|Year : 2014 | Volume
| Issue : 2 | Page : 66-69
Intraradicular splinting of a mid-root fracture with a fiber post
Viraj S Yalgi1, Madhu Pujar2, Hemant T Vagarali3, Suprit Pawar4
1 Senior Lecturer, Department of Conservative Dentistry and Endodontics, Maratha Mandal's Nathajirao G. Halgekar Institute of Dental Sciences and Research Centre, Bauxite Road, Belgaum, Karnataka, India
2 Head of the Department, Department of Conservative Dentistry and Endodontics, Maratha Mandal's Nathajirao G. Halgekar Institute of Dental Sciences and Research Centre, Bauxite Road, Belgaum, Karnataka, India
3 Reader, Department of Conservative Dentistry and Endodontics, Maratha Mandal's Nathajirao G. Halgekar Institute of Dental Sciences and Research Centre, Bauxite Road, Belgaum, Karnataka, India
4 Post Graduate Student, Department of Conservative Dentistry and Endodontics, Maratha Mandal's Nathajirao G. Halgekar Institute of Dental Sciences and Research Centre, Bauxite Road, Belgaum, Karnataka, India
|Date of Web Publication||2-Jun-2014|
Department of Conservative Dentistry and Endodontics, Maratha Mandal Nathajirao G Halgekar Institute of Dental Sciences & Research Centre, R.S. No. 47 A/2, Bauxite road, Belgaum - 590 010
Source of Support: None, Conflict of Interest: None
Introduction: Trauma causes fractures of anterior teeth commonly, where extraction is not considered as a part of treatment plan. This case report presents the endodontic management of a horizontally fractured right central incisor involving healing with granulation tissue, using an intraradicular splinting technique. Case Report: A patient complained of pain and mobility of the upper right front teeth since 1 day. The root canal therapy of the upper central incisor was done. The intraradicular stabilization involved placing a fiber post in the canal and luting with resin cement. Discussion: This case demonstrates that intraradicular splinting can be used to manage horizontally fractured teeth with necrotic and mobile coronal segment. The recent improvements in the dental materials resin-based restorative materials with tooth-colored fiber post are of choice because of several advantages such as esthetics, bonding to tooth structure, and low modulus elasticity similar to that of dentin.
Keywords: Fiber post, intraradicular splinting, mid-root fracture, resin cement
|How to cite this article:|
Yalgi VS, Pujar M, Vagarali HT, Pawar S. Intraradicular splinting of a mid-root fracture with a fiber post. Dent Hypotheses 2014;5:66-9
| Introduction|| |
In the permanent dentition, fractures comprise 26-76% of dental injuries.  The most affected teeth are maxillary incisors due to their anterior position and protrusion caused by the erupting process.  The incidence of horizontal root fractures ranges from 0.5 to 7% in permanent teeth and from 2 to 4% in primary teeth for all traumatic dental injuries. Horizontal root fractures are common in maxillary central incisors and in the middle root segment compared with apical and coronal segments. A single fracture occurs in most cases and multiple root fracture is a rare finding. Clinically, the more coronal root fractures are usually more mobile. The healing of these fractures can be complicated because the wound in root fractures involves damage to all dental tissues, including the pulp, dentin, periodontal ligament, and cementum and is sometimes associated with damage to the supporting alveolar bone. Pathological complications following horizontally fractured teeth include pulp necrosis, root canal obliteration, external and internal surface resorption, inflammation around the fracture, and periapical inflammation.  The treatment principles for fractured teeth were established as repositioning the coronal segment if needed, stabilization with a rigid splint for 2-3 months, reduction, and recall for at least 1 year. Recently, Andreasen et al.,  stated that the splinting for more than 4 weeks does not influence the healing pattern with the exception of cervical fractures, which require a longer splinting period of 2-3 months because of the mobility of coronal segment. The injury factors such as the increased diastasis between fragments, dislocation of the coronal part, and mobility of the coronal fragment following the trauma may adversely affect the survival of pulp tissue and eventual healing of the fractured tooth. In 1958, Lindahl observed that root fractures could heal even after endodontic treatment of the tooth.  Reattachment of tooth fragments should be the first choice and is a viable alternative to conventional approach with minimal or without violation of biological width because of simplicity, natural esthetics, and conservation of tooth structure.
Reattachment of tooth fractured at cervical level can be reinforced with the use of post as it interlocks the two fragments and minimizes the stresses on the reattached tooth fragment. With the recent improvements in the dental materials resin-based restorative materials with tooth-colored fiber post are of choice because of several advantages such as esthetics, bonding to tooth structure, and low modulus elasticity similar to that of dentin. 
| Case Report|| |
A male patient aged 22 years reported to the clinic with chief complaint of pain and mobility of the upper right front teeth since 1 day. History revealed trauma as the patient accidentally slipped and fell on the floor that resulted in pain. The pain aggravated on consuming food and also on consumption of hot or cold water. Soft tissue examination revealed mild inflammation of gingival with respect to maxillary right central incisor. Hard tissue examination revealed maxillary right central incisor fractured in labio-palatal direction without displacement of fragment. Fracture fragment was mobile though the fragment was held in position by soft tissue, which suggested that fracture line was subgingival. The tooth was tender on percussion. Intraoral periapical radiograph of maxillary right central incisor revealed a radioluscent oblique line near the mid-root region of the right central incisor [Figure 1]. The patient was in army and wanted to get the treatment immediately due to lack of time. So root canal treatment was planned along with intraradicular stabilization with fiber post.
Local anesthesia (Xicaine® ICPA Health Products Ltd, Ankleshwar, India) was administered and single visit root canal treatment was done as the tooth was vital [Figure 2]. The patient was then recalled on the third day and procedure for post-placement was started. Gutta percha filling was removed with peeso reamer upto two-third of the canal by retaining approximately 5-6 mm of gutta-percha apically. Post-space preparation was done and a radiograph was taken for confirmation. Then a fiber post (Glassix Nordin, Chailly-Montreux, Switzerland) was tried in the tooth and another radiograph was taken, thus confirming the post length [Figure 3]. The canal was then dried and a self-etching adhesive (Xeno 1V Dentsply) was applied to the root dentin for 15 s with applicator tips, and a thin coat was also applied to the fiber post. Self-cure resin cement [Rely X ARC (3M ESPE, St. Paul, MN, USA)] was mixed on a paper pad and was applied to the canal and post. The post was cemented into the canal by positioning the coronal mobile fragment with slight pressure [Figure 4]. Excess cement was removed and the fragment was held in position and the cement was cured for 40 s. A radiograph was taken [Figure 4]. The excessive length of the fiber post was cut and the access cavity was restored with composite resin. The patient was recalled after 6 months for evaluation. Periodontal status and reattachment were found to be satisfactory [Figure 5].
|Figure 4: (a) Post cementation. (b) Post cementation intra oral periapical radiograph|
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|Figure 5: (a) The 6-months follow up IOPA. (b) The 6-months follow-up picture|
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| Discussion|| |
Preservation of the natural dentition and restoration of the oral cavity to a normal functional state is a primary goal in dentistry.  In the present case report, the maxillary right central incisor was fractured due to trauma with the fracture line present in the middle-third region of the root. The fracture fragment was intact and held in position without the displacement though the fragment was mobile. Factors influencing the treatment modalities include the following:
- Site of fracture.
- Size of fragment remnant.
- Periodontal status.
- Pulpal involvement.
- Maturity of root formation.
- Biological width invasion.
Depending on these factors various treatment options are as follows:
- Reattachment of fractured fragment
- Composite restoration
- Orthodontic extrusion
- Surgical extrusion
- Crown lengthening 
A progressive improvement in the field of adhesive dentistry allows clinician to reattach a broken tooth structure mechanically, chemically, and esthetically.  In the present case, a fiber composite post was used along with a resin cement as an intraradicular splint to reattach the coronal fragment. Several advantages of fiber post for reattachment are conservation of tooth structure, simple procedure, esthetics, bonding to the tooth structure, cost effective, functional rehabilitation.  Luting agents including zinc phosphate, zinc polycarboxylate, glass ionomer, and filled and unfilled resin cements have been investigated extensively. The literature does not suggest that one luting agent is superior to another. Both zinc phosphate and glass ionomer are frequently used because of their ease of manipulation along with the history of success in luting procedures.  However, the use of various types of fiber-reinforced post and resin cements is becoming popular.  Although some clinical studies have shown a significant increase for post retention with resin cements, others have not confirmed these findings.  Adhesive resin cements have been advocated for cementation of post because they bond the post to the tooth structure. These agents achieve chemical adhesion as well as micromechanical bonding. The reduction of microleakage between the tooth and the restoration was a major advantage over nonbonding agent. Although the research has demonstrated that resin cement provides greater retention than non-resin cement, it should be chosen only in condition where excess retention is required.  Early retrospective studies indicate that clinical performance of fiber post is promising and failure rate recorded is 3.2% over a period of upto 4 years. 
| Conclusion|| |
The retention of a post is a major factor in the survival of restoration. Reattachment of original tooth fragment with improved adhesive protocol and reinforcement technique is a simple conservative approach to provide immediate natural esthetics and functional rehabilitation. Most of the clinical studies revealed promising results with low fracture rates though long-term trials are scarce. Longevity and degradation of bonding to root canal dentin as well as clinical long-term performance of a flexible and less rigid post material have still to be investigated.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]