Use of a bondable reinforcement fiber for post-and-core

buildup in an endodonticaily treated tooth: A case report

Gurcan Eskita§cioglu, DDS, PhDVSema Belli, DDS,

Ttie restoration for an enidodontically treated tooth shculd be conservative and should not increase hori-
zcntal and vertical forces. A recently developed bondable reinforcement fiber is reported to be an alterna-
tive to conventional post materials because of its esthetic qualities, mechanical properties, and the neutral
color o! the reinforcing material. This article describes the treatment of one patient, in whom a bondable
polyethylene ribbon was used as a post-and-core buiid-up material. (Quintessence Int 2002:33:549-551)

Key words: endodontic therapy, fiber-reinforced resin composite, post-and-core build-up material,
restoration

ost and cores are often required for endodonticaUy

P treated teeth to provide resistance and retention.
Previous studies have confitTned that a post placed
in an endodontically treated tooth does not
strengthen the tooth but is used to retain a core or
foundation for the final restoration.'^ Most dowel
cores require removal of sound tooth structure to
gain a path of insertion and remove undercuts, fur-
ther weakening the tooth. Some authors have
claimed that the removal of tooth structure for post
preparation compromises the strength of the tooth
and makes it susceptible to fracture.'^ Therefore,
minimal removal of tooth structure is suggested.'*
With the advent of adhesive restorative materials and
a reinforced, endodontically hondahle ribbon (Ribhond,
Ribbond). it is possible to rebuild a post-and-core sys-
tem conservatively. This esthetic andflexihlefiber-resin
composite laminate post is reported to minitnize micro-
craek propagafion in the root." This article reports the
treanrtertt of a patient in whom a fiber-resin eomposite
laminate post and core was used as a conservative alter-
native to provide a post-and-core build-up restoration.
CASE REPORT
A 36-year-old woman was dissatisfied with an old
fixed partial denmre, supported by the maxillary right
canine and first premolar, that had a cantilever repiac-
'Associste Professor, Department of Prosthetic Dentistiy, Faculty of
Oerttistry, University of Selçuk, Konya, Turtiey.
'Associate Professor. Department of Operative Dentistry, Faculty of
Dentistry, University of Selçuk, Konya, Turkey.
Reprtnt Requests: Dr Sema Belli. Selçuk University, Facutty of Dentistry,
43079, Campus. Konya. Turkiye. E-mail; sbelli ©selcuk.edu.tr
ing the second premolar (Fig 1). The cantilever pros-
thesis was removed, and extensive loss of tooth struc-
ture, resulting from secondary' caries, was ohsen-ed on
the canine. Radiographs revealed the presence of peri-
apical infiammation with limited radiolucency.
The treatment plan included the removal of the ex-
isting restoration, ertdodontic treatment of the canine,
placement of afiher-reinforcedresin post and core for
retention and reinforcement, and final restorafion with
a new porcelaln-fuscd-to-metal fixed partial denture
without a distal cantilever to avoid future similar prob-
lems inflicted by cantile\'er tmits. At the same time, an
e.xisting crowTt on the adjacent lateral incisor was to be
replaced with a single porceiain-fused-to-metal crowTi,
First, the maxillary right canine was treated en-
dodontically. Three weeks after endodontic treatment,
the pulp chamber and the coronal part of the root
canal were cleaned. A rubber dam was placed with a
clamp to isolate the area (Fig 2).
The reinforcement fiber was selected by width (2
mm width was used). A periodontal probe was in-
serted in the canal space to measure the post space.
This measurement was tripled, and the length of fiber
was measured. Two pieces of fiber were then cut with
special scissors.
The fiber pieces were then coated with a dual-cur-
ing resin (Liner Bond II V, Kuraray) and set aside
under a light-protective container. The internal sur-
faces of the root canal and pulp chamber were treated
with the primer of the same system for 30 seconds
(Liner Bond II V, primer A and B mixture. Kuraray)
and dried with a gentle air stream for 15 seconds.
A dual-curing dentin bonding agent (Liner Bond
II V, bond A and B mixture, Kuraray) was applied to
the Internal surfaces of the canal and pulp chamber
and thinned \vith a brush, A highly filled, dual-curing

Ouintesseo^J 549
• Eskita|ciogiu/Bell

Fig 1 A cantilevered fixet) partial denture is present Fig 2 A rubber dam is placed with a clamp to iso-
on the maxillary right canine and firsi premolar. iaie the area.

Fig 3 TwQ pieces oi liber are condensed into the Fig 4 The tree ends ol the tibers are iwisied and
canal space. ccndensed into ihe canal

Fig 5 Final preparalion of the lib er-re in to reed resin

composite cere is completed.

Fig 6 (right) The fiber post-and-core buiidup is con-

firmed with a final radiograph.

550
 Rg 7 The final restoration tías improveO esthetics.
hybrid resin (Variolink II, Vivadent) was injected
itito the canal space.
One piece of reinforcement fiber, which had been
coated with bonding agent, was wrapped and con-
densed as lightly as possible into the canal space «ith
an endodontic pltigger. A second piece was then con-
densed into the canal space perpendicular to the first
piece (Fig 3). The excess resin was removed, and the
iree ends of the fiber were twisted and condensed into
the canal (Fig 4). The entire fiber-resin post was cured
for 20 seconds.
A dentin-shaded hybrid resin was selected as a core
materia! (Clearfil AP-X, Kuraray) and condensed
around the fiber protruding from the canal. The core
material was citred for at least 2 minutes with a resin
composite-curing unit. Final shaping of the core and
preparafion margins was accomplished with diamonds
and fiuted carbide burs (Fig 5), Tbe fiber post-and-core
buildup was checked on a final radiograph (Fig 6).
A provisional fixed partial denture, extending from
the right second premolar to the canine, and a single
provisional crown for the right lateral incisor were
then delivered. The final restorations included a
porcelain-fused-to-metal three-unit fixed partial den-
ttire and a single crowTi, which were fabricated in tbe
usual manner. The restorations were cemented with
polycarboxylate cement (Fig 7).
At the clinical follow-up examination. 6 months
later, the patient was doing well and the restorations
exhibited no problems (Fig 8).
CONCLUSION
This case report describes a conservative and esthetic
post-and-core build-up technique that incorporates a
bondable ribbon (Ribbond). The final result is a con-
servative, morphologic, versatile post-and-core
restoration that requires little time to complete. The
Quintess
Fig 6 A radiograph is used to confirm the success
of the final restoration at the clinical follow-up exanû-
nation, 6 months posttreatment.
procedure permitted the preparation and impression
of the core in the same appointment In this case, a
porcelain-fused-to-metal fixed prosthesis was neces-
sary', for which the esthetic properties of this material
were not critical. It would, however, be effective es-
thetically for all-ceramic restorations.
This easily handled material and bondable rein-
forcement fiber post-and-core build-up technique must
be evaluated in long-term clinical studies.
ACKNOWLEDGMENTS
The authors would like lo thank Dr Serhan Akman and Dr Tolga
YUcel for their special help tlurino clinicat procedures. The authors
would also like to acknowledge Dr David Rudo (Ribbond) for his in-
sight and for suppty ing material to Selçuk Universitj.
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