Von Bonald Decker
Vor einigen Monaten hatte ich Ihnen hier einen Behandlungsfall nach erfolgloser Revitalisierungbehandlung vorgestellt. So sah der Abschluss der Behandlung seiner Zeit aus:
Abschlussaufnahme nach MTA-Apexifikation
Vor Kurzem war der junge Patient zur Nachkontrolle sechs Monate nach Behandlungsabschluss bei uns. Hier die entsprechende Aufnahme:
Radiologische Nachkontrolle 6 Monate später – es zeigt sich eine Remission der apikalen Parodontitis
Gegenüberstellung: September 2015 zu März 2016
Ich bin guter Dinge, dass diese Behandlung auch entsprechend nachhaltig sein wird. Um dies zu fördern wäre in meinen Augen weiterhin ein intrakanalär adhäsiv befestigter Glasfaserstift wünschenswert…
Erst einmal Glückwunsch zur Heilung!
Was wäre der Vorteil des Glasfaserstiftes, gegenüber, reinem (narürlich dentinadhäsivem) Composite-Aufbau? Gibt es dazu Studien?
Lieber Stephan,
die gibt es reichlich und sie sind mittlerweile völlig kontrovers. Einzig der Aspekt C-Faktor scheint unumstritten.
LGM
Hallo Stephan. Hier eine kleine Auswahl.
J Dent. 2009 Sep;37(9):652-7. doi: 10.1016/j.jdent.2009.05.026. Epub 2009 May 29.
The restoration of permanent immature anterior teeth, root filled using MTA: a
review.
Desai S(1), Chandler N.
Author information:
(1)Department of Oral Rehabilitation, University of Otago, School of Dentistry,
Dunedin, New Zealand.
OBJECTIVES: Immature anterior teeth are at high risk of root fracture following
root canal treatment. The literature was explored to determine the current status
for post-endodontic restorative management of these teeth.
DATA AND SOURCES: The authors explored multiple search engine databases to
November 2008. Experiments included in the review involved simulated human or
animal immature teeth with mineral trioxide aggregate as an apical plug. The
experiments were designed to assess and compare the fracture strength of teeth
restored with various materials. Studies that did not fulfil inclusion criteria
were omitted from the review.
STUDY SELECTION: Four in vitro studies fulfilled selection criteria and were
systematically reviewed. All studies differed in sources of teeth, their
simulated immature tooth model and mode of force application.
CLINICAL IMPLICATIONS: Current evidence, mostly from laboratory studies, suggests
the use of composite resin materials placed deep into the coronal aspect of the
root canal to impart superior fracture resistance. Further clinical research is
needed to assess other reinforcing materials, which include a variety of post
systems and luting agents.
Dent Traumatol. 2014 Oct;30(5):348-55. doi: 10.1111/edt.12103. Epub 2014 Feb 27.
Fracture resistance of endodontically restored, weakened incisors.
Cauwels RG(1), Lassila LV, Martens LC, Vallittu PK, Verbeeck RM.
Author information:
(1)Department of Paediatric Dentistry and Special Care – Paecomedis Research
Group Research, Ghent University, Ghent, Belgium.
OBJECTIVES: To test the fracture strength of weakened bovine incisors
endodontically treated with mineral trioxide aggregate (MTA), calcium phosphate
bone cement (CPBC) or fibre reinforced composite (FRC) posts, and to evaluate the
fracture mode.
METHODS: Weakened bovine incisors (n = 75), standardized according to the
dentinal wall thickness at the cervical area, were randomly assigned to one
control group and three experimental groups. Unfilled teeth were assigned to
group 1 (n = 20) and served as control group. Group 2 (n = 17) consisted of teeth
filled with MTA. In group 3 (n = 18), the incisors were filled with CPBC and in
group 4 (n = 20) with FRC posts. All specimens were subjected to load at a
cross-head speed of 60 mm min(-1) until fracture occurred. The initial (IL) and
final fracture (FL) loads (N) were recorded, and the failure mode among the
different groups was evaluated.
RESULTS: anova showed a statistically significant difference in fracture load
among the groups. Tukey’s test revealed a significant difference for the IL
between the control group and the experimental groups with exception of the MTA
group. The FL was not significantly different among the experimental groups. A
high percentage of favourable fractures was seen in the FRC and CPBC groups.
CONCLUSION: FRC posts and CPBC could be promising materials to strengthen
non-vital structurally compromised teeth.
Int Endod J. 2014 Oct;47(10):958-66. doi: 10.1111/iej.12241. Epub 2014 Feb 1.
Fracture resistance and stress distribution of simulated immature teeth after
apexification with mineral trioxide aggregate.
Brito-Júnior M(1), Pereira RD, Veríssimo C, Soares CJ, Faria-e-Silva AL, Camilo
CC, Sousa-Neto MD.
Author information:
(1)Interinstitutional PhD program, State University of Montes Claros, Montes
Claros, Brazil; Department of Restorative Dentistry, Faculty of Dentistry,
University of São Paulo, Ribeirão Preto, Brazil.
AIM: To evaluate the effect of adhesive restorations on fracture resistance and
stress distribution in teeth with simulated immature apices and apical plugs of
mineral trioxide aggregate (MTA).
METHODOLOGY: Sixty bovine incisors were sectioned 8 mm above and 12 mm below the
cemento-enamel junction (CEJ). The root canal was enlarged using a diamond bur,
resulting in remaining root canal walls with 0.1-0.2 mm of thickness. A 5-mm
apical plug of MTA was placed and the teeth were restored according to the
following groups: GP–the root canal was filled with gutta-percha and endodontic
sealer; CR–the root canal was filled with light-cured composite resin inserted
incrementally; FP–a fibre post was cemented into the root canal; and RFP–the
fibre post was relined with composite resin prior to the cementation into the
root canal. A load was applied on the crown of all teeth at 135° to their long
axis until fracture. Data was analysed by one-way anova and SNK tests (α = 0.05),
whilst the fracture pattern was evaluated according to the position of the
fracture. Stress distributions in the restored teeth were verified by finite
element analysis.
RESULTS: Teeth restored with fibre posts and relined fibre posts were associated
with the highest fracture resistance, whilst the GP group had the lowest values.
GP and RC groups had similar fracture resistance values (P = 0.109). All
fractures types involved the cervical and middle thirds of roots. The GP model
had high levels of stress concentration in the cervical and middle thirds of
roots. No difference was found amongst the stress concentration in the RC, FP and
RFP models.
CONCLUSION: Restorative protocols alter the fracture resistance and stress
distribution of immature teeth after placement of MTA apical plugs.
Dent Traumatol. 2014 Feb;30(1):49-54. doi: 10.1111/edt.12034. Epub 2013 Feb 4.
Investigation of the effect of different prefabricated intracanal posts on
fracture resistance of simulated immature teeth.
Dikbas I(1), Tanalp J, Koksal T, Yalnız A, Güngör T.
Author information:
(1)Faculty of Dentistry, Department of Prosthodontics, Yeditepe University,
Istanbul, Turkey.
AIM: The aim of this study was to assess fracture resistances of simulated
immature single-rooted teeth whose roots have been backfilled using 3 different
post systems after a 4 mm apical mineral trioxide aggregate (MTA) placement.
MATERIALS AND METHODS: Forty-eight maxillary anterior teeth were assigned into
four groups. The lengths of each root were standardized by cutting off the
coronal and apical portions to obtain 13 ± 1 mm samples and root canals were
enlarged. The #6 Peeso reamers were allowed to protrude 1 mm beyond apex to
simulate immature teeth. Apical 4 mm of each tooth was filled using MTA. The
remaining portions were treated as follows: Group 1 (Control): AH
Plus + Gutta-percha cold lateral compaction. Group 2: Glass fiber posts (FRC
Postec Plus post) cemented using self-adhesive resin cement. Group 3: Quartz
fiber posts (D.T. Light post) cemented using self-adhesive resin cement. Group 4:
Zirconia posts (Cosmopost) were placed using self-adhesive resin cement.
Specimens were embedded in self-curing acrylic. A compressive load was applied
lingually at a crosshead speed of 1 mm/min at an angle of 45º until fracture in a
universal testing machine.
RESULTS: The mean fracture resistances were 823.17 ± 188.80, 1155.50 ± 190.37,
1208.00 ± 254.32, and 1153.25 ± 195.71 Newtons for Groups 1, 2, 3, and 4,
respectively. All experimental groups had significantly higher fracture
resistance compared with the control group (P 0.05).
CONCLUSIONS: All post systems exerted a similar reinforcing effect to a simulated
immature tooth and may be preferred specifically in situations which require
additional reinforcement.