

17-04-2010

5. TITLE OF THE TOPIC: FRACTURE RESISTANCE OF ENDODONTICALLY TREATED PERMANENT ANTERIOR TEETH RESTORED WITH THREE DIFFERENT ESTHETIC POST SYSTEMS An in vitro study.

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BRIEF RESUME OF THE INTENDED WORK 6.1 NEED FOR THE STUDY:

Anterior teeth commonly fracture as a result of traumatic injuries . The prevalence of traumatic injuries has been found to be 13.8% and is often associated with various factors such as age group involved, sex, place of injury, and overjet of the dentition1. A proper coronary reconstruction that produces satisfactory esthetic and functional conditions for endodontically treated and extensively damaged teeth is still a challenge for restorative dentistry, considering that, to achieve these conditions, the making of an intra-canal retention, aimed at a better retention and stability of the dental fragments, becomes imperative. This retention can be performed by using posts made from several materials such as fiberglass, carbon fiber, metal and ceramic. However, no commercially available pre-manufactured post meets all ideal biological and mechanical properties.2 The use of biological posts made from natural, extracted teeth represents a feasible option for the strengthening of the root canal, thus presenting the potential advantages2: (1) Does not promote dentin stress, (2) Preserves the internal dentin walls of the root canal, (3) Presents total biocompatibility and adapts to conduct configuration, favoring greater tooth strength and greater retention of these posts as compared to pre-manufactured posts, (4) Presents resilience comparable to the original tooth, (5) Offers excellent adhesion to the tooth structure and composite resin and at a low cost. Hence, this study will be undertaken to evaluate and compare the fracture resistance of simulated traumatized endodontically treated anterior teeth restored with two commercially available esthetic post systems and a customized biologic dentin post system.

6.2 REVIEW OF LITERATURE

Endodontically treated teeth with insufficient tooth structure are often

restored with crowns. If there is insufficient dentin to support a restoration, a post-core is required to provide retention and support . Although posts are recommended to strengthen the teeth several investigators have cautioned that posts with inadequate resistance to rotational forces on the posts can weaken the teeth. Consequently, root fractures constitute the most serious type of failure in post-restored teeth . To prevent root fractures, a post should have an elastic modulus similar to that of dentin a property which enables a more uniform distribution of stress by distributing the occlusal load. On the other hand, while it is important to ensure that a post is firmly cemented to provide adequate retention for the restoration and adequate protection of the remaining tooth structure, it should yet be easily removed if retreatment were required.3 Traditionally, titanium, carbon, polyethylene fiber, and stainless steel posts were used for the anterior region. However, when all-ceramic restorations are preferred, metal posts may negatively affect the esthetic results. Besides, corrosion reactions can cause metallic taste, oral burning, oral pain, sensitization, and other allergic reactions. With regard to both esthetic and health concerns, non-metal posts not only render esthetic superiority over metallic posts, but also preclude the possibility of corrosion and reduce the risk of toxicity . For these advantageous reasons, a wide range of esthetic posts have become commercially available, such as fiber reinforced composite resin posts (FRC) and yttrium stabilized zirconia-based ceramic posts.3 Zirconia posts were first introduced by Meyenberg et al., who reported that the flexural strengths (9001200 MPa) of these posts were comparable to cast gold or titanium, and that it is possible to have the same post dimensions as high gold alloys or titanium . Currently , zirconia is a widely used material because of its good chemical stability, high mechanical strength, high toughness, and a Youngs modulus similar to that of stainless steel alloy. The high initial strength and fracture toughness of partially stabilized zirconia stems from a physical property known as transformation toughening. Apart from its favorable chemical and physical properties, zirconia also wields the esthetic advantage of having a color similar to that of natural teeth3 Fiber reinforced with composite (FRC) posts were introduced to dentistry around 15 years ago and are composed of carbon, glass or quartz fiber embedded in epoxy resin4. They have bonding ability to dentin and the core material7. They can reinforce the tooth, and as their elasticity is compatible with dentin ,they can absorb stresses and protect the root from fracture. Saupe and co-workers 10 reported that fiber reinforced with composite posts treated teeth had more resistance to masticatory forces.

FRC posts have a lower fracture strength compared to cast posts and cores, but in case of failure, the post or core will fracture ,instead of roots in cast post and core restored teeth. There are several reports which show that FRC posts minimize the root fracture8, and if required, removal of FRC posts from the canal is easier than other post systems. Two groups of FRC posts are available, including chair side fabricated FRC post , composed of polyethylene woven fiber tapes and prefabricated FRC post , comprising of three types. Carbon fiber post composed of pyramidal carbon fibers embedded in an epoxy resin matrix, which is biocompatible, corrosion , and fatigue resistant, and has physical properties similar to dentin9, whereas its dark color is considered as its main disadvantage. The fiber post comprises of unidirectional glass fiber in an epoxy resin matrix, and the quartz fiber post, which was recently transmits the light4 A biological restoration meets up to the esthetic and the structural standards of natural teeth .They provide natural posts and crowns which can fit into the treated root stumps of individual and replace coronal portion esthetically6 Patrica Correa- Farria and co-workers 2 reported a case study in which coronary destruction extended to the cervical third of the crown, where intraradicular reinforcement was obtained using dentin posts prepared from donated canines. The authors opined that dentine posts allowed for juxtaposed adaptation of the root canals, and did not cause stress to the dentine ,since they contained the same biomechanical behavior as the restored teeth. The adhesion provided among the Biological post, the cementing agent and the dental structure allowed one to attain a sole biomechanical system (monoblock) with materials that were compatible among themselves. Carlos Eduardo pinto de, Patricia correa-faria, Arthuso vasconcellos, and Maria Leticia Ramos Jorge5 described a case report in which the esthetic and functional recovery of a maxillary central incisor was staged using a dentin post (biological post) reinforcement and reattachment of the fractured fragment. From the outcomes achieved, they had concluded that this technique gave promising results. Dentin posts have also been used in the primary dentition with promising clinical and laboratory results.5 introduced , provides the most esthetic results, and

6.3 AIMS AND OBJECTIVES OF THE STUDY

1. To evaluate and compare the fracture resistance of permanent central incisors restored with three different post systems including biologic dentin posts. 2. To evaluate the mode and location of failure of these post systems

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MATERIALS AND METHODS 7.1 SOURCE OF DATA Atraumatically extracted 40 permanent maxillary central incisors will be collected from the Dept. of Oral and Maxillofacial surgery, Coorg Institute of Dental Sciences, Virajpet. 7.2 METHOD OF COLLECTION OF DATA SAMPLE SIZE:

40 permanent maxillary central incisors extracted for therapeutic reasons. Selection of Teeth: Inclusion criteria:

Maxillary permanent central incisors extracted due to therapeutic reasons.

Exclusion criteria:

Teeth with incompletely closed apices.

Teeth with evidence of dental caries, craze lines or fracture lines on the root surfaces.

PROCEDURE:

40 permanent maxillary central incisors extracted for therapeutic reasons, will be selected for this study. Buccolingual and mesiodistal radiographs will be taken to ensure that the teeth have a similar internal anatomy. The crowns of these teeth will be amputated just above the cemento-enamel junction using a water cooled diamond disc. All the teeth will be endodontically prepared to a standard size and obturated with gutta percha. Standardized post spaces will be created in the individual samples using peeso reamers and all the samples will be embedded in

standardized acrylic resin blocks. Grouping Of Teeth: All the samples will then be randomly divided into the following four equal groups. GROUP I - Control group 10 prepared samples restored with a composite resin core without any intraradicular post placement. The composite core dimension being similar to core dimensions of the experimental groups.

GROUP II - Zirconia Post group. 10 prepared samples restored with a standardised composite core and intraradicular zirconia post placement. GROUP III - Fiber Post group 10 prepared samples restored with a standardized composite core and intraradicular fiber post placement GROUP IV - Biologic Dentin Post group. 10 prepared samples restored with a standardized composite core and intraradicular biologic dentin post placement. Method of preparation of Biologic Dentin Posts: 10 extracted, donated permanent incisors will be used following standard sterilisation protocols2. Using a diamond disc the crowns of the teeth will be separated and the roots sectioned mesio-distally along the long axis of the tooth. The irregular surfaces of these sectioned roots will be smoothened using a diamond disc and shaped to obtain Biologic Dentin Posts2. The various post systems in all the samples will be cemented using resin bonded cement as per the manufacturers instructions.

All specimens will be subjected to a compressive load using a testing

machine until fracture occurs. After testing the failure mode will be evaluated and classified under a stereo-microscope.

The results obtained will be tabulated and subjected to statistical analysis.

STATISTICAL ANALYSIS: The data obtained will be tabulated and statistically analysed using t test and ANOVA.

7.3

DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY.

This in-vitro study involves the use of extracted human permanent maxillary incisors.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF
THE ABOVE STUDY?

Yes.

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LIST OF REFERENCES

1) Gupta K, Tandon S , Prabhu D. Traumatic injuries to the incisors in children of south canara dist. a prevalence study. J Indian Soc Pedo Prev Dent. 2002 Sep ; 20(3):107- 113. 2) Patrcia Corra-Faria, Carlos Eduardo Pinto De Alcntara, Marcus Vincius Caldas-diniz, Adriana Maria Botelho, Karine Tas Aguiar Tavano. Biological Restoration root canal and coronal reconstruction. J Esthet Restor Dent. 2010; 22(3):168178 3) Zeynep Ozkurt, Ufuk Ieri , Ender Kazazolu. Zirconia ceramic post systems; a literature review and a case report. Dent Mater J.2010; 29(3): 233245. 4) Kianoosh Torabi , Farnaz Fattahi .Fracture resistance of endodontically treated teeth restored by different FRC posts: an in vitro study. Indian J Dent Res.2009; 20(3): 282-287. 5) Carlos Eduardo Pinto De Alcantara, Patrcia Correa-Faria, Walison Arthuso Vasconcellos, Maria Leticia Ramos-Jorge . Combined technique with dentin post reinforcement and original fragment reattachment for the esthetic recovery of a fractured anterior tooth: a case report. Dent Traumatol. 2010; 26: 355358. 6) Grewal N , Reeshu S .Biological Restorations: An alternative esthetic treatment for restoration of severely mutilated primary anterior teeth. Int J Clin Pedi Dent. 2008 Sept-Dec; 1(1):42-47. 7) Newmann MP, Yaman P, Dennison J, Rafter M, Billy E. Fracture resistance of endodontically treated teeth restored with composite post. J prosthet dent.2003;89:360-7. 8) Pereira JR, Ornelas FD, Rodrigues PC, Valle AL. Effect of a crown ferrule on fracture resistance of endodontically treated tooth restored with prefabricated posts. J Prosthet Dent. 2006; 95:50-4. 9) Christensen GJ. Posts and cores: State of art .J Am Dent Assoc. 1998 Jan; 129:96- 80. 10) Saupe WA, Gluskin AH, Radke RA Jr . A comparative study of fracture resistance between morphologic dowel and cores and a resin-reinforced dowel system in the intraradicular restoration of structurally compromised roots. Quintessence Int.1996 Jul;27(7):483-91.

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Signature of the candidate

10.110.

Remarks of the guide

11.1 111111.

Name & Designation of (in block letters) 11.1 Guide 11.2 Signature

DR. AMEET. J. KURTHUKOTI PROFESSOR

11.3 Co- guide (if any) 11.4 Signature

11.5 Head of the Department 11.6 Signature

DR. B.M. SHANTHALA PROF. & H.O.D.

12.112.

12.1 Remarks of the Chairman & Principal 12.2 Signature DR. SEQUEIRA PETER SIMON