Indian J Stomatol 2012;3(1):77-80

2010;1(1):1-5

Restoration of a Fractured Tooth with Glass Fibre Post and Metal Ceramic Crown -
A Case Report

Meetu Mathur1, Deepak Sharma2, K Ravi Verma3

Abstract
Aim: The aim of this clinical report is to describe restoration of fractured right maxillary lateral incisor tooth with fibre post,
composite resin with additional metal-ceramic crown coverage.
Method: A 20-year-old male patient reported with acute pain in maxillary right lateral incisor. Clinical examination revealed
fracture of the coronal portion of tooth involving pulp. The tooth was treated endodontically and filled with gutta percha and
resin sealer. Afterwards the gutta percha was removed with Gates Glidden drill, without enlarging the canals. 5mm of gutta
percha was left at the apex of the root. Root canal was rinsed and dried. Canal was etched with 37% of phosphoric acid for 15
seconds. 2 coats of bonding agent were applied with brush and cured with LED light for 20 seconds. Post was inserted into the
root canal and shortened to appropriate length with scissors. Prior to cementation, dual cure resin cement was applied to the
surface of post and inside the canal space. It was light cured for 40 seconds. Composite core build up was done followed by tooth
preparation for metal-ceramic crown. Appropriate shade was selected and final crown was cemented with luting cement.
Result: The patient was recalled after 6 months. Retention of crown was evaluated and found to be acceptable.
Conclusion: A fractured tooth restored with a glass fibre post and metal-ceramic crown exhibited a favourable result after 6
months and was evaluated to be successful.

Key words: Glass fibre post, metal-ceramic crown, dual cure resin cement.

Introduction clinical examination revealed a complicated crown

Injury to anterior teeth is a relatively common incident that fracture. Vitality test was done with electric pulp tester and
affects children and adolescents. It may be due to involv- both right maxillary central and lateral incisors were found
ement in dangerous activities, sports or by accidents. to be non-vital. Sinus opening was not present. The radio-
Coronal fracture of tooth by trauma is the most frequent graph revealed a large periapical pathology involving both
type of dental injury in permanent dentition. The incidence right maxillary central and lateral incisor and no associated
of complicated crown fractures ranges from 2% to 13% of root fracture (Figure 2). It was diagnosed as chronic peri -
all dental injuries. There are always two components in any apical abscess. Treatment plan consisted of endodontic
traumatic injury namely- physical and psychological; both therapy followed by glass fibre post, composite core built
of which hamper individual's daily activities. So these sce- up and final restoration by metal-ceramic crown.
narios require quick decision and prompt clinical action to Root canal treatment for teeth 11 and 12, was started with
get the individual back to their daily activities. Manage- proper access preparation. Gates Glidden drills (Maillefer,
ment of such trauma cases involves simple to complex Ballaigues, Switzerland) in sizes 2 and 3 were used to obta-
restorative intervention depending upon the severity and in straight access in the middle and the coronal third of the
extent of the fracture.1,2 Modern techniques in dentistry that root canals. The root canals were then prepared by step
restore tooth structure and esthetics are of immense value back method. Silicone stoppers were placed around the file
and should be considered. Restoration of endodontically shaft to control the working length of the files and the accu-
treated teeth with root canal dowel is usually indicated racy of the internal canal dimensions were ensured. After
when the remaining crown structure is less.3-5 intermittent rinsing with 2.5% sodium hypochloride, the
canals were dried with paper points (Union Broach), and
Aim calcium hydroxide dressing was placed in both canals for 3
The aim of this clinical report is to describe restoration of weeks.
fractured right maxillary lateral incisor tooth with a glass After 3 weeks when the teeth were asymptomatic the roots
fibre post and composite resin with additional metal- were prepared for obturation. The master apical file for 11
ceramic crown. was 70 and for 12 was 60. The master gutta percha point
was coated with AH plus sealer and seated in the canals to
Clinical report the working length. A finger spreader was inserted into the
A 20-year-old male patient reported to the Department of canal to a level approximately 1mm short of the working
Conservative Dentistry with the history of trauma and length. Lateral condensation with non standardized fine
fractured maxillary right lateral incisor involving pulp gutta percha points was performed until both canals were
(Figure 1).Chief complaint was masticatory difficulty and obturated (Figure 3). Patient was recalled after a week for
loss of esthetics. History revealed trauma around 4 years post endodontic treatment and was found to be asympto-
back. Medical history was non-contributory. Intra-oral matic.

1
Sr. Lecturer Deptt. of Conservative Dentistry and Endodontics, Rajasthan Dental College and Hospital, 2Professor, 3Professor and Head,
Deptt. of Conservative Dentistry and Endodontics, Jaipur Dental College and Hospital, Jaipur, India. Correspondence: Dr. Meetu Mathur,
email: [email protected]

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 Indian J Stomatol 2012;3(1):77-80

Figure 1: Fractured right Figure2: Periapical pathology Figure 3:11,12 obturated with
lateralincisor involving pulp involving 11,12 gutta percha & AHplus sealer

Figure 4: Post space prepared Figure 5: Radiograph Figure 6: Post stabilised in 12

according to prefabricated post in 12 showing post in 12

Figure 7: Composite core built up Figure 8: Tooth preparation Figure 9a: Metal ceramic crown
done (buccal view) cemented

Figure 9b: Metal ceramic crown Figure 10a: Clinical photograph showing Figure 10b: Radiograph showing
cemented (palatal view) follow up after 6 months follow up after 6 months

Two-thirds of the canal length was used for post. Gutta canal surface was etched with 37% phosphoric acid soluti-
percha was left upto 5mm within the canal in lateral incisor, on for 15 seconds, rinsed thoroughly, and dried with paper
and post space was prepared according to the prefabricated points. 2 coats of bonding agent were applied, air dried and
fibre post (Figure 4). cured for 20 seconds. Equal parts of base paste and catalyst
A proper-sized EASY Fiber Post (Dentsply Maillefer) was of the dual-cure resin cement (Relyx U 100-3M ESPE)
selected according to the canal thickness and then cut at the were mixed and was spread on the surface of the fiber post
required length. The post was adjusted into the canal. The and then into the post preparation with lentulo spiral. The
preferred adhesive technique here was dual-cure resin post was immediately seated carefully and cured for 40
cementation. The working field was isolated. The root seconds (Figure 5). Excess cement was removed with the

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help of a blunt instrument. The post was stabilized for appr- Similar results were reported by Reid et al.,14 and Junge et
oximately 6 minutes for it to set properly (Figure 6). al.15 They reported that posts cemented with resin cements
Once the post was stabilized, all the accessible areas of the were more resistant to cyclic loading than those cemented
post was light cured with visible light curing unit (470nm) with zinc phosphate or resin-modified glass-ionomer
for 20 seconds each. Coronal part was built-up with comp- cement. Bonded resin cements have been recommended
osite core (Esthetx) material (Figure 7). for their strengthening effect in roots with thin walls.16,17
Tooth preparation: After core built up the tooth was prep- Currently, composite resin is the most popular core mate-
ared with a 1.5mm ferrule in order to ensure long term post rial. It can be bonded to many of the current posts and to the
and core performance beneath the crown restoration, with- remaining tooth structure to increase retention.18 It has high
out sharp line angles for the planned metal-ceramic tensile strength and the tooth can be prepared for a crown
restoration (Figure 8). immediately after polymerization.Pilo et al., showed that
The color of final restoration was selected with shade composite cores have fracture resistance comparable to
guide. After the tooth preparation, gingival retraction was amalgam and cast post and cores.19
done with No.00 size [Ultra Dent Product, Utah, USA]; The use of fiber posts will probably continue to grow, assu-
and an impression with polyvinyl siloxanes (Aquasil soft ming that future long-term clinical research studies report
putty and Aquasil LV, Dentsply Intl) was made using putty similar levels of success as seen in the relatively short-term
wash technique in a rim lock impression tray. Impression studies already published. Further modifications of their
was poured and master cast fabricated and sent to the physical and mechanical properties will probably also
laboratory for fabrication of metal-ceramic crown. Provisi- improve their clinical performance.
onal restoration was fabricated and luted using eugenol-
free zinc oxide cement [Rely X Temp NE, 3M ESPE]. Conclusion
Patient's approval was taken prior to the final cementation Post endodontic treatment of fractured tooth with glass
of the fixed partial denture. Trial was done before the final fibre post, with improved adhesive protocol and final resto-
cementation. Masticatory function and optimal esthetics ration with metal ceramic crown is a simple conservative
were obtained and maxillomandibular relationship enhan- approach to provide esthetics and functional rehabilitation.
ced to a certain degree by fabrication of definitive metal-
ceramic restoration. Finally metal ceramic crown was References
cemented with glass ionomer cement (GC Gold label- 1. Andreasen JO, Andreasen FM. Textbook and colour atlas of
luting and lining cement) (Figure 9a, 9b). Definitive treat- traumatic injuries to the teeth. 3rd edn. Copenhagen: Munks-
ment outcomes in terms of function and esthetics satisfied gaard Publishers,1993;762.
the expectations of the patient. 2. Purton DG, Chandler NP, Love RM. Rigidity and retention
of root canal posts. Br Dent J 1998;184:294-96.
Result 3. Sorensen JA, Engelman MJ. Effect of post adaptation on
Patient was recalled after 6 months and retention of crown fracture resistance of endodontically treated teeth. J Prosthet
Dent 1990;64:419-24.
was evaluated which was found to be acceptable (Figure 4. Cohen BI, Pagnillo MK, Newmen I, Musikant BL, Deutsch
10a, 10b). AS. Comparison of the torsional forces at failure for seven
endodontic post systems. J Prosthet Dent 1995;74:350-57.
Discussion 5. Holmes DC, Diaz Arnold AM, Leary JM. Influence of post
The introduction of fibre post has had a great impact on the dimension on stress distribution in dentin. J Prosthet Dent
clinical procedures for restoring endodontically treated 1996;75:140-47.
teeth.6 Since their introduction in 90's, there has been 6. Schwartz RS, Robbins JW. Post placement and restoration
continuous research to modify the fibres-from carbon to of endodontically treated teeth: A literature review. J Endod
2004;30(5):289-01.
quartz to glass. Technical evolution has enabled manufac-
7. Meng QF, Chen YM, Guang HB, Yip KH, Smales RJ. Effect
turers to provide fibre posts that, besides offering superior of a ferrule and increased clinical crown length on the in
esthetics and mechanical properties (first qualities to be vitro fracture resistance of premolars restored using two
appreciated in comparison with metal or cast post) are also dowel-and-core systems. Oper Dent 2007;32:595-01.
radiopaque and available in great variety of shapes. 8. Tan PL, Aquilino SA, Gratton DG, Stanford CM, Tan SC,
The prognosis of fractured teeth and retention of definitive Johnson WT, et al. In vitro fracture resistance of endo-
restorations would have been questionable without suppo- dontically treated central incisors with varying ferrule heig-
rt of post and core foundations. Posts placed in endodont- hts and configurations. J Prosthet Dent 2005;93:331-36.
ically treated teeth with severe coronal destruction increase 9. Al-Wahadni A, Gutteridge DL. An in vitro investigation into
the effects of retained coronal dentine on the strength of a
fracture resistance.7-9 Patient's concern for esthetics is the tooth restored with a cemented post and partial core restora-
primary factor in the decision to restore maxillary anterior tion. Int Endod J 2002;35:913-18.
teeth.10 10. Ng CC, Dumbrigue HbB, Al-Bayat MI, Griggs JA,
Fabrication of metal-ceramic crown over glass fibre post- Wakefield CW. Influence of remaining coronal tooth struct-
composite core systems is one of the treatment options. ure location on the fracture resistance of restored endod-
Recent trend has been towards resin cements, as they ontically treated anterior teeth. J Prosthet Dent 2006;95:
increase retention and tend to leak less than other 209-06.
cements.11,12 A study by Bachicha et al., reported less leak- 11. Mezzomo E, Massa F, Libera SD. Fracture resistance of
teeth restored with two different post-and-core designs
age when resin cement was used with glass fibre and carb- ceme- nted with two different cements: an in vitro study,
on fiber posts compared with zinc phosphate or glass- Part I. Quintessence Int 2003;34:301-06.
ionomer cements.13 12. Nissan J, Dmitry Y, Assif D. The use of reinforced composite

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resin cement as compensation for reduced post length. J and a resin-reinforced dowel system in the intra radicular
Prosthet Dent 2001;86:304-08. restoration of structurally compromised roots. Quintessence
13. Bachicha WS, DiFiore PM, Miller DA, Lautenschlager EP, Int 1996;27:483-91.
Pashley DH. Microleakage of endodontically treated teeth 17. Katebzadeh N, Dalton BC, Trope M. Strengthening immat-
restored with posts. J Endod 1998;24:703-08. ure teeth during and after apexification. J Endod 1998;24:
14. Reid LC, Kazemi RB, Meiers JC. Effect of fatigue testing on 256-59.
core integrity and post microleakage of teeth restored with 18. Hsu YB, Nicholls JI, Phillips KM, Libman WJ. Effect of
different post systems. J Endod 2003;29:125-31. core bonding on fatigue failure of compromised teeth. Int J
15. Junge T, Nicholls JI, Phillips KM, Libman WJ. Load fatigue Prosthodont 2002;15:175-78.
of compromised teeth: a comparison of 3 luting cements. Int 19. Pilo R, Cardash HS, Levin E, Assif D. Effect of core stiffn-
J prosthodont1998;11:558-64. ess on the in vitro fracture of crowned, endodontically trea-
16. Saupe WA, Gluskin AH, Radke RA Jr. A comparative study ted teeth. J Prosthet Dent 2002;88:302-06.
of fracture resistance between morphologic dowel and cores

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may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express
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Copyright of Indian Journal of Stomatology is the property of Indian Journal of Stomatology and its content
may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express
written permission. However, users may print, download, or email articles for individual use.