Dr Rakesh Kumar Yadav

INTRODUCTION
Most of the teeth can be restored with

amalgam and composite but if large crown

portion lost due to caries or some other
reasons, the remaining tooth structure is
decrease and difficult to obtained resistance
and retention form so prepare dentine lock
and slot but when these retention features are
insufficient to provide desired retention then
pin supported restorations are used.

TRETMENT OF BADLY BROKEN

TOOTH
First-Evaluate biologically and mechanically
Status of pulp and periodontium should be

evaluated.
Involvement of pulp or not
Restorative design planning
if pulp is not involve-pin,inlay,onlay
Pulp involvement- pulpotomy ,pulpectomy,
pin,full coverageTooth anterior or posterior

HISTORY
In 1958, Dr. Miles Markley introduced a practical
instrumentation for the use of a stainless steel
cemented pin that resulted in the extensive
use of cemented pins in dentistry

DEFINITION
Defined as any restoration which requires the
placement of one or more pins in dentin to
provide to adequate resistance and retention
form to the restoration.
It has a greater retention than those using
boxes or bonding system.

INDICATIONS
Badly broken down or mutilated teeth.
Questionable prognosis-Controlled

restoration in tooth with questionable pulp

or periodontal prognosis
As a foundation under fixed
restoration(core)
Economics
Age and health of the patient

CONTRAINDICATIONS
Occlusal problems
Esthetics-Rarelly used in anterior

teeth(Bonding Technique).
Access difficulties-In class V horizontal groove
in the gingival & occlusal aspect etc.

ADVANTAGES
Conservation of tooth structure
save time compared with cast restoration.
Greater resistance and retention form
Economics

DISADVANTAGES
Dentinal micro fractures or crazing
Lowered fractured resistance
Strength of amalgam restoration is reduced
Micro leakage around pin
Perforations of pulp or ext. tooth structure.
Difficulty to achieve proper contours

TYPES OF PINS
1. Cemented pins
2. Friction locked pins
3. Self threaded pins

FRICTION LOCKED PINS

Developed by Dr. Goldstein

in 1966
Made of stainless steel
More retentive than
cemented pins
Used in vital teeth with good
access and ease of
tapping/locked the pins
Cause craze lines or cracks
Retain by resilience of dentin

SELF THREADED PINS

Developed by Dr. Going in

1966
Most popular type among
all, the different types and
most extensively used pin.
Made of stainless steel or
gold plated titanium pins
Provide maximum retention
among all types of pins
Cause craze lines
Used in vital teeth

CEMENTED PINS

FRICTION LOCKED
PINS

SELF THREADED PINS

Stainless steel
with threads or
serrations

Stainless steel
with threads

Stainless
steel/Titanium
with gold plating

Pin channel
[0.020 to 0.32]
larger than pin
size [0.018 to
0.30]

Pin channel is
0.001 smaller
than pin size

Pin channel is
0.015 to 0.004
smaller than pin
size

Luted with
standard luting
agents

Taped into place

with mallet

Placed by hand
wrench or contra
angle hand piece

Ease of placement Pin placement is

difficult

Pin placement is
easy

CEMENTED PINS

FRICTION LOCKED
PINS

SELF THREADED PINS

Less internal
stresses

Increased internal Increased internal

stress
stresses

Least retentive

2-3 times more

retentive than
cemented pins

5-6 times more

retentive than
friction locked
pins

SELF THREADED PINS

THREAD MATE SYSTEM

SELF THREADED PINS

THREAD MATE SYSTEM

REGULAR

MINIM

MINIKIN

MINUTA

Largest
diameter pins
Causes
maximal
stress
Causes
maximum
dentinal
crazing
Rarely used

Next smaller
diameter pins
Lesser stress
are created
Lesser
dentinal
crazing
Good
retention

Diameter is
lesser than
minim pins
Very less risk
of dentinal
crazing
Good
retention
MINIM AND
MINIKIN ARE
COMMONLY
USED SIZES
OF TMS
SYSTEM

SMALLEST
SIZE of
pins
They are
too small
to provide
adequate
retention
Not widely
used

PIN DESIGNS

Standard 7mm long

design
They have flattened heads to fit into the hand
wrench or handpiece chuck
After placement the pin is reversed 1/4th turn to
reduce stresses on dentin
Pin height can be adjusted appropriately
Self
shearing
design

Available in varying lengths

They have flattened heads to fit into the hand wrench or
handpiece chuck
During pin placement when the pin reaches the bottom
of the pin hole, the head automatically shears off, leaving
a portion projecting from dentin

Two in
one
design

It consists of 2 pins connected by means of a joint which

serves as a shear line for peripheral pin
Total length is 9mm and 2 pins are about 4mm each
They have flattened heads to fit into the hand wrench or
handpiece chuck
The handpiece need not be reloaded during insertion of
more than 1 pin

Link series They have a plastic sleeve that fits into the latch
design
type contra angle handpiece or a special plastic
hand wrench
Self shearing
Pin engages the dentin and the plastic sleeve
can be discarded
Can align well into pin channels

Link plus
design

Similar to link series design

Self shearing
Available as single or 2 in 1 pins
The major difference in this pin design is that pins have
sharper threads and a tapered tip to decrease dentinal
stresses while seating

ADVANTAGES OF TMS
PINS
Versatile design
Wide range of pin

sizes
Color coding allows
ease
of use
Gold plating
eliminates
corrosion
Good retention

FACTORS AFFECTING THE

RETENTION OF
THE PIN IN DENTIN AND
AMALGAM

Orientation, number and diameter

-Non-parallel pin - retention
-Bending of pin not desirable
Interfere with condensation of amalgam
Weaker pin, fractured dentin

no. of pin - retention

crazing & fracture
amount of dentin available
amalgam strength

PIN PLACEMENT
1. MECHANICAL ASPECTS
2. ANATOMICAL ASPECTS
3. MECHANO ANATOMICAL ASPECTS

MECHANICAL
ASPECTS
A] STRESSING CAPABILITIES OF PINS
B] RETENTION OF PINS IN DENTIN
C] MICROCRACKING AND CRAZING

MECHANICAL
[PINS AND TOOTH
STRUCTURE]
ASPECTS
A] Stressing capabilities of pins
Type of pins
Diameter of pins
Pin depth and dentinal
engagement
Bulk of dentin
Type of dentin

Shape of pin

channels
Loose pins
Irregularly shaped
dentinal end of
pins
Ratio of dentinal
engagement : pin
protrusion [ideal
2:1]
Number of pins in
one tooth

Drill its use and function

Stresses induced during shortening pins
Retentive features
Inserting pins in stress concentration area of

tooth

B] RETENTION OF PINS
IN DENTIN
Type of pin
Pin depth and dentinal

engagement
Pin channel
circumferential shape
relative to that of pin
Inter pin distance

Type of cement
Ratio of dentinal engagement : pin protrusion

[ideal 2:1]
Type of involved dentin
Surface roughness of the pins
Mode of shortening of pins after insertion of
pins
Bulk of dentin around the pin

C] MICROCRACKING AND CRAZING

Type of pin
Proximity of pin to DEJ
Induced stresses in involved dentin
Type of dentin

ANATOMICAL ASPECTS
Knowledge of

anatomy
Radiograph
Outer surface of
tooth
Amount of dentin

MECHANO ANATOMICAL
ASPECTS FOR PIN
Anatomical features
PLACEMENT
Tooth alignment
Cavity extent

Effect of age or relative age on the pulp

chamber

TECHNIQUES FOR
INSERTING PINS
Pin channel preparations
Cemented pin technique
Threaded pin technique
Friction grip pin technique

PIN CHANNEL PREPARATION

Twist drill-By using twist drill latch type or

depth limiting drill at low speed ( 300-500)

RPM
No. 1/4 round burs- first make pilote hole
with round bur to localize position of the pin
the complete the hole in one or two thrust(
movement)
Apply intermittent pressure

CEMENTED PIN TECHNIQUE

INDICATIONS
Ideal technique
Only technique for endodontically treated

tooth
Only technique to be used when avaliable
location of the pin is close to DEJ

Ideal technique for a sclerotized / tertiary /

calcific barrier / highly demineralized /

dehydrated dentin
For class IV restorations
When there is limited bulk of dentin

PROCEDURE
Preparation of pin channel
Checking the surface irregularities of pins
Slow setting phosphate / polycarboxylate
introduced by perio explorer tip or lenticulo
spiral at slow speed
Placement of pin using lock in or magnetised
tweezer or hemostat

Large amalgam plugger is needed to check

the complete seating of the pin

In case of class IV restorations, bending of the
pins is to be done before cementation of the
pin channel

THREADED PIN TECHNIQUE

INDICATIONS
Vital teeth
Dentin to engage the pin is either primary
or secondary
Minimum avaliable location is 1.5mm
from DEJ
If minimum pins are needed for the
restoration

PROCEDURE
Preparation of pin channel
Pin is engaged to a driving device and pin is
continuously threaded into the pin channel
until it offer resistance initiated by the pin
channel floor
Desired length of the pin can be cut using
small bur and high speed handpiece in the
direction of threading and with light
intermittent touches
Surface irregularities are corrected
No bending should be performed

FRICTION GRIP PIN TECHNIQUE

INDICATIONS
For vital teeth
When bulk of dentin is present [min 4mm
in all 3 dimensions]
Only in the accessible areas

PROCEDURE
Pin channel is prepared
Checking the surface irregularities of pins
Put a colored mark on the pin to indicate
the exact depth of the pin channel using a
measuring probe
Pin is held in its place at the entrance of
the cavity
Concave headed seater is placed on the
pin

With the hammer light strokes are given until

that colored mark

Remove all the holding devices
Check for cracks, chipped pieces or grossed
fractures

CAVITY PREPARATION
Remove all carious and weakened tooth

structure
Initial cavity is prepared with dovetails,
boxes, grooves etc
Facial and lingual walls are kept parallel
wherever possible
Margins are placed supra-gingivally

Areas to receive pins should be flat and

perpendicular to long axis of the tooth.

There must be enough dentin for pin
placement
Weakened cusps should be reduced and
occlusal contour should follow the normal
contour of the unreduced tooth
PULP PROTECTION

CLASS II DESIGN
Pins should be put in apically deepest and

most peripheral parts of the cavity

Pin should not be placed below the cusp
Decreasing the stress concentration on the
pin
Use of minimum number of pins with less
diameter
Placement of the pin should be such that
theres enough restorative material around it

CLASS V DESIGN

Pins are placed axially

parallel to the adjacent

proximal surface
Pin protrusion should be
minimal
Deep retentive grooves are
placed
Pins should be placed
midway in the preparation
but as close to gingival wall
as possible

RESTORATI
ON

COMPLICATIONS
Drill breakage
Pin breakage
Loose pins
Heat generation
Dentinal cracks
Perforation into pulpal space or external tooth

surface

FAILURES

EFFECT OF PINS ON PULP

Generally it responds positively and accepts

its presence without any adverse effects

Histologic evaluation reveals inflammatory
response, necrotic tissue encapsulation,
fibrous tissue regeneration and formation of
pre dentin by odontoblasts
Inflammatory reactions have been observed
under all kinds of pins

CONCLUSION
The prognosis of the involved tooth and its

role in overall treatment plan helps to decide

the restoration to be placed
If amalgam is selected as the restorative
material to be placed, pins placed in dentin
improve the retention of the restoration
Pins have been extensively used in the past to
restore such badly broken tooth