|Year : 2014 | Volume
| Issue : 1 | Page : 31-33
Recreation with biological restoration: A root canal reconstruction
Kanika Gupta Verma1, Pradhuman Verma2, Tanya Goyal1
1 Department of Pediatric and Preventive Dentistry, Surendera Dental College and Research Institute, Sriganganagar, Rajasthan, India
2 Department of Oral Medicine and Radiology, Surendera Dental College and Hospital, Sriganganagar, Rajasthan, India
|Date of Web Publication||30-Jan-2014|
Kanika Gupta Verma
Department of Pediatric and Preventive Dentistry, Surendera Dental College and Research Institute, His Highness Gardens, Power House Road, Sriganganagar, Rajasthan
Traumatic injuries are frequent cause of anterior tooth fracture in dentistry. Biological restorations are the reconstruction of extensively damaged teeth with adhesive cementation of biological posts and crowns. This case report refers to the rebuilding of fractured maxillary central incisor through biological post and core in a 14-year-old child. This treatment option represents a low-cost and alternative technique for the aesthetics and functional rehabilitation of extensively damaged anterior teeth.
Keywords: Aesthetics, biological restoration, core, post
|How to cite this article:|
Verma KG, Verma P, Goyal T. Recreation with biological restoration: A root canal reconstruction. J Health Spec 2014;2:31-3
|How to cite this URL:|
Verma KG, Verma P, Goyal T. Recreation with biological restoration: A root canal reconstruction. J Health Spec [serial online] 2014 [cited 2020 Jan 26];2:31-3. Available from: http://www.thejhs.org/text.asp?2014/2/1/31/126066
| Introduction|| |
Several authors have suggested the use of tooth structure biologically and conservatively, as a restorative material, in an attempt to widen the treatment options to rehabilitate severely damaged tooth structure. The term 'biological restoration' was coined by Santos and Bianchi in 1991.  This technique consists of bonding sterile dental fragments to teeth with large coronal destruction. Ramires-Romito et al., used teeth from the Human Tooth Bank of Sao Paulo University Dental School as natural post and crown to fit into the roots and rebuild the coronal portion of tooth.  Fragments obtained may be used as a safe and reliable alternative to restore dental anatomy and function with excellent biomechanical properties.  Several reports have described the advantages of biological restorations such as shorter and low treatment cost without involvement of laboratory procedures, preservation of healthy tooth structure, less chances of galvanic corrosion, good adherence to canal surface, favourable aesthetics, functional and masticatory effectiveness, and no need of complex material resources.  This article describes a case in which biological post and core was done using a natural tooth to rebuild the fractured maxillary central incisor.
| Case Report|| |
A 14-year-old child presented with the chief complaint of pain and sensitivity to hot and cold in upper front tooth region since 10 - 15 days. History of present illness revealed pain was severe, continuous in nature and aggravated with hot and cold food items. Past dental and medical history was non-contributory. Intraoral examination revealed an Ellis class III fracture in the permanent left maxillary central incisor [Figure 1]a. Intraoral periapical (PA) radiograph revealed PA abscess with widening of periodontal ligament [Figure 1]b. Patient was recommended for pulpectomy followed by post and core with regards to (WRT) 21.
|Figure 1: (a) Intraoral photograph showing Ellis class III fracture WRT 21. (b) Intraoral periapical (PA) radiograph revealing PA abscess with widening of periodontal ligament|
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Local anaesthesia in the form of infraorbital and nasopalatine nerve blocks was given to the patient. Isolation was done with rubber dam and access opening was made using airoter handpiece WRT 21. Biomechanical preparation included instrumentation of the canal up to the working length with intermittent sodium hypochlorite and normal saline irrigation with enlargement up to F3 protaper. Obturation of canals was performed with F3 protaper gutta percha cones and AH-26 root canal sealer [Figure 2]a. After one week, the post space was prepared with a number 3 Gate Glidden drill to a depth of 14 mm from chamfer line, leaving 5 mm gutta percha in apical third [Figure 2]b.
|Figure 2: (a) Intraoral PA showing obturated canal (b) Prepared post space, leaving 5 mm of gutta percha in the apical third of canal. (c) Selective maxillary central incisors taken from tooth bank. (d) Prepared biological post|
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An extracted maxillary central incisor was taken from tooth bank, considering the colour and dimensions of the tooth to act as biological restoration [Figure 2]c. The canal of extracted tooth was cleared off from necrosed pulp and infected dentin using Hedstrome and K-files, along with intermittent irrigation [Figure 2]d. Flowable resin was used to fill the canal space of the tooth to act as biological post.
The width and length of post space prepared was measured with the help of divider using intraoral PA radiograph. The root and coronal portion of selected extracted tooth was adjusted according to the dimensions required for post and core using airoter handpiece until it fitted the canal. The prepared biological post was autoclaved at 120°C for 20 mins and intraoral PA radiograph was taken to check the fit of biological post in the canal [Figure 3]a.
|Figure 3: (a) Intraoral PA revealing the fit of biological post in the canal. (b) Adapted and cured biological post. (c) Core build-up with composite. (d) Porcelain fused to metal crown WRT 21|
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Single step sixth generation bonding agent was applied both in the post space and on the biological post. Bonding agent was light-cured for 60s. Dual cure composite resin was applied to the post space according to the manufacturer's instructions. The biological post was adapted to the post space and was chemically cured and light-cured for 60s [Figure 3]b. Core build-up was done with light cure composite resin and the occlusion was checked with articulating paper [Figure 3]c. Patient was recalled after 2 days for crown cutting WRT 21. Porcelain fused to metal crown was prepared for the patient which satisfies the aesthetics and functional anatomy [Figure 3]d.
| Discussion|| |
The autogenous or allogenous biological restorations are the two forms that can be used to restore the severely mutilated teeth. When fractured fragment or tooth is available from the same patient, it is known to be autogenous, whereas restoration using donated extracted teeth is allogenous biological restoration. ,
Various procedures have been tried to restore severely mutilated anterior teeth in which intracanal posts become mandatory. Recent development in restorative materials, placement techniques and adhesive protocols facilitate these restorations, but these procedures turn out to be expensive, technique sensitive and also require expertise of operator.  A cost-effective alternative approach for treating such cases is the biological restoration. The extracted tooth was procured from the tooth tissue bank, where teeth were stored after sterilisation and thorough scaling and removal of soft tissue, periodontal remnants and pulpal tissue from the root-canals. Tooth tissue bank is maintained at 4°C using Hank's balanced salt solution with donor identification and various tooth parameters like dimensions, colour, shape and age. 
The biological crown and post restoration is proved to be a cost-effective alternative, making it possible to recycle precious biological tissue, which has been discarded as bio-waste.  However, the patient acceptance of a biological restoration is an important issue. In the present case, the parents were informed that the extracted tooth used for biological restoration was previously submitted to a rigorous sterilisation process that completely eliminates any risk of contamination or disease transmission to their child.
No commercially available pre-manufactured post meets all ideal biological and mechanical properties. The use of biological post represents a feasible option for strengthening root canal, as it preserves the internal dentine wall of root canal, adapts to conduct configuration, favouring greater tooth strength and retention. 
However, fabrication of dentinal post may require a technically sound system to get an exact fit post, crack-free dentinal structure, shade guide system for colour matching and tooth bank for availability. 
| Conclusion|| |
Based on the positive results in the literature and on our own clinical experience, it may be concluded that the biological restoration technique has a practical clinical applicability and is a viable, cost-effective restorative procedure for severely damaged teeth.
| References|| |
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[Figure 1], [Figure 2], [Figure 3]