Journal articles on the topic 'Endodontics; tooth fracture; prosthodentics'

Regenerative endodontics has been defined as “biologically based procedure designed to replace damaged structures, including dentin and root structures, as well as cells of the pulp–dentin complex.” This is an exciting and rapidly evolving field of human endodontics for the treatment of immature permanent teeth with infected root canal systems. These procedures have shown to be able not only to resolve pain and apical periodontitis but continued root development, thus increasing the thickness and strength of the previously thin and fracture-prone roots. In the last decade, over 80 case reports, numerous animal studies, and series of regenerative endodontic cases have been published. However, even with multiple successful case reports, there are still some remaining questions regarding terminology, patient selection, and procedural details. Regenerative endodontics provides the hope of converting a nonvital tooth into vital one once again.

Preservation of natural tooth in dental arch is ultimate objective of dental treatment. After endodontic treatment, tooth becomes brittle and prone to fracture which results in reduction of strength of crown causing fracture of cusp or sometimes weakness of the roots. In order to strengthen crown some anchorage within teeth has to be made and that anchorage and support is gained by rigid structure which is known as post. This article focuses on recent advances in post systems and their application, merits and demerits in endodontics.

Pulpitis and subsequent pulp necrosis results in tissue degradation by-products causing staining of the dentin.This is a common cause of localised intrinsic staining of the teeth. Reversible pulpitis is a condition of pulpal inflammation in which the pulp can be returned to the normal state if the cause of the pulpitis is treated or removed; however, if this is not achieved, the condition will progress to irreversible pulpitis and pulp necrosis. If left untreated, a tooth with pulp necrosis can result in periapical abscess, radicular cyst, granuloma, fistula, osteomyelitis, pathological fracture, periodontal disease and tooth loss. The treatment options for a tooth with pulp necrosis include endodontic or exodontic therapy. The purpose of endodontic therapy is to alleviate pain and to treat or prevent inflammation and infection in order to preserve the tooth function. This case report describes the endodontic treatment of a discolored left maxillary canine tooth in a dog.

During root development, if tooth is subjected to trauma or caries, it results in tooth with immature and open root apices. The primary factor affecting the success of endodontics is achievement of perfect apical seal. Apexification is done to achieve an apical barrier against which the obturating material can be condensed. Various treatment modalities are used to treat immature open root apices. In the following case reports, apexification using different treatment modalities and both traditional and newer biomaterials have been explained.

ABSTRACT Aim To evaluate the prevalence of anterior tooth fracture due to trauma in 2000 patients randomly from the population of south Canara district. Materials and methods The present study was conducted on 2000 patients attending the Department of Conservative Dentistry and Endodontics, AB Shetty Dental College, Mangalore, and rural satellite centers of Nitte University. Each patient was examined for anterior tooth fracture due to trauma under dental chair in a good illumination of light using sterilized mouth mirror, explorer, tweezer and teeth are isolated by cotton roles. The patient who had anterior tooth fracture were questioned with a standard questionnaire from oral health survey WHO format 2013, to find its relation associated to age, gender, location, occupation, etiology, type of fracture and its relation to molar. Results According to the present study, prevalence of anterior tooth fracture due to trauma in south Canara population was low and found to be 18.8% with increase in prevalence in males (56.2%) between the age group of 36 and 45 years (33.2%), common etiological factor seen was falls (44.7%). The most common type of fracture was enamel-dentine fracture (44.7%) with class 1 molar relation (55.6%). Conclusion The prevalence of anterior tooth fracture due to trauma was most commonly seen in males with increased prevalence in age group between 36 and 45 years, common etiological factor being falls, type of fracture most commonly seen are cases with enamel-dentine fracture with class 1 molar relation. How to cite this article Hegde MN, Abootty S, Attavar S. Prevalence of Anterior Tooth Fracture due to Trauma. World J Dent 2015;6(2):77-81.

ABSTRACT This article presents a clinical case of horizontal root fracture, in an adult patient, male, in the apical third, due to the practice of sports, which, along with other factors, has led to pulp necrosis. Initially, the patient sought emergency care, and then he underwent treatment by endodontics, using calcium hydroxide between sessions. After a monitoring period, root canal obturation was performed and the tooth is clinically and radiographically stable 2 years after the trauma. In this case, monitoring is long-lasting, divided into 12-month periods for 10 years, with clinical and radiographic evaluation. Dental fracture in children and teenagers from 10 to 14 years is very common, especially during the practice of sports and recreation activities. It is expected that young male individuals have greater propensity to damage their teeth than young female individuals. Maxillary central incisor is the tooth most commonly involved, and it often evolves to pulp necrosis after trauma.

Management of non-vital immature anterior permanent teeth in children remains a challenge in paediatric dentistry and endodontics. Once the tooth becomes non-vital, root development ceases, rendering the tooth weak, and unable to withstand physiological forces of mastication. This results in a high rate of root fracture with poor prognosis in the medium to long term. Despite being endodontically treated, over 50 % of such teeth will be lost in the first 10 years following trauma. Traditional endodontic treatment does not contribute to any quantitative or qualitative increase in root dimensions resulting in life-long oral disability. The advancement in the science of Endodontics - Regenerative Endodontics has revolutionized current treatment strategies in treating the immature non-vital permanent tooth which has overcome the drawbacks of traditional treatment approaches. This report provides an insight view on successful maturogenesis of immature non-vital permanent incisors by induction of intracanal bleeding along with complications endured during the process. Regenerative endodontics is defined as “biologically based procedures designed to replace damaged structures, including dentin and root structures, as well as cells of the pulp - dentin complex”.1 Continued root development and reestablishment of pulp - dentine complex can be achieved by these procedures. Two major concepts in the regenerative endodontics are guided tissue regeneration (GTR) and tissue engineering. The base of these procedures is stem cells which can differentiate into the desired tissue component, growth factors or other tissue - inducing mediators and scaffold.2 Regenerative endodontic procedure (REP) includes induction of intracanal bleeding, placement of platelet rich fibrin (PRF), and platelet rich plasma (PRP). The goals of these procedures were elimination of signs and symptoms, continued root development, apical healing, and positive response to vitality testing. But preparation of PRP and PRF requires withdrawal of blood and sight of syringe can add emotional stress to young patients. Revascularization may be defined as the invagination of undifferentiated periodontal cells from the apical region in immature teeth.3,4 The nature of tissue formed after revascularization is not certain and can be confirmed by histological evaluation. Presence of blood supply is reliable. Revascularization considers only one facet - nature of newly formed tissue thus making term revascularization inaccurate and thus many authors disagreed with this term.5

Functional forces might also lead to fracture after endodontic treatment. This might occur secondary to exposure to erosion, abrasion, physical trauma, and caries. Interventing against these events can be achieved by conducting long follow-up periods and enhancing the endodontic treatment approaches. The current endodontic treatment modalities aim at tissue preservation to enhance resistance to fractures and prevent potential post-treatment complications. In this context, evidence shows the validity of minimally invasive modalities in endodontic treatment with favorable outcomes and reduced frequency of complications. In the present literature review, we have discussed the efficacy of minimally invasive biological treatment in endodontics. It is vital to maintain the integrity of the structures of the tooth-related paracervical area, particularly when treating molars. This is attributed to enhancing the long-term survival rates of the pericervical dentin of these teeth. The current trends represent a revolution in the field of endodontic treatment. This is attributed to the novel development of the various disinfection modalities, which do not need to shape the canal into a round form and induce flaring reactions. Overall, the main advantages of vital pulp therapy include being simple, reduced cost, and reduced risk of treatment-related complications secondary to overcoming the difficulties with the anatomy of the root canals.

Root canal treatment of teeth presenting immature development is a great challenge for both the patient and the professional. The thinness of the root canal walls of immature teeth may lead to root fracture and thus the outcomes of such treatments are uncertain. Revascularization is based on root canal decontamination followed by the induction of blood migration from the periapical tissues and the development of new vascular tissue in the canal space. The principle of disinfection in regenerative endodontics is that it should be achieved with minimum root canal instrumentation; an intracanal medication is used to inhibit bacterial growth and appropriate sealing of the coronal portion is performed. The American Association of Endodontists (AAE) considerations for regenerative endodontics include calcium hydroxide as an alternative intracanal dressing. This material has also been claimed to diminish the possibility of dental staining during revascularization procedures. The relatively new treatment protocol has been widely reported in the last few years; however it should be performed only when other alternatives are not reasonable. This case report presents a 3-year follow-up of a case of revascularization of a maxillary central incisor using calcium hydroxide as a root canal disinfection dressing.

Dental trauma in young patients is very common in clinical daily life and directly influences the patient’s esthetics and function. The objective of this work is to present a clinical case of a young patient who suffered dental trauma and rehabilitation with Endodontics, cementation of a fiberglass post and restoration of the dental crown with composite resin. Patient AM, 12 years old, attending the Endodontics Specialization at FASURGS, changing a dental trauma with a coronopulpal fracture of the dental element 11, an initial periapical radiograph was performed and it was found the pulp involvement. Exposing the treatment options, the patient and guardian agreed to perform Endodontics and rehabilitate tooth 11 with a fiberglass post and composite resin. Following the treatment plan, the patient was anesthetized and the dental pulp was removed, the root canal system was prepared using 2.5% NaOCl and k # 10 manual and rotary files of the Logic # 25:01, # 25:05, and insertion of MIC (Ultracal). In the second session, the medication was removed and the PQM was completed, filled, a fiberglass post was cemented and the dental element was restored using a silicone guide, which had been previously made. Appropriate planning brings great results with a conservative approach, making it possible to maintain a dental structure that offers comfort, restores aesthetics, and improves the patient’s quality of life.

Aim: The purpose of this investigation was to document the reasons for placement, and replacement of crowns and fixed partial denture in a Nigerian Teaching Hospital. Methods: a retrospective review of patients that had advanced conservative procedures. A data collection form was used to gather the relevant information from the patients’ case notes. Section A sought information on age , gender, educational level, patients’ occupation etc. Section B recorded information on tooth/teeth involved, reason for fabrication of prosthesis and material used. Results: Three hundred and twenty six had 398 crowns while 23 patients received bridges. Patients’ ages ranged from 16-85 years with a mean of 47.7± 17.2years and a male to female ratio of 1:1.3. Thirty five percent of the crowned teeth were in the upper right quadrant, followed by the upper left quadrant with 29.4%. Upper right central incisors were the most frequently (15.6%) crowned teeth. Endodontics and esthetics were the most common reasons for initial crown placement and replacement respectively. About 60% of bridges fabricated were new, while 22.2% of replaced bridges were due to fracture of porcelain and unacceptable marginal adaptation. Conclusion: Endodontics and esthetics were the most common reasons for initial crown placement and replacement.

ABSTRACT The patients loose tooth/teeth for various reasons at different year of age. The most common reason are caries and periodontal disease. There is debate on the main cause out of these two. This may vary depending on other variables like age, food habits, general condition. The other causes of tooth extraction are failure of endodontics, fracture, infection. Some disease free teeth need to be sacrificed for orthodontic or prosthetic treatment plan. There is need of evaluation of reasons for tooth mortality. This will be the indicator of status of oral health awareness among population and success of oral healthcare delivered. In a prospective survey at our department collected data of 1186 subjects undergoing extractions of tooth/teeth. This data were evaluated for age and gender distribution, prevalence of reason for extraction and that of each tooth type in both arches. Aim The aim of survey is to study of prevalence and reasons of extraction of teeth according to age groups. In this prospective survey, the data were collected from the outpatient registration desk of extraction room of department of oral and maxillofacial surgery of Government Dental College and Hospital, Mumbai, India. The assessment of the data was done by a single senior faculty. The data were analyzed for age, gender, reason for extraction and tooth/teeth extracted. Total 1,568 extractions were performed on 1,186 subjects. Conclusion The dental caries and its sequel is the principal reason for extraction of teeth followed by periodontal disease. The first molar of both arches is the tooth extracted most frequently for caries and its sequel in young age group of 15 to 25 years. How to cite this article Manekar VS, Kende P, Kulkarni S. Tooth Mortality: An Analysis of Reasons underlying the Extraction of Permanent Teeth. World J Dent 2015;6(2):93-96.

Pulp necrosis in immature permanent teeth represents a challenge for clinical management. The dentin wall in immature teeth is thin and the root is short, leading to an unfavorable long-term prognosis due to the risk of root fracture. Regenerative endodontic procedures have been shown to be effective and improve the prognosis of the compromised immature tooth by re-establishing functional pulp tissue that promotes continued root development and immune competence. The objective of the study was to report a case of a young permanent molar, diagnosed with necrosis and incomplete rhizogenesis. A female patient, 08 years old, attended the clinic of the specialization course in Endodontics, Faculty of Dentistry São Leopoldo Mandic, Belo Horizonte Unit. Regenerative therapy was proposed, which involved the following steps: anesthesia, opening, odontometry, minimal instrumentation, disinfection with 2% chlorhexidine gel, irrigation with saline solution, intracanal medication with calcium hydroxide paste, induction of bleeding to form a blood clot, cervical sealing with mineral trioxide aggregate and composite resin. The patient remained symptom-free up to 5 months after treatment. However, radiographically, an increase in the periapical radiolucent area was noted, so it was decided to carry out the conventional endodontic treatment. Regenerative therapy can be an alternative to apexification in immature teeth in cases of irreversible pulpitis and pulp necrosis associated or not with a periapicalesionson. It is a simple treatment with advantageous results as it promotes an increase in the length and thickness of the dentin wall and apical closure as seen in the case described in this work.

Fracture of endodontic files can be considered a real concern during root canal treatment. This procedural accident is caused both by overusing instruments due to economic reasons and using an incorrect technique in root canals with difficult anatomy. A broken endodontic file does not always regard the treatment as a failure. Frequently the broken fragment can be bypassed, and the root canal treatment completed. In other cases, when the file is separated in a tooth with associated apical disease, its retrieval using ultrasonic tips is advised. Separation of a file usually occurs in molars, mainly in the mesiobuccal canal due to major curvature, poor access or small diameter. Our research was conducted to determine the in vitro efficiency of the ultrasonic removal method and the bypass technique by using 40 extracted molars with moderately curved roots. #25 K-files were deliberately broken in the middle third of mesiobuccal root canals after making a small excavation in the apical third of their active part. The results showed a significantly higher success rate of the ethylenediaminetetraacetic acid (EDTA) aided bypassing technique compared to the ultrasonic removal method.

Meticulous analysis for almost 300 endodontic microsurgery cases is an impressive work performed by six Spanish authors and presented on eight pages of the well-written paper. The purpose of the study was brilliantly accomplished by performing a comparison of healing rates after 1-4 versus 5-9 years of follow-up. The authors emphasize that the duration of follow-up is a key parameter for the final evaluation. In the cohort (a group of patients with a shared characteristics) with a shorter follow-up (1-4 years), the healing rate was 67.2 percent versus 86.9 percent in the cohort with a longer follow-up (5-9 years). Moreover, the study revealed – when the vertical root fracture cases are excluded from the study, in the patients with 1-4 years of follow-up, the healing rate was 92.5 percent, versus 82.6 percent in those with 5-9 years of follow-up. The authors also stated that the crestal bone level in relation to the cementoenamel junction of the tooth influences the prognosis. The prognosis is worse in cases when the probing depth is more than 3 mm.

Traumatic injuries to an immature permanent tooth may result in cessation of dentin deposition and root maturation. Novel revascularisation endodontic procedure (REP) has been considered as an option for treatment of immature teeth with damaged pulp tissue. The continuous development of the root and the root canal has been recognised as a major advantage of this technique over traditional apexification approach. Traditional apexification procedures may resolve pathology but have not been able to prove tooth survival due to absence of continued root development and risk of root fracture. A successful REP results in resolution of signs and symptoms of pathology, radiographic signs of healing, proof of continued root development as well as presence of pulp vitality due to the regeneration of pulp tissue in the root canal. Currently, repair rather than true regeneration of the ‘pulp-dentine complex’ is achieved and further root maturation is variable. According to Glossary of Endodontic terms published by American Association of Endodontists, REP’s are biologically based procedures designed to physiologically replace damaged tooth structures, including dentin and root structures, as well as cells of the pulp-dentin complex.1,2 Apexification treatment has been a routine procedure to treat and preserve such teeth for many decades.3 Apexification is the process by which a suitable environment is created within the root canal and periapical tissue to allow for the formation of a calcific barrier across the open apex. Calcium hydroxide [Ca(OH)2] has been the material of choice for apexification as Frank reported its capacity to induce physiological closure of immature pulpless teeth in 1966.4 However, this technique has several disadvantages, including the unpredictability of apical barrier formation and the long duration of treatment, which often requires multiple visits.5 A retrospective study by Jeruphuaan et al.6 has shown a higher survival rate with regenerative endodontic treatment when compared to both mineral trioxide aggregate (MTA) and Ca(OH)2 apexification. The first evidence of regeneration of dental tissues was in 1932 by G.L. Feldman, who showed evidence of regeneration of dental pulp under certain optimal biological conditions.7 In 1971, a pioneer study in regenerative endodontics conducted by Nygaard-Ostby concluded that bleeding induced within a vital or necrotic canal led to resolution of signs and symptoms of necrotic cases and in certain cases, apical closure.8 According to Windley et al. (2005), the successful revascularisation of immature teeth with apical periodontitis is mainly dependent upon: 1. Canal disinfection 2. Scaffold placement in the canal for the growing tissues 3. Bacteria-tight sealing of the access opening.9 The purpose of this case report is to illustrate the outcome of a revascularisation endodontic procedure in a non-vital immature young permanent central incisor.

Background: When a tooth is diagnosed with irreversible pulpitis, root canal therapy (RCT) is generally performed to completely remove pulp tissue, which might lead to a higher risk of loss of vascularity, and teeth being more prone to fracture. Vital pulp therapy (VPT) is a personalized method of treating irreversible pulpitis, which conforms to the trend of minimally invasive endodontics. The remaining vital pulp could promote the physiological development of the roots of young permanent teeth with incomplete apical foramen. However, clear guidelines for VPT indication are still missing. Objective: This prospective cohort study evaluated the outcomes of vital pulp therapy (VPT) using iRoot BP Plus (Innovative Bioceramix Inc, Vancouver, BC, Canada) in permanent teeth of 6- to 20-year-old patients with irreversible pulpitis caused by caries and analyzed the preoperative factors affecting VPT prognosis. Methods: Fifty-nine permanent teeth in 59 patients with irreversible pulpitis caused by caries were treated with VPT using iRoot BP Plus. All patients received VPT under a standardized protocol. After informed consent, teeth were isolated with a dental dam, then operators performed VPT with iRoot BP Plus and restored the teeth with composite resin or stainless steel crown. Patients were postoperatively recalled after 3, 6 and 12 months and then recalled annually. Successful cases were defined as successful in both clinical and radiographic evaluations. A statistical analysis was performed using the Fisher exact test, and the level of significant difference was p < 0.05. Results: After 6–36 months of follow-up, a total of 57 teeth from 57 patients were accessible for evaluation. The mean age of subjects was 11.75 ± 3.81 years. The overall clinical and radiographic success rate of VPT was 91.2% (52/57). With an observation time of one year or more, the success rate was 90.5% (38/42). All the symptoms and physical examination findings showed no significant effect on VPT prognosis (p > 0.05) using a binary logistic regression model. Conclusions: Permanent teeth in 6- to 20-year-old patients diagnosed as irreversible pulpitis caused by caries can be successfully treated with VPT using iRoot BP Plus.

Regenerative endodontics has become a revolutionizing tissue engineering concept in the treatment of immature permanent teeth for over two decades. It has been described as a ‘paradigm shift’ in the treatment of immature teeth, since it fosters continued root maturation. An immature necrotic permanent tooth is usually a result of trauma or infection due to which the tooth becomes non-vital before completing root development. In such cases, the root walls are left thin and weak with an open apex. Traditional apexification procedures may resolve pathology but have not been able to prove tooth survival due to absence of continued root development and risk of root fracture. A successful regenerative endodontic procedure (REP) results in resolution of signs and symptoms of pathology, radiographic signs of healing, proof of continued root development as well as presence of pulp vitality due to the regeneration of pulp tissue in the root canal. Various stem cells, growth factors, scaffolds and suitable environment form the tetrad of elements necessary to induce regeneration of dental pulp. While there has been some success in isolating dental pulp cells with in-vitro experiments, it has been proven to be rather difficult to implement the same in a practical perspective ex vivo. Although there has been clinical success related to REP, histologically they seem to undergo guided endodontic repair rather than true regeneration of physiologic pulp tissue. This review provides an overview of components of tissue engineering, clinical protocol and predictable outcomes for REP and recent advances in regenerative dentistry.

One of the most important steps in endodontic therapy is obtaining an adequate access to the root canal system. This ensures adequate instrumentation, irrigation, visibility, access and disinfection, making endodontic therapy more predictable. However, in the process of gaining a good convenience form, access cavities are being excessively widened, weakening the tooth to masticatory forces and increasing their chance of fracture. Clark and Khademi introduced evidence based new concepts of modern endodontic access designs which primary aims at preservation of tooth structure and increasing fracture resistance of the tooth. Several techniques of modern access designs have been proposed but they all correspond to one fundamental concept, bio-minimalism. This review aims to comprehensively summarize the principles of modern access cavity preparation as well as highlight the various techniques of modern access cavity designs.

Management of traumatic injuries to the teeth is a challenge to the practicing dentist. It has no prescriptive method for occurring, possesses no significant predictable pattern of intensity or extensiveness and occurring at times when dentists are least prepared for it. Ninety-two percent of traumatic injuries results in fracture of maxillary permanent central incisors because of its protrusive and anterior positioning. The young permanent maxillary central incisor root canal chamber is large and tapered. This case report describes the management of Ellis Class III fractured tooth in a young permanent maxillary central incisor by an innovative clinical procedure. Keywords: tooth fracture, cast post core, trauma, metal ceramic

We have come a long way in dentistry from “extension for prevention” to “prevention of extension”. Asimilar approach in endodontics is going to change the future of dental practice with Minimal Invasive Endodontics (MIE). MIE mainly includes preservation of structural integrity of tooth, alternate access cavity designs, guided endodontic access, modern burs, cleaning and shaping, 3D irrigation and disinfection, magnication aids like loupes and dental operating microscope. Survival of an endodontically treated tooth depends mainly on its remaining structural integrity after access preparation. The concept of Conservative endodontic cavities (CEC) was introduced to preserve the pericervical dentin (PCD), which is crucial to transfer the occlusal load to the root. In traditional endodontic cavities (TEC) much of PCD is lost which reduces the fracture resistance of tooth. Guided endodontic access was introduced as an attempt to preserve the PCD. It ensures predictable outcome without any procedural errors. The present paper attempts to narratively summarize the scope of Guided endodontic access in dental practice and explain its benets to the practitioners compared with conventional technique

The fracture of an endodontic instrument is an obstacle in the completion of successful endodontic therapy. Non-surgical re-treatment and surgical endodontics are not always viable solutions. The various methods of re-treatment for a separated instrument include le bypass, le retrieval or the surgical method of Apicoectomy. However, the mode of treatment also depends on the position of the separated instrument in the tooth, the anatomy of the tooth and also the root. In certain cases, le bypass or retrieval is not advocated. In such cases, other options for re-treatment are needed to be considered. Intentional replantation is a treatment option considered by many as a procedure of last resort when non-surgical and surgical endodontics is contraindicated. This procedure is often indicated where the separated instrument is at or beyond the apex. The case report discussed in this paper presentation demonstrates the procedure of intentional replantation as a viable solution where other retreatment procedures are not possible.

Regenerative endodontic procedures have been described for over a decade as a paradigm shift in the treatment of immature necrotic permanent teeth, owing to their ability to allow root maturation with subsequent enhancement of the tooth’s fracture resistance in addition to the potential for regeneration of vital intracanal tissues. Concomitantly, minimally invasive endodontics is another rising concept with the main concern of preservation of tooth structure. Stemming from their potential to preserve the original tooth structure, both regenerative and minimally invasive endodontics could be considered as two revolutionary sciences with one common goal. Achieving this goal would entail not only employing the appropriate strategies to recreate the ideal regenerative niche but modifying existing concepts and protocols currently being implemented in regenerative endodontics to address two important challenges affecting the outcome of these procedures; conservation of tooth structure and achieving effective disinfection. Therefore, the search for new biomimetic cell-friendly disinfecting agents and strategies is crucial if such a novel integratory concept is to be foreseen in the future. This could be attainable by advocating a new merged concept of “minimally invasive regenerative endodontic procedures (MIREPs),” through modifying the clinical protocol of REPs by incorporating a minimally invasive access cavity design/preparation and biomimetic disinfection protocol, which could enhance clinical treatment outcomes and in the future; allow for personalized disinfection/regeneration protocols to further optimize the outcomes of MIREPs. In this review, we aim to introduce this new concept, its realization and challenges along with future perspectives for clinical implementation.

This case report describes the post and core treatment of a maxillary central incisor. An 18-year-old female patient reported to the Department of Conservative Dentistry and Endodontics with the chief complaint of pain in upper front tooth region. On clinical examination, there was Ellis class III fracture resulting in loss of significant tooth structure necessitating post and core treatment. Treatment was initiated with removal of carious region, canal was located, working length was established followed by chemo mechanical preparation and obturation. Post space preparation was done in the canal followed by post cementation and core build up. Keywords: Post, core, ceramic, crown lengthening.

Introduction: Tooth fracture is one of the most undesirable phenomena in Endodontically Treated Teeth (ETT) and usually leads to tooth extraction. Basically, removal of any hard tissue from the canal walls raises the chance of root fracture. Aim: To evaluate the impact of root canal taper on fracture resistance of ETT prepared by two different file systems (Hero Shaper and RaCe file systems). Materials and Methods: This in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics at Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Sangli and Praj Metallurgical Laboratory Pune, Maharashtra, India, frome February 2021 to November 2021. The study included 44 freshly extracted mandibular premolar teeth were randomly divided into four groups. Group 1a had Hero Shaper 4%, group 1b had 6% Hero Shaper, group 2a had RaCe 4% and group 2b had RaCe 6% file system. After cleaning and shaping the root canals, obturation was completed using cold lateral compaction and root canals were embedded in standardised autopolymerising acrylic resin blocks, subjected to a vertical load in universal testing machine to cause vertical root fracture. The forces required to induce fractures were measured in Newtons. Data was analysed by using independent t-test and two-way Analysis of Variance (ANOVA) test for intergroup comparison. A p-value≤0.05 was considered as statistically significant. Results: Among instrumented groups, group 1a (Hero Shaper 4%) showed higher fracture resistance of 372.5 Newtons and group 2b (RaCe 6%) showed lowest fracture resistance of 314.56 Newtons as compared to other groups. Statistically significant difference (p-value=0.026) was seen in the mean fracture resistance among the group 1a and 1b, and group 2a and 2b. At pair wise comparison there was statistically significant difference in group 1a and group 2a (p-value=0.016). Conclusion: Amongst the instrumented groups, Hero Shaper file system showed the higher fracture resistance, than RaCe file system. Marked reduction in fracture resistance of ETT was seen with the use of greater taper instruments.

After endodontic treatment, teeth are structurally different from untreated vital teeth, so these teeth require specialized treatment. The toughness of an endodontically treated tooth is associated to the tooth structure left. In vertical root fracture, resection of the affected root or extraction of the tooth is mandatory. Hence, this is a serious concern as there is an unfavorable prognosis leading to endodontic failure. One major cause for tooth fracture is found to be endodontic treatment in many in vivo studies. Vital teeth are less prone to fracture than nonvital teeth. It is a well-known fact that loss of structural integrity associated with the access preparation results in increased cuspal deflection during function leading to a higher occurrence of fractures. It is difficult to establish whether the occurrence of fractures depends on change in dentin structure or missing tooth structure. If endodontically treated teeth are not restored immediately, there is bacterial contamination and coronal microleakage, and this can lead to retreatment or endodontic failure. Hence, bonded restorations must be used to avoid microleakage. Based on above findings the present study was planned to evaluate the In Vitro Evaluation of Fracture Resistance of Endodontically Treated Teeth with the Use of Different Root Canal Sealers. The present study was planned in Department of Conservative Dentistry and Endodontics, Buddha Institute of Dental Science and Hospital, Patna, Bihar, India. For the in vitro study, 30 extracted maxillary central incisors from patients in the age group 30-55 years were obtained. After extraction, soft tissue and calculus were mechanically removed and teeth were stored in 5% sodium hypochlorite solution for 24 h to remove any remaining soft tissue. Certain teeth that had fracture lines, calcifications, surface irregularities were discarded, and a total of 20 teeth samples were obtained for the study. Although the sample size was small, it was sufficient to achieve a statistical difference. The teeth were sectioned at the cementoenamel junction using a diamond disc and water spray The sectioned teeth were taken, and a working length for each root was then established 1 mm short of the apical foramen using a No. 20 K-file. Further, the roots were divided randomly into four groups. The data generated from present study concludes that increased the fracture toughness of the instrumented roots after obturation. Therefore the ability of these materials i.e., Resilon and Epiphany sealer, Gutta-percha and AH plus sealer, guttapercha and Endomethasone sealer to reinforce the Endodontically treated teeth looks very promising but further long-term clinical studies are necessary to collect evidence based data thus to be able to support the confident use of these materials in day to day practice. Keywords: Fracture resistance, root canal sealers, Resilon, Epiphany, AH Plus Sealer, Endomethasone sealer, etc.

Introduction: The concept of ‘extension for prevention’ accelerates treatment processes but eliminates precious dentin at the pericervical area, resulting in biomechanically weakened tooth structure after endodontic treatment. Pericervical Dentin (PCD) is a new paradigm for endodontic success supports the idea that the amount of residual tooth structure is closely associated with long-term retention of the tooth and resistance to fracturing. Aim: To determine the impact of two endodontic access cavity designs and biomechanical preparation on the pericervical dentin thickness using 3D Cone Beam Computed Tomographic (CBCT) visualisation technique and fracture resistance of the maxillary anterior teeth under compressive load using universal testing machine. Materials and Methods: The in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics at Karnavati School of Dentistry, Gandhinagar, Gujarat, India, from October 2020 to March 2021. Study was carried out on the 30 single rooted freshly extracted maxillary central incisors and were randomly divided into two groups of conventional and conservative access preparation groups (n=15). Group 1 was conventional group, samples were accessed using endo access bur #1. Group 2 was conservative group, samples were accessed using CK micro-endodontic bur under a dental operating microscope. Cleaning and shaping was done using 17% Ethylenediamine Tetraacetic Acid (EDTA) as lubricant and 4% Hyflex CM rotary file system. The CBCT scans were taken preoperatively, following access cavity preparation and postobturation to evaluate the amount of pericervical dentin loss in mesial, lingual, facial and distal surfaces of the teeth at the levels of 1 mm to 4 mm above and below Cementoenamel Junction (CEJ). The samples were then loaded to fracture in the Universal Testing Machine, and the data were analysed using Independent sample t-test using Statistical Package for Social Sciences (SPSS) software version 20.0. Results: In comparison to the group 2, group 1 led to an increase in substantial tooth structure loss in the pericervical region. Among all surfaces, pericervical dentin loss was more pronounced on the lingual surface in the group 1 than in the group 2 (p-value <0.001). Higher fracture resistance was observed in group 2 (1136.75 N) compared to group 1 (687.22 N) under compressive load (p-value <0.001). Conclusion: Incisal cavity design is a less invasive method of accessing maxillary central incisors that preserves pericervical dentin. Under compressive load, pericervical dentin conservation provided greater fracture resistance in the conservative group than in the conventional group.

Calcific metamorphosis is also called pulp canal obliteration. Canals can be partially or fully obliterated. Most common reasons for calcified canals are trauma and aging. These calcific deposits can cause a considerable challenge to the dental practitioner in locating the canals, reaching the working length and also cleaning and shaping the canals. Attempt to negotiate the canals and perform biomechanical preparation without proper and thorough knowledge on management of calcified canals can lead to iatrogenic errors caused by the clinician such as perforation, fracture of instrument, transportation etc.Most important thing before attempting to negotiate such calcified canals is to have a thorough knowledge on the normal anatomical form and morphology of the root canal system of the particular tooth. Practicing under dental loupes or microscope can add to the clear vision and aid in locating and negotiating the canal. Different armamentarium is available for this purpose like basic small size k file, c pilot files, Endo guide burs, ultrasonic, chelating agents, endodontic surgery to advanced Guided Endodontics.

Root fractures are relatively uncommon compared to other types of dental traumas. It is sometimes extremely difficult for practitioners to decide what should be done and which approach was the optimal choice for patients. This study describes the treatment of an oblique root fracture in the right maxillary central incisor (tooth 11) using mineral trioxide aggregate (MTA) and lingual splint with composite and 0.3 mm 3-strand twisted stainless steel wire. The study performs a detailed management from the first visit to the next appointments. After four months, the tooth was asymptomatic with neither discoloration nor draining sinus. Radiographs show the increasing of periapical radiolucency in the fracture area. Thus, the tooth needs further interventions. Keywords: Dental trauma, root fracture, mineral trioxide aggregate, dental trauma splint. References [1] J. O. Andreasen, L. Andreasen, F. M. Andreasen, R. Fractures, F. M. Andreasen, J. O. Andreasen, G. Tsilingaridis, Textbook and Color Atlas of Traumatic Injuties to the Teeth, John Wiley & Sons Ltd Edition, UK, 2019, pp. 377-407.[2] M. Gharechahi, Horizontal Root Fracture Accompanied by Luxation of Coronal Fragment in a Maxillary Central Incisor: a Case Report, Journal of Dental Research, Dental Clinics, Dental Prospects, Vol. 7, No. 4, 2013, pp. 244-247, https://doi.org/10.5681/joddd.2013.039.[3] M. M. Bornstein, A. B. W. Hanssen, P. Sendi, T. Von Arx, Comparison of Intraoral Radiography and Limited Cone Beam Computed Tomography for the Assessment of Root-Fractured Permanent Teeth, Dental Traumatology, Vol. 25, No. 6, 2009, pp. 571-577, https://doi.org/10.1111/j.1600-9657.2009.00833.x.[4] J. J. May, N. Cohenca, O. A. Peters, Contemporary Management of Horizontal Root Fractures to the Permanent Dentition: Diagnosis-Radiologic Assessment to Include Cone-beam Computed Tomography, Journal of. Endodontics., Vol. 39, No. 3, 2013, pp. S20-S25, https://doi.org/ 10.1016/j.joen.2012.10.022.[5] P. Makowiecki, A. Witek, J. Pol, J. B. Radlińska, The Maintenance of Pulp Health 17 Years After Root Fracture in a Maxillary Incisor Illustrating the Diagnostic Benefits of Cone Beam Computed Tomography, International Endodontic Journal, Vol. 47, No. 9, 2014, pp. 889-895, https://doi.org/10.1111/iej.12221.[6] C. Bourguignon, International Association of Dental Traumatology Guidelines for the Management of Traumatic Dental Injuries: 1. Fractures and Luxations, Dental Traumatology, Vol. 36, No. 4, 2020, pp. 314-330, https://doi.org/10.1111/edt.12578.[7] American Association of Endodontists, , The Recommended Guidelines of American Association of Endodontists for the Treatment of Traumatic Dental Injuries, https://www.aae.org/specialty/clinical-resources/treatment-planning/traumatic-dental-injuries/, 2013 (accessed on: September 5th, 2013).[8] P. V. Abbott, Diagnosis and Management of Transverse Root Fractures, Journal of Endodontic, Vol. 45, No. 12, 2019, pp. S13-S27, https://doi.org/ 10.1016/j.joen.2019.05.009.[9] M. Torabinejad, Mineral Trioxide Aggregate Properties and Clinical Applications. John Wiley & Sons, Inc, USA, 2005.[10] R. V. Roudsari, S. Jawad, C. Taylor, J. Darcey, A. Qualtrough, Modern Endodontic Principles Part 8: The Future of Endodontics, Dental Update, Vol. 43, No. 5, 2016, pp. 430-441, https://doi.org/10.12968/denu.2016.43.5.430.[11] F. Guerrero, A. Mendoza, D. Ribas, K. Aspiazu, Apexification: A Systematic Review, Journal of Conservative Dentistry, Vol. 21, No. 5, 2018, pp. 462, https://doi.org/10.4103/jcd.jcd_96_18.[12] R. Rothom , P. Chuveera, Differences in Healing of a Horizontal Root Fracture as Seen on Conventional Periapical Radiography and Cone-Beam Computed Tomography, Case Reports in Dentistry, Vol. 2017, 2017, pp. 1-5, https://doi.org/10.1155/2017/2728964.[13] N. Hadziabdic, The Basics of Splinting in Dentoalveolar Traumatology, Maxillofacial Surgery and Craniofacial Deformity - Practices and Updates, 2020, pp. 1-16, https://doi.org/10.5772/intechopen.88061.[14] S. Gautam, A. Thapa, Composite Wire Splint , an Economical , Maintainable and Flexible Option , in Stabilizing Luxated , Avulsed and Intruded Teeth : A Prospective Study, Nepal Medical College Journal, Vol. 18, No. 3-4, 2016, pp. 124-127. [15] K. Oikarinen, Comparison of the Flexibility of Various Splinting Methods for Tooth Fixation, International Journal of Oral and Maxillofacial Surgery, Vol. 17, No. 2, 1988, pp. 125-127. https://doi.org/10.1016/S0901-5027(88)80166-8.[16] K. Oikarinen, Tooth Splinting: A Review of the Literature and Consideration of the Versatility of a Wire‐Composite Splint, Dental Traumatology, Vol. 6, No. 6, 1990, pp. 237-250, https://doi.org/ 10.1111/j.1600-9657.1990.tb00426.x.[17] S. C. Kwan, J. D. Johnson, N. Cohenca, The Effect of Splint Material and Thickness on Tooth Mobility After Extraction and Replantation Using a Human Cadaveric Model, Dental Traumatology, Vol. 28, No. 4, 2012, pp. 277-281, https://doi.org/10.1111/j.16009657.2011.01086.x.[18] M. Khalid Saeed, T. Muhammad Arslan, W. Ali, S. S. Kazmi, A Comparison of Two Wire-Composite Splints Having Different Wire Diameters in the Management of Traumatic Dental Injuries, Pakistan Oral & Dental Journal, Vol. 39, No. 1, 2019, pp. 56, https://www.podj.com.pk/index.php/podj/article/view/348 (accessed on: September 5th, 2013).[19] Y. Zhu, H. Chen, L. Cen, J. Wang, Influence of Abutment Tooth Position and Adhesive Point Dimension on the Rigidity of a Dental Trauma Wire-Composite Splint, Dental Traumatology, Vol. 32, No. 3, 2016, pp. 225-230, https://doi.org/ 10.1111/edt.12241.[20] K. A. Ebeleseder, K. Glockner, C. Pertl, P. Städtler, Splints Made of Wire and Composite: an Investigation of Lateral Tooth Mobility In vivo, Dental Traumatology, Vol. 11, No. 6, 1995, pp. 288-293, https://doi.org/10.1111/j.1600-9657. 1995.tb00506.x.[21] C. Berthold, A. Thaler, A. Petschelt, Rigidity of Commonly Used Dental Trauma Splints, Dental Traumatology, Vol. 25, No. 3, 2009, pp. 248-255, https://doi.org/10.1111/j.16009657.2008.00683.x.[22] C. Berthold, F. J. Auer, S. Potapov, A. Petschelt, Influence of Wire Extension and Type on Splint Rigidity - Evaluation by a Dynamic and a Static Measuring Method, Dental Traumatology, Vol. 27, No. 6, 2011, pp. 422-431, https://doi.org/10.1111/j.16009657.2011.01033.x.[23] G. Hu, J. Y. Heithersay, Australian Dental Association, Australian Dental Journal, Vol. 56, No. 4, 2011, pp. S16-S17, https://doi.org/10.1111/ j.1834-7819.1974.tb05045.x.[24] B. Kahler, J. Y. Hu, C. S. M. Smith, G. S. Heithersay, Splinting of Teeth Following Trauma: A Review and a New Splinting Recommendation, Australian Dental Journal, Vol. 61, 2016, pp. 59-73, https://doi.org/10.1111/adj.12398.[25] H. S. Zagalska, K. Emerich, Assessment of a Power Chain as a New Dental Trauma Splint and Its Comparison With Two Commonly Used Splinting Materials, Applied Sciences, Vol. 10, No. 23, 2020, pp. 1-13, https://doi.org/10.3390/app10238398.[26] M. W. B. Hassan, L. Andersson, P. W. Lucas, Stiffness Characteristics of Splints for Fixation of Traumatized Teeth, Dental Traumatology, Vol. 32, No. 2, 2016, pp. 140-145, https://doi.org/10.1111/edt.12234.[27] T. Shirako, H. Churei, T. Wada, M. Uo, T. Ueno, Establishment of Experimental Models to Evaluate the Effectiveness of Dental Trauma Splints, Dental Materials Journal, Vol. 36, No. 6, 2017, pp. 731-739, https://doi.org/10.4012/dmj.2016-333.[28] J. O. Andreasen, F. M. Andreasen, A. Skeie, E. H. Hansen, O. Schwartz, Effect of Treatment Delay upon Pulp and Periodontal Healing of Traumatic Dental Injuries - A Review Article, Dental Traumatology, Vol. 18, No. 3, 2002, pp. 116-128, https://doi.org/10.1034/j.1600-9657.2002.00079.x.[29] J. O. Andreasen, F. M. Andreasen, I. Mejàre, M. Cvek, Healing of 400 Intra-Alveolar Root Fractures. 2. Effect of Treatment Factors such as Treatment Delay, Repositioning, Splinting Type and Period and Antibiotics, Dental Traumatology, Vol. 20, No. 4, 2004, pp. 203-211, https://doi.org/10.1111/j.1600-9657.2004.00278.x.[30] R. R. Welbury, M. J. Kinirons, P. Day, K. Humphreys, T. A. Gregg, Outcomes for Root-Fractured Permanent Incisors: A Retrospective Study, Pediatric Dentistry, Vol. 24, No. 2, 2002, pp. 98-102.[31] L. Shafie, F. Farzaneh, M. A. Hashemipour, Repair of Horizontal Root Fracture: A Case Report, Iranian Endodontic Journal, Vol. 6, No. 4, 2011, pp. 176-178, https://doi.org/10.22037/iej.v6i4.2464[32] A. Majorana, S. Pasini, E. Bardellini, E. Keller, Clinical and Epidemiological Study of Traumatic Root Fractures, Dental Traumatology, Vol. 18, No. 2, 2002, pp. 77-80, https://doi.org/10.1034/j.16009657.2002.180206.x.[33] F. M. Andreasen, J. O. Andreasen, T. Bayer, Prognosis of Root‐Fractured Permanent Incisors — Prediction of Healing Modalities, Dental Traumatology, Vol. 5, No. 1, 1989, pp. 11-22, https://doi.org/10.1111/j.1600-9657.1989.tb00331.x.[34] Y. J. A. Kim, N. P. Chandler, Determination of Working Length for Teeth With Wide or Immature Apices: A Review, International Endodontic Journal, Vol. 46, No. 6, 2013, pp. 483-491, https://doi.org/10.1111/iej.12032.[35] F. Goldberg, S. Frajlich, S. Kuttler, E. Manzur, B. B. Marroquín, The Evaluation of Four Electronic Apex Locators in Teeth with Simulated Horizontal Oblique Root Fractures, Journal of Endodontics, Vol. 34, No. 12, 2008, pp. 1497-1499, https://doi.org/10.1016/j.joen.2008.09.002.[36] J. O. Andreasen, B. Farik, E. C. Munksgaard, Long-Term Calcium Hydroxide as a Root Canal Dressing may Increase Risk of Root Fracture, Dental Traumatology, Vol. 18, No. 3, 2002, pp. 134-137, https://doi.org/10.1034/j.1600-9657 .2002.00097.x.[37] D. R. Prithviraj, H. K. Bhalla, R. Vashisht, K. M. Regish, P. Suresh, An Overview of Management of Root Fractures, Kathmandu University Medical Journal, Vol. 12, No. 47, 2014, pp. 217-225, https://doi.org/10.3126/ kumj.v12i3.13724.[38] M. Singh, M. M. Khan, B. L. Bhavya, H. Tiwari, P. Gupta, A. Choudhary, Success Rate of Calcium Hydroxide vs Mineral Trioxide Aggregate as Apexification Agents : A Systematic Review, Annals of the Romanian Society for Cell Biology, Vol. 25, No. 6, 2021, pp. 835-839, https://www.annalsofrscb.ro/index.php/journal/article/view/5499 (accessed on: September 5th, 2013).[39] C. M. Bramante, R. Menezes, I. G. Moraes, N. Bernardinelli, R. B. Garcia, A. Letra, Use of MTA and Intracanal Post Reinforcement in a Horizontally Fractured Tooth: A Case Report, Dental Traumatology, Vol. 22, No. 5, 2006, pp. 275-278, https://doi.org/10.1111/j.1600-9657.2006.00353.x.[40] G. Erdem, A. P. Ozdas, D. O. Dincol, E. Aren, Case Series-Root Healing with MTA after Horizontal Fracture, European Archives of Paediatric Dentistry: Official Journal of the European Academy of Paediatric Dentistry, Vol. 10, No. 2, 2009, pp. 110-113, https://doi.org/10.1007/BF03321611.[41] K. Er, D. Çelik, T. Taşdemir, T. Yildirim, Treatment of Horizontal Root Fractures Using a Triple Antibiotic Paste and Mineral Trioxide Aggregate: A Case Report, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and. Endodontology, Vol. 108, No. 1, 2009, pp. 63-66, https://doi.org/ 10.1016/j.tripleo.2009.03.028.[42] A. Kusgoz, T. Yildirim, M. Tanriver, C. Yesilyurt, Treatment of Horizontal Root Fractures Using MTA as Apical Plug: Report of 3 Cases, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, Vol. 107, No. 5, 2009, pp. e68-e72, https://doi.org/10.1016/j.tripleo.2009.01.031.[43] D. Kim, W. Yue, T. C. Yoon, S. H. Park, E. Kim, Healing of Horizontal Intra-Alveolar Root Fractures after Endodontic Treatment with Mineral Trioxide Aggregate, Journal of Endodontics, Vol. 42, No. 2, 2016, pp. 230-235, https://doi.org/10.1016/j.joen.2015.11.016.[44] P. Yadav, P. J. Pruthi, R. R. Naval, S. Talwar, M. Verma, Novel Use of Platelet-Rich Fibrin Matrix and MTA as an Apical Barrier in the Management of a Failed Revascularization Case, Dental Traumatology, Vol. 31, No. 4, 2015, pp. 328-331, https://doi.org/10.1111/edt.12168.

Aim: Aim of the present study was to determine the incidence of restoration replacement and associated factors among South Canara population. Place of Study: Department of Conservative Dentistry and Endodontics, AB Shetty Memorial Institute of Dental Sciences, Deralakatte, Mangaluru. Duration of Study: May 15, 2018-June 15, 2018 (1 month). Methodology: 2000 patients were examined using mouth mirror and explorer under good lighting facilities, followed by a questionnaire to determine the incidence of restoration replacement and the parameters checked for correlations were type of the restorative material, class of the restoration, reason for the failure, type and position of the tooth, and patient factors such as age-group, gender and oral hygiene measures followed. Statistical Analysis: Data obtained was statistically analysed by using IBM SBSS version 24. Differences between variables were analysed by Chi-square test. Results and Conclusion: Significant differences were found in case of age groups, reason of replacement and the class of restoration The incidence of restoration replacement was 18.2% as 364 patients out of 2000 patients showed the need for replacements. The main cause of the failure was secondary caries followed by material fracture and discoloration. Amalgam was the most commonly replaced restorative material and lower molar teeth showed more failures. It also indicated that replacements were more prevalent in males and for individuals brushing once daily followed by ones with occasional brushing and lastly who brushed twice daily.

Background: Autologous platelet concentrates such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) have gained overwhelming popularity in regenerative endodontics. Clinical evidence reveals the lack of a particular advantage of using PRP or PRF over an evoked blood clot in promoting canal wall thickening and/or continued root development in immature necrotic teeth. Moreover, despite stimulating tissue repair and repopulating the root canals of immature and mature permanent teeth, the new vital tissue may not possess the functional activity of the native pulp tissue. Methods: To better understand the origin, nature, and long-term fate of the tissue types found within the pulp space, we critically examine all available histo-/morphological evidence for pulp–dentine complex regeneration using PRP and/or PRF, alone or together with an evoked blood clot, specialised or unspecialised primary cells, and other biomaterials. Results: Histological data from clinical studies is scant. Reportedly, the inner dentinal surface supports cementum-like tissue formation, but this interface likely deviates in structure and function from the native cementodentinal junction. Presence of bone-like tissue within the pulp space is intriguing since de novo osteogenesis requires closely coordinated recruitment and differentiation of osteoprogenitor cells. Compared to untreated necrotic teeth, an evoked blood clot (with/without PRF) improves fracture resistance. Tooth regeneration using PRF and dental bud cells is unreliable and the constituent neoformed tissues are poorly organised. Conclusion: PRP/PRF fail to demonstrate a significant advantage over an induced blood clot, alone. The true nature of neoformed tissues remains poorly characterised while their response to subsequent insult/injury is unexplored.

Introdução: Após fratura decorrente de trauma e consequente tratamento endodôntico, os dentes têm sua resistência mecânica reduzida, sendo necessária, em alguns casos, a utilização de um retentor intrarradicular. Objetivo: Descrever um caso clínico de reabilitação de um dente anterior que apresentava fratura decorrente de trauma, de um paciente adolescente. Relato do caso: Paciente do sexo masculino, 15 anos de idade, apresentou-se com a queixa da aparência estética do dente 32. Na anamnese o paciente relatou que há cerca de 1 ano havia fraturado o referido dente enquanto brincava, e que sentiu dor apenas nas primeiras horas após o acidente, não se queixando mais de qualquer sintomatologia dolorosa desde então. Ao exame radiográfico, observou-se fratura do dente 32, além da presença de imagem radiolúcida na região periapical do mesmo dente. Assim, baseado na avaliação radiográfica e após criteriosos exames com recursos semiotécnicos empregados na Endodontia, confirmou-se o diagnóstico de necrose pulpar no referido dente. Foi instituído o tratamento endodôntico previamente ao tratamento restaurador. A reabilitação consistiu inicialmente pelo tratamento endodôntico. Na sequência optou-se pela instalação de um pino de fibra de vidro (PFV). Por fim, a reconstrução coronária foi realizada de forma direta, em resina composta e com o auxílio de uma coroa de cloreto de polivinila (PVC). Conclusão: Através do resultado final obtido, concluiu-se que esta é uma alternativa rápida e viável para casos como o apresentado, proporcionando não somente o restabelecimento funcional e estético do dente, mas também satisfação e elevação da autoestima de pacientes hebiátricos.Descritores: Traumatismos Dentários; Dente não Vital; Restauração Dentária Permanente.ReferênciasMazzoleni S, Graf F, Salomon E, Simionato F, Bacci C, Stellini E. Influence of root canal posts on the reattachment of fragments to endodontically treated fractured incisors: an in vitro experimental comparison. J Esthet Restor Dent. 2016;28(2):92-101.Andersson L. Epidemiology of traumatic dental injuries. J Endod. 2013;39 (3 Suppl):S2-5.Barreto BCF, Silva GR, Bertaglia PC, Caldeira MMPS, Soares CJ, Martins LRM. Traumatismo dentário na hebiatria: relato de caso clínico. ROBRAC (Online). 2012;21(57):510-14.Flores MT, Andreasen JO, Bakland LK, Feiglin B, Gutmann JL, Oikarinen K et al. Guidelines for the evaluation and management of traumatic dental injuries. Dent Traumatol. 2001;17(2):49-52.Altun C, Tözüm TF, Güven G. Multidisciplinary approach to the rehabilitation of a crown fracture with glass-fibre-reinforced composite: a case report. J Can Dent Assoc. 2008;74(4):363-66.Cvek M, Cleaton-Jones PE, Austin JC, Andreasen JO. Pulp reactions to exposure after experimental crown fractures or grinding in adult monkeys. J Endod. 1982;8(9):391-97.Lee R, Barrett EJ, Kenny DJ. Clinical outcomes for permanent incisor luxations in a pediatric population. II. Extrusions. Dent Traumatol. 2003;19(5):274-79.Aleisa K, Al-Dwairi Z, Alghabban R, Glickman G, Hsu ML. Effect of cement types and timing of cementation on the retentive bond strength of fiber posts. J Dent Sci. 2012;7(4):367-72.Prado MAA, Kohl JCM, Nogueira RD, Geraldo-Martins VR. Retentores intrarradiculares: revisão da literatura. UNOPAR Cient Cienc Biol Saude. 2014;16(1):51-5.Petrie CS, Walker MP. Effect of airborne-particle abrasion and aqueous storage on flexural properties of fiber-reinforced dowels. J Prosthodont. 2012;21(4):296-303.Rocha AC, Cardoso J, Coradini SU. Reforço radicular: relato de caso clínico. Stomatos. 2009;15(28):87-93.Ausiello P, Franciosa P, Martorelli M, Watts DC. Mechanical behavior of post-restored upper canine teeth: a 3D FE analysis. Dent Mater. 2011;27(12):1285-94.Cecchin D, Farina AP, Vitti RP, Moraes RR, Bacchi A, Spazzin AO. Acid etching and surface coating of glass-fiber posts: bond strength and interface analysis. Braz Dent J. 2016;27(2):228-33.Feuser L, Araújo E, Andrada MAC. Pinos de fibra: escolha corretamente. Arq odontol. 2005;41(3):255-62.González-Lluch C, Rodríguez-Cervantes PJ, Sancho-Bru JL, Pérez-González A, Barjau-Escribano A, Vergara-Monedero M et al. Influence of material and diameter of pre-fabricated posts on maxillary central incisors restored with crown. J Oral Rehabil. 2009;36(10):737-47.Gomes GM, Gomes OM, Reis A, Gomes JC, Loguercio AD, Calixto AL. Effect of operator experience on the outcome of fiber post cementation with different resin cements. Oper Dent. 2013;38(5):555-64.Sorrentino R, Salameh Z, Zarone F, Tay FR, Ferrari M. Effect of post-retained composite restoration of MOD preparations on the fracture resistance of endodontically treated teeth. J Adhes Dent. 2007;9(1):49-56.Rosentritt M, Fürer C, Behr M, Lang R, Handel G. Comparison of in vitro fracture strength of metallic and tooth-coloured posts and cores. J Oral Rehabil. 2000;27(7):595-601.Schwartz RS, Fransman R. Adhesive dentistry and endodontics: materials, clinical strategies and procedures for restoration of access cavities: a review. J Endod. 2005;31(3):151-65.Egilmez F, Ergun G, Cekic-Nagas I, Vallittu PK, Lassila LV. Influence of cement thickness on the bond strength of tooth-colored posts to root dentin after thermal cycling. Acta Odontol Scand. 2013;71(1):175-82.Baba NZ, Golden G, Goodacre CJ. Nonmetallic prefabricated dowels: a review of compositions, properties, laboratory, and clinical test results. J Prosthodont. 2009;18(6):527-36.Clavijo VGR, Souza NC, Andrade MF, Susin AH. Pinos anatômicos: uma nova perspectiva clínica. Rev dental press estét. 2006;3(3):100-21.Conceição EN. Dentística: saúde e estética. Porto Alegre: Artmed; 2007.Maurício P, Reis J. Tendências na reabilitação de dentes com tratamento endodôntico em prótese fixa. Revista OMD. 2014;2-8.Bastos PCA, Faria DE, Bridi EC, Amaral FLB, França FMG, Flório FM et al. Push-out bond strength and sealing ability of etch-and-rinse and self-etching adhesives used for fiberglass dowel bonding at different depths of the root canals. Rev odontol UNESP. 2011;40(4):174-81.da Silva NR, Aguiar GCR, Rodrigues MP, Bicalho AA, Soares PBF, Veríssimo C et al. Effect of resin cement porosity on retention of glass-fiber posts to root dentin: an experimental and finite element analysis. Braz Dent J. 2015;26(6):630-36.Bottino MA, Quintas AF, Miyashita E, Giannini V. Núcleos. In: Estética em reabilitaҫão oral: metal free. São Paulo: Artes Médicas; 2011.Dallari, A. Comunicação pessoal, Brescia, 2001. In: Scotti, R. Pinos de fibra-considerações teóricas e aplicações clinicas. Artes Médicas; 2003.Grandini S, Sapio S, Goracci C, Monticelli F, Ferrari M. A onestep procedure for luting glass fibre posts: an SEM evaluation. Int Endod J. 2004;37(10):679-86.