Mutilated Teeth Research Articles

Super natural power of MTA!! Successful management of badly mutilated young molars, report of two cases with 3 years follow up

Apexification in one visit with Mineral Trioxide Aggregate (MTA) is beneficial in effectively sealing the open apices of young mutilated teeth. Although, placement of MTA through canals is difficult and many a times leads to over extrusion due to wide apex. This case report presents the outcome of extruded MTA during apexification in mandibular young permanent molars in children. On long term follow-up, complete healing of the periapical radiolucency was evident around MTA without any symptoms. MTA apexification in incisors have been found in literature, but very few cases are reported with long term follow up regards to young molars.

Comparison of Fracture Resistance between Different Treatment Modalities of Mutilated Endodontically Treated Teeth Using Polyether Ether Ketone.

To compare fracture resistance of multiple treatment modalities intended for mutilated teeth using polyether ether ketone (PEEK) and zirconia materials. The study was divided into four groups according to treatment modality adopted (n = 14): fiber post (F), Nayyar core (N), endocrown (E), and Richmond crown (R). Each group was further subdivided into two groups (n = 7) according to the type of material used: zirconia (Z) and PEEK (P). Using computer-aided design/computer-aided manufacturing, restorations were constructed from both materials following tested treatment options and manufacturer direction. Finished restorations were then tried, seated, and cemented to their corresponding acrylic teeth. All specimens were tested for fracture resistance in universal testing machine with cross head speed of 0.5 mm/min speed until failure, which was confirmed by a sudden drop in the measurements of the testing machine. Results were recorded, tabulated, and statistically analyzed. Shapiro-Wilk normality tests were considered to evaluate the normality of the data distributions. One-way analysis of variance (ANOVA) followed by Tukey's post hoc analysis was conducted to analyze the fracture resistance significant differences. Descriptive statistics of the restoration material revealed statistically a higher mean value for PEEK material (3609 ± 188.1) than zirconia (2404 ± 425.6). One-way ANOVA revealed statistically significant differences between zirconia group (p < 0.0001). Regarding zirconia group statistical significance was detected between fiber post vs endocrown (p = 0.0299), fiber post vs Richmond crown (p < 0.0001), and Nayyar core vs Richmond crown (p = 0.0004). However, there was no statistically significant difference between PEEK group (P = 0.1614). Polyether ether ketone could present a reliable treatment option in endodontically treated teeth. Using one-piece Richmond crowns constructed of PEEK could present a viable treatment option against conventional treatment options of root canal treatment (RCT) single-rooted teeth.

Rehabilitation with Tooth-supported Overdenture Incorporating Matrix Attachment System in a Teenager and a Hexagenerian: A Clinical Technique

The aim of this study is to evaluate the improvement in masticatory efficiency and retention of tooth-supported overdenture using customized copings over abutment teeth with a silicone-based matrix attachment system present an alternative to prefabricated precision attachments. Saving mutilated teeth and using them for overdenture has been a good alternative to the conventional dentures. Using customized attachments improved the retention of the prosthesis. The new material which has been widely used for implant-supported overdentures has been used with tooth-supported overdentures for improved function and comfort. A 14-year-old patient reported with difficulty in eating due to decayed teeth. Customized copings were fabricated on endodontically treated teeth 13, 23, 33, and 43 and overlay prosthesis was conventionally fabricated. The intaglio surfaces corresponding to the abutments were lined with Multisil primer and retention. Sil 600 and the patient were asked to bite to aid the removal of excess material. A 65-year-old patient complained of missing teeth and inability to chew. A thimble-shaped coping was fabricated on endodontically treated teeth 33, 34, and 43. Subsequent procedures were similar to the aforementioned case. The use of polyvinyl siloxane-based resilient liners has proven to be able to provide clinically satisfactory retention in patients with compromised manual dexterity. Significant results, in retention with the use of two different coping designs and single-matrix system, masticatory efficiency, and esthetics have been observed and economical alternative to the use of expensive attachments.

Biomechanical Performance of Mandibular Molars with Deep Mesio-Occlusal-Distal Cavities Rehabilitated with Horizontal Posts: A 3D Finite Element Analysis.

To compare and contrast by three-dimensional finite element analysis the biomechanical performance of deep mesio-occlusal-distal cavities of mandibular molars reinforced by different sizes of horizontal fiber posts. The finite element (FE) stress analysis was performed with the ANSYS, a commercial finite element method package. Based on the evidence-based scientific data and on the mechanical properties of materials, i.e., Young's modulus and Poisson ratio, the model of a mandible and mandibular first molar was replicated. The mandibular molar models replicating the clinical scenarios were simulated, designed, and built, assuming all materials to be homogenous, isotropic, and linearly elastic as follows: Model 1 control: the model of an intact first mandibular molar. Model 2: the prepared cavity mesio-occlusal-distal is replicated by the subtraction Boolean method. The remaining thickness of dentin is 1 mm. Model 3: these were rehabilitated by three different diameters of two horizontal fiber posts. Model 3A: fiber post diameter 1 mm, Model 3B: 1.5 mm and Model 3C: 2 mm. The dimensions of the cavity, the intercuspal distance between buccal walls and lingual walls, and the distance of placement of the post from occlusal reference points were all kept constant for all three subgroups of Model 3. The cavities of Model 3 were restored with Filtek bulk-fill posterior composite. After meshing the models, loads were defined on the buccal and lingual distal cusps with a constant value of 600 N and at an angle of 45°. The results of finite element analysis are expressed as stresses, i.e., tensile compressive, shear, or a combination known as von Mises stresses. The overall von Mises stresses were as follows: Model 1:154.83 Mpa; Model 2: 376.877 Mpa; Model 3A: 160.221 Mpa; Model 3B: 159.488 Mpa; Model 3C: 147.231 Mpa. Statistical analysis of the compiled data was carried out. It was seen that there was a significant difference in stress values from the intact tooth Model 1 and cavity Model 2 (p < 0.05) with means values of 53.1 and 139.22, respectively. The means of all subgroups were comparable but there was a statistically significant difference between Model 3, i.e., 3A (67.74), Model 3B (60.47), Model 3C (53.70), and Model 2. Model 1 and Model 3C had comparable mean values. Rehabilitation of deep mesio-occlusal-distal cavities of molars with intact buccal and lingual walls with the aid of a horizontal post of any diameter has a similar stress distribution to an intact tooth. However, the biomechanical performance of a 2 mm horizontal post was exacting of the natural tooth. Horizontal posts can be included in expanding our restorative option for rehabilitating grossly mutilated teeth.

Comparative evaluation of the fracture resistance of three different recent composite systems in large class II MOD cavities

Background: For severely mutilated teeth, this research evaluated the most contemporary restorative material. Aim: Repair of Class II MOD cavities in premolars with Ever X posterior in the recent past, Beautifil restorative, and the Universal TetricEevoCream composite systems will be evaluated and compared in this research. “Materials and Methods:” Sixty human maxillary premolars were chosen for the study. As a check, we utilised a group of fifteen healthy teeth (Group 1). The remaining 45 teeth were fitted with MOD cavities of standardised dimensions and randomly assigned to one of three groups (Groups 2, 3, and 4) (n = 15). They used Beautifil restoratives for teeth in Group 2, GC Ever X posterior for teeth in Group 3, Universal Tetric EvoCream for teeth in Group 4. Newtons were used to measure the strength of a material (N). Results: Group 4 exhibited the greatest mean fracture resistance of the four groups, followed by Groups 3, 1, and 2 and finally Group 4. Conclusion: It was found that the Universal Tetric EvoCream composite had the greatest fracture resistance among the test groups. There was a substantial statistical difference between all of the groups.&#x0D;

Full mouth rehabilitation of child with early childhood caries

Early childhood caries (ECC) is a serious public health issue that has a severe impact on the oral health of infants and children. Early loss of primary anterior teeth due to trauma or caries can cause masticatory inefficiency, reduced esthetics, mispronunciation of labiodental sounds, and development of parafunctional habits such as tongue-thrusting and psychological problems. The restoration of severely decayed primary teeth is often a difficult procedure that presents a special challenge to pediatric dentists. This case report documents full mouth rehabilitation of severely mutilated teeth in a patient with ECC.

Rehabilitation of Mutilated Teeth - A Systematic Review

Rehabilitation of Mutilated Teeth - A Systematic Review

A cost-effective method of restoring primary anterior teeth with loss of crown structure

Managing a child with severely mutilated anterior teeth is a task for pedodontists. Although various options are available today for esthetically rehabilitating anterior teeth, they are costly and technique sensitive. In the present case, we esthetically rehabilitated a 5-year-old child with severe early childhood caries with chairside fabricated indirect composite shell crowns. The technique described in this case report is simple, requires minimal compliance from the child, is less technique sensitive, and can be completed in an accepted chairside time.

Restorative management of grossly mutilated molar teeth using endocrown: A novel concept

The endocrown is a restorative option for endodontically treated teeth. It consists of a circular butt-joint margin and a central retention cavity inside the pulp chamber and lacks intraradicular anchorage. Endocrowns are formed from a monoblock containing the coronal portion integrated into the apical projection that fills the pulp chamber space and possibly the root canal ingresses. This article describes the rationale and clinical guidelines for the placement of endocrowns. In the cases presented, extensively damaged teeth were superseded with endocrowns composed of pressed ceramics (Empress 2, Ivoclar), following endodontic and periodontal therapy. The substructure of this technique is to utilize the surface available in the pulpal chamber to assume the stability and retention of the restoration through adhesive procedures. By eliminating the utilization of a post and filling core, the number of adhesive bond interfaces is reduced, thus making the restoration less susceptible to the adverse effects of degradation of the hybrid layer. In these clinical cases, the 24 months survival of the endocrown restoration may be considered prosperous.

Amelogenesis Imperfecta: Rehabilitation and Brainstorming on the Treatment Outcome after the First Year.

Amelogenesis imperfecta (AI) affects enamel on primary and permanent dentition. This hereditary disorder is characterized by loss of enamel, poor esthetics, and hypersensitivity. Functional and cosmetic rehabilitation is challenging with variety of treatment options. This report presents the treatment of an AI patient using conventional fixed dentures and discusses issues related to posttreatment complications and prosthetic treatment outcome after 1 year of follow-up. A 19-year-old male AI patient with impaired self-esteem presented with hypersensitive, discolored, and mutilated teeth. Clinical examination revealed compromised occlusion and anterior open-bite. After hygiene maintenance full-coverage porcelain-fused-to-metal fixed restorations were indicated and applied. At the end of the treatment acceptable functional and esthetic results could be achieved. However, nearly a year after treatment a gingival inflammation in the esthetic zone complicated the outcome. Insufficient oral hygiene was to be blamed. Tooth sensitivity present from early childhood in these patients may prevent oral hygiene from becoming a habit. The relaxation due to relieve of hypersensitivity after treatment makes oral hygiene learning difficult. Continuous oral hygiene maintenance motivation may be crucial for the success of the treatment of AI patients. Treatment of AI patients should be carefully planned and an acceptable risk-benefit balance should be established.

Biological Posts: Natural Alternatives in Restoring Smile

Traumatic injuries leading to severely mutilated anterior teeth are common in dentistry. These injuries may leave a severe impact when they affect ndodontically treated teeth as strength of such teeth is compromised. Proper functional and esthetic rehabilitation of such badly broken teeth is a challenge. Dealing with the patient’s mental suffering and their impatience to regain the natural smile back makes the treatment even more challenging. An effective treatment plan including a suitable and cost-effective choice of post is very much necessary in such conditions. Biological posts obtained through extracted teeth from another individual represent an economic option and alternative technique for the functional recovery of extensively damaged teeth. All-ceramic crowns further add to enhanced esthetics. This paper presents a case where biological posts with composite core build up followed by all-ceramic crown adaptation have been used with successful outcome

Restoring Smiles for the Young: Aesthetic and Functional Rehabilitation of 3 Year Old Children with Early Childhood Caries: Case Reports

Early childhood caries results in early pulp involvement and gross destruction of the anterior and posterior teeth. This leads to decreased masticatory efficiency, difficulty in speech, compromised esthetics, development of abnormal tongue habits and subsequent malocclusion and psychological problems. The restoration of severely decayed deciduous teeth especially anteriors presents a special challenge to dentists, particularly in uncooperative children. The following case reports document the restoration of severely mutilated deciduous teeth in two emotionally immature patients resulting in an improvement in not only their oral and general health but also helping them gain self-confidence.

Multidisciplinary Approach for Restoring Function and Esthetics in a Patient with Amelogenesis Imperfecta: A Clinical Report

Amelogenesis Imperfecta (AI) is a genetically determined and enamel mineralization defect reported, depicted as "Hereditary brown teeth." AI is characterized as a clinical entity and its clinical manifestations, histological appearance, and genetic pattern are characterized by their heterogeneity. The need for prosthodontic management of this group of patients varies. Some patients need oral hygiene instructions only, whereas others need extensive dental treatment that includes composite restorations, metal ceramic crowns, all ceramic crowns, porcelain veneers. A 20-year-old male patient presented with sensitive, discoloured, and mutilated teeth, with a decreased vertical dimension of occlusion. The 4-year recall examination revealed no pathology associated with the full mouth rehabilitation, and the patient's aesthetic and functional expectations were satisfied. The rehabilitation included all-ceramic crowns on anterior teeth and metal-ceramic crowns on posterior teeth following endodontic treatment and a crown-lengthening procedure for eliminating tooth sensitivity, improving the aesthetics and occlusion, and for restoring function.

The perio-esthetic-restorative approach for anterior rehabilitation

Ensuring clinical success begins with a careful discussion of treatment planning, comprehensively covering all variables in simple to complex cases. Procedures including the crown lengthening surgery, furcation treatment and mucogingival therapy and tooth restoration are essential treatment regimens requiring multifaceted expertise. The interplay of periodontics and restorative dentistry is present at many fronts including the response of the gingival tissue to the restorative preparations. Dental restorations and periodontal health are inseparably interrelated. The adaptation of the margins, the contours of the restoration, the proximal relationships and the surface smoothness have a critical biological impact on the gingiva and the supporting periodontal tissues. The different surgical procedures used for crown lengthening are gingivectomy/gingivoplasty, apically positioned flap with or without osseous resection and orthodontic extrusion. The paper presents crown lengthening of severely mutilated teeth to increase the clinical crown height for adequate restoration.

Biological restorations: Option of reincarnation for severely mutilated teeth

Abstract Objective: Esthetic and functional rehabilitation of severely mutilated fractured central incisors teeth using homogenous biological fragment bonding. Materials and Methods: Freshly extracted maxillary central incisors were treated endodontically and post spaces were prepared. Intra-radicular biological post core were fabricated from the sectioned roots of extracted canines. Cementation of biological post core in prepared space was done after clinical and radiological confirmation. Subsequent esthetic rehabilitation was done using adaptation of biological crown which was prepared from morphologically similar extracted maxillary central incisor. Results: The association between biological crowns and post core offers excellent esthetic, functional, and psychosocial results, which justifies the use of this technique to achieve the morphofunctional recovery of extensively damaged teeth. Conclusion: The biological restorations are an alternative technique for reconstruction of extensively damaged teeth that provides highly functional and esthetic outcomes.

English

Healthy oral cavity is primary requisite for beautiful looks. Aesthetic requirement of severely mutilated teeth has been a challenge to dentist. This paper presents endodontic treatment of grossly decayed tooth followed by the placement of a fibre-reinforced composite resin post. The crown reconstruction was done with full ceramic crown. Resin fibre post has best properties in elasticity, translucency, adaptability and resistance to traction.

Canal Projection - A Technique for the Management of Badly Mutilated Teeth: Case Reports

Isolating a severely broken down tooth is a considerable challenge. Due to insufficient tooth structure either the rubber dam placement becomes difficult or the dam leaks. Coronal bonded build-up can simplify the endodontic phase and strengthen the tooth, decreasing the possibility of further damage to the tooth due to the rubber dam clamp or mastication. The canal projection technique allows for isolation of the individual canals bringing them to the cavosurface margin. This offers adequate visualization and convenience for instrumentation as straight line access is achieved and also provides a strong core and coronal seal of the operative field. In these case reports management of badly broken down teeth was done by canal projection technique using plastic delivering tips and hypodermic needles as projectors. Composite core build up was done, which helped in rubber dam placement.

Clinical evaluation of the fiber post and direct composite resin restoration for fixed single crowns on endodontically treated teeth

BackgroundThe restoration of an endodontically treated fractured tooth has been a challenge for restorative dentists for decades. The performance of fiber posts when used in conjunction with direct composite resin restorations have been largely unreported. This study was conducted with the aim of evaluating the survival rate of endodontically treated teeth restored with adhesive bonded fiber reinforced resin posts and direct composite core with additional crown coverage. MethodsSixty patients who required endodontic treatment with post core crown were selected from outpatient department of Air Force Institute of Dental Sciences, Bangalore. Sixty-four teeth were endodontically treated and restored with fiber post and direct resin composite core restoration. Patients were evaluated immediately after restoration and reevaluated at the end of first, second and third months. After 3 months of clinical evaluation, if teeth were asymptomatic they were restored with complete coverage porcelain fused to metal restorations and evaluated immediately, and again reevaluated at the end of first, third, and sixth months. ResultsAfter 3 months of clinical evaluation, only two teeth exhibited periapical lesion with clinical symptoms and three teeth without any clinical symptoms. Five teeth exhibited slight marginal staining, three teeth showed partial loss of restoration, and two teeth exhibited complete loss of restoration with the fracture of the post. At the end of sixth month after restoration with full coverage crown, two teeth had dislodged restoration due to fracture of post and two teeth exhibited displacement of the post. ConclusionFiber posts are the best alternative for restoration of fractured endodontically treated teeth. Fiber posts and direct composite resin core materials are strongly recommended for restoration of endodontically treated mutilated teeth among the dental establishments of Armed Forces.

A paradigm shift: An aid in the isolation of multiple mutilated teeth.

Multiple mutilated teeth often pose a problem in endodontic isolation. This article introduces a simple and effective modification of one of the oldest techniques used for isolating multiple adjacent teeth requiring endodontic therapy where the teeth to be isolated were not amenable to traditional isolation procedures. The method used here is that of a custom fabrication of an acrylic retainer in conjunction with a conventional rubber dam. Photographs of a model and a clinical case are used to illustrate the method and clinical applicability.

Perio-gnathic correction of traumatic anterior deep bite with skeletal class II and retrogenia

Correction of class II deep bite can be achieved by orthodontic treatment alone or by combination of orthodontics and orthognathic surgery. Orthognathic surgery is indicated when dental discrepancy cannot be corrected by the use of orthodontic mechanotherapy alone or when facial aesthetics are compromised. The purpose of this paper is to describe a technique of subapical osteotomy performed along with periodontal therapy, to correct the anterior traumatic deep bite, thus salvaging the mutilated teeth and achieving facial aesthetics.