fibre posts 2012

7/23/2019 Fibre Posts 2012

http://slidepdf.com/reader/full/fibre-posts-2012 1/12

12-03-09

1

1

Dr. Chris Wyatt Dr. Jeff Coil

Director of Graduate Prosthodontics Director of Graduate Prosthodontics

Certified Specialist in Prosthodontics Certified Specialist in Prosthodontics

Restoration of Structurally

Compromised Teethan endodontic & prosthodontic

perspective

2

Dr. Chris Wyatt

Director of Graduate Prosthodontics

Certified Specialist in Prosthodontics

Fibre Post SystemsScience & Procedure

3

Cast Metal Post & Core Prefabricated

METAL

CERAMIC

FIBRE

Posts

4

PostsThe foremost purpose of the dowel is to

provide retention for the core and coronal

restoration. It should also do so without

increasing the risk of root fracture

Pathways of the Pulp

10th Edition, 2011

5

PostsThe amount of remaining dentin is far

more significant to the long-term

prognosis of the restored tooth than is

the selection of artificial dowel, core or

crown material.

Pathways of the Pulp

10th Edition, 2011

INDICATION FOR Post & Cores

!

IS A POST NECESSARY ?

!

No difference between vital and endodontically

treated teeth in sheer strength, vertical load

fracture, and micro hardness (Sedgley, 1992)

6

7/23/2019 Fibre Posts 2012


12-03-09

2

Restoring Endodontically

Treated Teeth

7

Posts do NOT reinforce structurally sound anterior

teeth (Guzy & Nichols, 1979; Trope et al. 1985) and increase their

chance of non-restorable fractures (Heydecke et al. 2001)

INDICATION FOR Post & Cores

!

INADEQUATE TOOTH STRUCTURE TO

RETAIN A CORE FOR A CROWN

8

9

When do we need a post ?

N N ? Y Y

MINIMAL CORONAL TOOTH STUCTURE10

Ideal Properties of Posts!

Maximum protection of the root !

Adequate retention within the root !

Maximum retention of the core and crown !

Maximum protection of the crown margincement seal

!

Aesthetic !

High radiographic visibility !

Retrievable !

Biocompatibility (Corrosion)

Pathways of the Pulp 10 th Edition, 2011

11

Ideal Properties of Posts!

2/3 of the total root length

! 1/3 the diameter of the root

!

4-5mm of gutta percha

! Well fitting

!

Coronal stop !

Antirotational

Shillingburg & Kessler, 1982

!

Ferule Effect of 1-2 mm

Sorenson & Martinoff, 1984

Ferule

Crown Ferule Effect

12

Crown = RCT= FRL2mm > FRL0.5 >noFRL

Tan et al. 2005

7/23/2019 Fibre Posts 2012


12-03-09

3

13

Post Length!

1:1 above:below the bone (Hunter et al. 1989) ! 1:1 crown:root ratio (Sorenson & Martinoff, 1984)

! ! root length (Goodacre & Spolnik, 1995)

! 8 mm minimal post length (Neagley, 1969)

14

Resistance

! The ability of the post and tooth towithstand lateral & rotational forces

- Anterior vs. Posterior Teeth

- Occlusal Forces

! Post Length

! Post & Core Rigidity

! Anti-Rotational Features

! Crown Ferrule

Isador et al. 1999

15

RETENTION & RETRIEVABILITY

!

POST DIAMETER

!

POST LENGTH

- Increasing post length increases retention far

greater than proportional increases in diameter

(Nergiz et al. 2002)

!

10% post fracture

!

60% loss of retention (16% non-restorable)

!

30% root fracture… all non-restorable

" 72 prefabricated & cast post failures in a

follow-up study

(Torbjorner et al. 1995)

16

FAILURE of Metal Posts

17

FAILURE – Coronal Root Fracture

18

FAILURE – Root Fracture

7/23/2019 Fibre Posts 2012


12-03-09

4

19

CERAMIC POSTS!

Aluminum Oxide

! Zirconium Dioxide

20

Ceramic Posts

COSMOPOST

®

& CERAPOST

®

•

Tapered instead of parallel to conserve dentin

•

IPS Empress Ceramic Core

•

Radiopaque

21

Ceramic Posts!

Esthetic

!

High Modulus of Elasticity

(200 GPa"same as metal)

!

Failure due to root fracture similar to metalposts (Ferrari & Scotti, 2002)

! Bonding requires Silanation

! Problems with bonding to dentin after thermalcycling and dynamic loading in vitro

(Kwiatowski & Geller, 1989)

!

Difficulty removing without root perforation

22

Fibre Posts

23

Industrial Composite

•

FILLER ~60% volume

- pre-tensed continuous fibers

MATRIX ~40% volume

- UDMA epoxy resin

• INTERFACE- silane coupling agent

24

FIBRE POSTS!

Epoxy or polyester resin matrix

!

Carbon, Glass, or Quartz Fibre (35-65%) !

Barium Glass for Radiopacity

7/23/2019 Fibre Posts 2012


12-03-09

5

25

Fibre Posts

Weaker than metal posts

" usually larger in diameter

Tapered shape to match canal

" minimal dentin removal

Bond strengthen the root

" lost over time and with loadEasy to remove

" less risk of root perforation

No Corrosion

" seal & strength26

COMPOSIPOST ®

!

Research Technique Dentaire !

Marc Reynaurd & Bernard Duret

!

Industrial Composite

!

Composipost 1989

!

Aestheti-Post 1994

!

Light Post 2000

Reynaud & Duret, 1989

27

Evolution of Fibre Posts1995: C-POST

1997: AESTHETI-POST

1998: U.M. AESTHETI-PLUS

1999: AESTHETI-PLUS

1999: LIGHT-POST

2001

D. T. LIGHT-POST®

28

Post RigidityThe more similarly dowels,

cements and restorative

materials behave in

comparison to dentin!

!the less force is concentrated among the components and

the root during function.

Pathways of the Pulp 8th Edition, 2010

29

Young s Modulus of Elasticity

GPa Ceramic Ti GoldDentin Fiber

30

ANGLE (0)

0 10 20 30 45 60 90

E l a s t i c M o

d u l u s ( G P a )

20

40

60

80

100

120

140

160

180

200

220Stainless Steel & Ceramic (Zirconium Dioxide)

Titanium Alloy

Cast GoldC - P O S T

AE S T H E T I - P LU S LI G H T - P O S T

Young s Modulus Of Elasticity

7/23/2019 Fibre Posts 2012


12-03-09

6

31

Duret et al. 19961996.

STRESS TRANSFER TO TOOTH

- Finite Element Analysis

N /mm2

Protection of the Root

32

Bonding of Fibre Posts

5 – 15 micron surfaceroughness is ideal for

bonding

interface

Bond strength of cement

to post is greater than the

post itself!Duret et al. 1996

33

POST RETENTION

C a s t P o s t

Z n P O 4

C O S M O P O S T

C - P O S T

L I G H T - P O S T

A E S T H E T I - P L U S

P A R A P O S T

W H I T E

Hedlund et al. 2002

N e w t o n s

34

Radiographic Visibility

Radiolucentfiber post with

high-radiopacity

cement

Radiopaquefiber post with

resin cement

35

S n owP o s t ( Wh i t e )

L u c en t An ch or ( T r an s )

P ar aP o s t Wh i t e

D T L I G H T - P O S T ( T r a n s )

G l a s

s i x

P o

s t

( W h

i t e )

F i b r eK or P o s t ( Wh i t e )

S n owP o s t ( Wh i t e )

L u c en t An ch or ( T r an s )

P ar aP o s t Wh i t e

D T L I G H T - P O S T ( T r a n s )

G l a s

s i x

P o

s t ( W

h i t e )

F i b r eK or P o s t ( Wh i t e )

36

All fiber posts are NOT the same!PRODUCT FIBER % FIBER FLEXURAL

MODULUS (GPa)

TENSILESTRENGTH

(MPa)

FLEXURALSTRENGTH

(MPa)

ELASTICMODULUS

(GPa)

C-POSTPre-tensed

Carbon64% 130 2,260 1,900 17.8

AESTHETI-

PLUS

Pre-tensed

Quartz

62% 44 2,200 1,400 15

DT LIGHT-POSTPre-tensed

Quartz60% 46 2,050 1,600 15

FIBRE-KOR Glass 42% 29.2 1,200 960Not

Reported

PARAPOSTWHITE

Glass 42% 29.2 1,200 990Not

Reported

7/23/2019 Fibre Posts 2012


12-03-09

7

37

Fiber:Matrix ratio

38

Double Taper LIGHT-POST

5mm

10mm

DEJ

39


! University of Montreal

! M-D and B-L radiographs of967 extracted teeth

! Endodontics: step-back,crown-down & mechanical

rotary techniques

! Measurements of the canalafter root canal treatments.

40


3 post sizes that satisfy the Endodontist and the Prosthodontist

Diameter

Diameter

Taper Taper

0.9mm 1.0mm 1.2mm

1.5mm 1.8mm 2.2mm

.06 .08 .10

.02 .02 .02

41


MAXILLARY MANDIBULAR

Central Incisor No. 3 No. 1

Lateral Incisor No. 2 No. 1

Canine / Cuspid No. 2 or 3 No. 2 or 3

First Premolar No. 1 No. 2 or 3

Second Premolar No. 2 or 3 No. 2 or 3

Molars Palatal: No. 2 or 3

Mesial: No. 1

Distal: No. 1

Distal: No. 2 or 3

Mesiobuccal: No. 1

Mesiolingual: No. 1 42


7/23/2019 Fibre Posts 2012


12-03-09

8

43

MULTI-CENTER CLINICAL TRIALSUniversity Teeth Post

Fracture

RootFracture

Paris VII 404 0 0

Nice 137 1 0

Toulouse 150 0 0

Montreal 320 2 0

Modena 470 0 0

Sienna 1,314 0 0

Padua 450 0 0

Karolinska 236 0 0

TOTALS 3,477 3 0

NO ROOT FRACTURE!!!44

SUCCESSRetrospective study of 1,304 posts

- 249 Aestheti-Plus posts (quartz fibre)

- 215 Aestheti-Posts (quartz & carbon fibre)

- 840 Composiposts (carbon fibre)

97% success over 1- 6yrs

- 25 adhesive failures- 16 periapical lesions

- NO post fractures, dislodgements or root fractures

Ferrari et al. 2000

45

Quartz Fibre Posts!

DT Light Post

46

RDT Double Taper Light-Post ILLUSION X-RO

•

Same sizes and properties asoriginal

Double Taper

Light-Posts

•

Color-coded to match drills,prevent mix-ups

•

Color disappears upon

placement".reappears

on cooling for easier

removal

47

Double Taper LIGHT-POST ILLUSION X-RO

.02 .02 .02 .02

.04 .06 .08 .04

1.25mm 1.5 1.8 2.2

0.8mm 0.9 1.0 1.2Diameter

Diameter

Taper

Taper

48

Now you dont

Now you see it


ILLUSION X-RO22OC

37OC

7/23/2019 Fibre Posts 2012


12-03-09

9

49

FIBRE POST PLACEMENT

Trim the Post with coarse

diamond or separating disc

Well fitting post allows for

thin cement layer…lesspolymerization shrinkage

and better force distribution

to the root (Ferrari & Scotti, 2002)

50

FIBRE POST BONDING

" Significant differences between fiber post systems inlight transmission (Goracci et al. 2008)

"

Translucent post only able to transmit ! the light

intensity to the apex (Ferrari & Scotti, 2002)

51

FIBRE POST BONDINGLight-Cure or Dual-Cure Bond

Dual-Cure Resin bondrecommended due to limited

light transmission Bassi et al. 2009

52

FIBRE POST BONDINGDual-Cure Bond

• Etch, Bond, Resin Cement...

Bisco Duo-Link

• Self-Etching & Bonding"

Bisco BisCem

53

FIBRE POST BONDING•

Self-Etching & Bonding"Bisco BisCem

54

Root Dentin BondingModulus of Elasticity close to dentin (Monobloc)

!

Dentin 14.2 Gpa

!

Fibre Post 1-2x

!

Stainless Steel 8-9x

!

Ceramic 15x Cormier et al. 2001

Bonded posts strengthen the root initially (Saupe et al. 1996)

but exposure to functional stresses weakens bond

over time (Heydecke et al. 2001)

7/23/2019 Fibre Posts 2012


12-03-09

10

55

Root Dentin Bonding!

Bonding is less predictable due to decreased

dentinal tubule density, altered collagenexpression (Mannocci et al. 2003)

!

No difference between microtensile bondstrength between translucent or opaque quartzfibre posts or photo- or auto-polymerizedbonding systems (Mallmann et al. 2007)

Coronal Middle Apical

9.16 MPa 7.08 MPa 7.31 MPa

56

Root Fracture! 3-10% for endodontically treated and

restored teeth (Walton et al. 1986)

! Fibre Posts have fewer root fractures

than Metal or Ceramic Posts, but nodifference in force to failure when cast

restoration placed in vitro (Cormier et al. 2001)

57

POST FRACTURE!

INADEQUATE TOOTH STRUCTURE TO

RETAIN A CORE FOR A CROWN

Fractured Carbon Fibre Post58

DTLP ILLUSION REMOVAL

Drill out the post using a diamond burr following down its long axis

Create a pilot

holeCool to identify the post

59

Root Fracture!

40 intact human incisors, sectioned,endodontically treated root, post and core,

and crowned

- Cast Post & Core (Parapost plastic burnout post) - Stainless Steel Parapost with composite core - Carbon Fibre Post with composite core - Ceramic Post with composite core

!

Ceramic Posts were more likely to fail due to

post and root fractures

Hu et al. 2003 60

SUCCESSRandomized clinical trial comparing bondedglass fibre and titanium posts with

composite resin cores found no difference

in success rates or complications

- 91 patients, 87 evaluated after 24-36 months - 46 glass fibre & 45 titanium posts

- All posts 1.4mm diameter and 13mm long

- 2mm ferrule (13 crown lengthenings)

96% success overall

- 1 caries

- 1 horizontal root fracture Naumann et al. 2007

7/23/2019 Fibre Posts 2012


12-03-09

11

61

New Fibre Post System

Questions???

!

Fibre Material!

Matrix Material

!

Shape of Post (length & width)

!

Shape of Head

!

Sizes (posts, drills, reamers)

!

Color

!

Bond or Cement

!

Light Transmission

!

Packaging & Organization62

What

s Next ???!

RDT FiberconeTM

!

Auxiliary Post System for Cores

!

Quartz fibre, translucent, radiopaque

63

What

s Next ???!

RDT FiberconeTM

64

What

s Next ???!

RDT FiberconeTM

65

Conclusions

!

Preserve coronal & radicular dentin

!

Preserve 4-5mm gutta percha apical seal

!

Avoid contamination of the gutta percha

!

Use posts only when necessary to retain a core

!

Post length & Crown retention/resistance formare more important than actual post system

… ferrule effect

!

Restore tooth ASAP (days not months)

66 Any Questions?

THANK YOU

7/23/2019 Fibre Posts 2012


12-03-09

12

67

fibre posts 2012

Documents