Restoring an Extremely Destructed Tooth with Flared Root Canal Walls: A Case Report
Abstract
Restoring severely damaged teeth has always been challenging when the remaining crown structure is limited, and retention might be necessary from the root canal using intracanal posts. However, the real challenge is when the root canal walls are also weak, and there is a high risk of vertical root fracture due to the wedging forces of a rigid post. This case report presents a tooth with flared root canal walls successfully restored with a newly introduced polymer made of polyether ether ketone (PEEK) (BioHPPfor2press,Bredent,UK) with one-year follow-up. Regarding its close elastic modulus to dentin, the ability to bond to tooth structure, shock-absorbing ability, and therefore favorable stress distribution, using this material for an intracanal post may minimize the risk of fractures commonly observed with cast metal posts. It combines good fitness of cast posts with low modulus of elasticity and optical properties of prefabricated fiber posts.
1. Öztürk C, Polat S, Tunçdemir M, Gönüldaş F, Şeker E. Evaluation of the fracture resistance of root filled thin walled teeth restored with different post systems. Biomed J. 2019 Feb;42(1):53-58.
2. Braz R, Mergulhão VA, Oliveira LR, Alves MS, Canto CA. Flared Roots Reinforced With Bulk-fill Flowable Composite - Case Report. Oper Dent. 2018 May/Jun;43(3):225-231.
3. Lloyd PM, Palik JF. The philosophies of dowel diameter preparation: a literature review. J Prosthet Dent. 1993 Jan;69(1):32-6. doi: 10.1016/0022-3913(93)90236-h.
4. S Soundar SI, Suneetha TJ, Angelo MC, Kovoor LC. Analysis of fracture resistance of endodontically treated teeth restored with different post and core system of variable diameters: an in vitro study. J Indian Prosthodont Soc. 2014 Jun;14(2):144-50.
5. Lee KS, Shin JH, Kim JE, Kim JH, Lee WC, Shin SW, et al. Biomechanical Evaluation of a Tooth Restored with High Performance Polymer PEKK Post-Core System: A 3D Finite Element Analysis. Biomed Res Int. 2017;2017:1373127.
6. Yousry MA, Hussein SA, Al Abbassy FH. Evaluation of shear bond strength of high-performance polymers to its resin veneering and to dentin (In vitro study). Alex Dent J. 2018 Aug 1;43(2):62-8.
7. Saad A, Inoue G, Nikaido T, Abdou AMA, Sayed M, Burrow MF, et al. Effect of dentin contamination with two hemostatic agents on bond strength of resin-modified glass ionomer cement with different conditioning. Dent Mater J. 2019 Mar 31;38(2):257-263.
8. Poggio C, Beltrami R, Scribante A, Colombo M, Lombardini M. Effects of dentin surface treatments on shear bond strength of glass-ionomer cements. Ann Stomatol (Roma). 2014 Mar 31;5(1):15-22.
9. Zoidis P. The Use of Modified Polyetheretherketone Post and Core for an Esthetic Lithium Disilicate Anterior Ceramic Restoration: A Clinical Report. Int J Prosthodont. 2021 Jan-Feb;34(1):120-125.
10. Sary S B, Samah M S, Walid A AZ. Effect of restoration technique on resistance to fracture of endodontically treated anterior teeth with flared root canals. J Biomed Res. 2019 Apr 22;33(2):131-138.
11. Boksman L, Hepburn AB, Kogan E, Friedman M, de Rijk W. Fiber post techniques for anatomical root variations. Dent Today. 2011 May;30(5):104, 106-11.
12. Bonfante G, Kaizer OB, Pegoraro LF, do Valle AL. Fracture strength of teeth with flared root canals restored with glass fibre posts. Int Dent J. 2007 Jun;57(3):153-60.
13. AbdElmohsen NA, Zohdy MM, Abdelsattar GA, Wahsh MM. Fracture resistance of different post-core systems restoring mandibular premolars. Mansoura J Dent. 2021; 8(4): 6-11.
14. Grandini S, Goracci C, Monticelli F, Borracchini A, Ferrari M. SEM evaluation of the cement layer thickness after luting two different posts. J Adhes Dent. 2005 Autumn;7(3):235-40.
15. Gomes GM, Gomes OM, Gomes JC, Loguercio AD, Calixto AL, Reis A. Evaluation of different restorative techniques for filling flared root canals: fracture resistance and bond strength after mechanical fatigue. J Adhes Dent. 2014 Jun;16(3):267-76.
16. Reda R, Zanza A, Galli M, De Biase A, Testarelli L, Di Nardo D. Applications and clinical behavior of biohpp in prosthetic dentistry: A short review. J Compos Sci. 2022 Mar 14;6(3):90.
17. Jin HY, Teng MH, Wang ZJ, Li X, Liang JY, Wang WX, et al. Comparative evaluation of BioHPP and titanium as a framework veneered with composite resin for implant-supported fixed dental prostheses. J Prosthet Dent. 2019 Oct;122(4):383-388.
18. El-Hosary AM, Al-Zordk W, Abdelkader A, Ghazy M. Influence of material type and preparation depth on the fracture resistance of endocrown restoration. Egyptian Dent J. 2022 Jan 1;68(1):597-605.
19. Leon S, Salah I, Halim C. Fracture resistance of endodontically treated premolars restored with lithium disilicate crowns retained with fiber posts compared to lithium disilicate and PEEK endocrowns (An in vitro study). Egyptian Dent J. 2022 Oct 1;68(4):3587-607.
20. Lalama M, Rocha MG, O’Neill E, Zoidis P. Polyetheretherketone (PEEK) Post and Core Restorations: A 3D Accuracy Analysis between Heat-Pressed and CAD-CAM Fabrication Methods. J Prosthodont. 2022 Jul;31(6):537-542. doi: 10.1111/jopr.13452. Epub 2021 Dec 3.
21. Naddar S, Hamdy I, Taymour M. Evaluation of The Internal Fit of Pressable Versus CAD/CAM Peek Post and Core Using Scanning Electron Microscope: An in Vitro Study. Egyptian Dent J. 2022 Oct 1;68(4):3671-82.
22. Stawarczyk B, Eichberger M, Uhrenbacher J, Wimmer T, Edelhoff D, Schmidlin PR. Three-unit reinforced polyetheretherketone composite FDPs: influence of fabrication method on load-bearing capacity and failure types. Dent Mater J. 2015;34(1):7-12.
23. Andrikopoulou E, Zoidis P, Artopoulou II, Doukoudakis A. Modified PEEK Resin Bonded Fixed Dental Prosthesis for a Young Cleft Lip and Palate Patient. J Esthet Restor Dent. 2016 Jul;28(4):201-7.
24. Song CH, Choi JW, Jeon YC, Jeong CM, Lee SH, Kang ES, et al. Comparison of the Microtensile Bond Strength of a Polyetherketoneketone (PEKK) Tooth Post Cemented with Various Surface Treatments and Various Resin Cements. Materials (Basel). 2018 May 29;11(6):916.
2. Braz R, Mergulhão VA, Oliveira LR, Alves MS, Canto CA. Flared Roots Reinforced With Bulk-fill Flowable Composite - Case Report. Oper Dent. 2018 May/Jun;43(3):225-231.
3. Lloyd PM, Palik JF. The philosophies of dowel diameter preparation: a literature review. J Prosthet Dent. 1993 Jan;69(1):32-6. doi: 10.1016/0022-3913(93)90236-h.
4. S Soundar SI, Suneetha TJ, Angelo MC, Kovoor LC. Analysis of fracture resistance of endodontically treated teeth restored with different post and core system of variable diameters: an in vitro study. J Indian Prosthodont Soc. 2014 Jun;14(2):144-50.
5. Lee KS, Shin JH, Kim JE, Kim JH, Lee WC, Shin SW, et al. Biomechanical Evaluation of a Tooth Restored with High Performance Polymer PEKK Post-Core System: A 3D Finite Element Analysis. Biomed Res Int. 2017;2017:1373127.
6. Yousry MA, Hussein SA, Al Abbassy FH. Evaluation of shear bond strength of high-performance polymers to its resin veneering and to dentin (In vitro study). Alex Dent J. 2018 Aug 1;43(2):62-8.
7. Saad A, Inoue G, Nikaido T, Abdou AMA, Sayed M, Burrow MF, et al. Effect of dentin contamination with two hemostatic agents on bond strength of resin-modified glass ionomer cement with different conditioning. Dent Mater J. 2019 Mar 31;38(2):257-263.
8. Poggio C, Beltrami R, Scribante A, Colombo M, Lombardini M. Effects of dentin surface treatments on shear bond strength of glass-ionomer cements. Ann Stomatol (Roma). 2014 Mar 31;5(1):15-22.
9. Zoidis P. The Use of Modified Polyetheretherketone Post and Core for an Esthetic Lithium Disilicate Anterior Ceramic Restoration: A Clinical Report. Int J Prosthodont. 2021 Jan-Feb;34(1):120-125.
10. Sary S B, Samah M S, Walid A AZ. Effect of restoration technique on resistance to fracture of endodontically treated anterior teeth with flared root canals. J Biomed Res. 2019 Apr 22;33(2):131-138.
11. Boksman L, Hepburn AB, Kogan E, Friedman M, de Rijk W. Fiber post techniques for anatomical root variations. Dent Today. 2011 May;30(5):104, 106-11.
12. Bonfante G, Kaizer OB, Pegoraro LF, do Valle AL. Fracture strength of teeth with flared root canals restored with glass fibre posts. Int Dent J. 2007 Jun;57(3):153-60.
13. AbdElmohsen NA, Zohdy MM, Abdelsattar GA, Wahsh MM. Fracture resistance of different post-core systems restoring mandibular premolars. Mansoura J Dent. 2021; 8(4): 6-11.
14. Grandini S, Goracci C, Monticelli F, Borracchini A, Ferrari M. SEM evaluation of the cement layer thickness after luting two different posts. J Adhes Dent. 2005 Autumn;7(3):235-40.
15. Gomes GM, Gomes OM, Gomes JC, Loguercio AD, Calixto AL, Reis A. Evaluation of different restorative techniques for filling flared root canals: fracture resistance and bond strength after mechanical fatigue. J Adhes Dent. 2014 Jun;16(3):267-76.
16. Reda R, Zanza A, Galli M, De Biase A, Testarelli L, Di Nardo D. Applications and clinical behavior of biohpp in prosthetic dentistry: A short review. J Compos Sci. 2022 Mar 14;6(3):90.
17. Jin HY, Teng MH, Wang ZJ, Li X, Liang JY, Wang WX, et al. Comparative evaluation of BioHPP and titanium as a framework veneered with composite resin for implant-supported fixed dental prostheses. J Prosthet Dent. 2019 Oct;122(4):383-388.
18. El-Hosary AM, Al-Zordk W, Abdelkader A, Ghazy M. Influence of material type and preparation depth on the fracture resistance of endocrown restoration. Egyptian Dent J. 2022 Jan 1;68(1):597-605.
19. Leon S, Salah I, Halim C. Fracture resistance of endodontically treated premolars restored with lithium disilicate crowns retained with fiber posts compared to lithium disilicate and PEEK endocrowns (An in vitro study). Egyptian Dent J. 2022 Oct 1;68(4):3587-607.
20. Lalama M, Rocha MG, O’Neill E, Zoidis P. Polyetheretherketone (PEEK) Post and Core Restorations: A 3D Accuracy Analysis between Heat-Pressed and CAD-CAM Fabrication Methods. J Prosthodont. 2022 Jul;31(6):537-542. doi: 10.1111/jopr.13452. Epub 2021 Dec 3.
21. Naddar S, Hamdy I, Taymour M. Evaluation of The Internal Fit of Pressable Versus CAD/CAM Peek Post and Core Using Scanning Electron Microscope: An in Vitro Study. Egyptian Dent J. 2022 Oct 1;68(4):3671-82.
22. Stawarczyk B, Eichberger M, Uhrenbacher J, Wimmer T, Edelhoff D, Schmidlin PR. Three-unit reinforced polyetheretherketone composite FDPs: influence of fabrication method on load-bearing capacity and failure types. Dent Mater J. 2015;34(1):7-12.
23. Andrikopoulou E, Zoidis P, Artopoulou II, Doukoudakis A. Modified PEEK Resin Bonded Fixed Dental Prosthesis for a Young Cleft Lip and Palate Patient. J Esthet Restor Dent. 2016 Jul;28(4):201-7.
24. Song CH, Choi JW, Jeon YC, Jeong CM, Lee SH, Kang ES, et al. Comparison of the Microtensile Bond Strength of a Polyetherketoneketone (PEKK) Tooth Post Cemented with Various Surface Treatments and Various Resin Cements. Materials (Basel). 2018 May 29;11(6):916.
| Issue | Vol 21 (Continuously Published Article-Based) | |
| Section | Case Report | |
| DOI | https://doi.org/10.18502/fid.v21i3.14760 | |
| Keywords | ||
| Post and Core Technique Conservative Treatment Tooth Nonvita Polyetheretherketone | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Kermanshah H, Estedlal T. Restoring an Extremely Destructed Tooth with Flared Root Canal Walls: A Case Report. Front Dent. 2024;21.
