Post obturation restoration in primary teeth

Post Obturation Restorations
In Primary Teeth
Presented By:- Dr. Parikshit S Kadam (JR II)

Contents
• Introduction
• Causes for altered tooth
structure in endodontically
treated teeth
• Effects of the endodontic
treatment
• Restorative treatment
planning
• Benefits of restorations
• Risk of restorative therapy
• Restoration of
endodontically treated teeth
• Review of literature
• Conclusion
• References
2

Introduction
• Endodontic treatment is largely performed on teeth
significantly affected by caries, multiple repeat restorations
and/or fracture

• Lack of satisfactory temporary or permanent restorations
during endodontic therapy ranked second amongst
contributing factors in continuing pain after commencement of
treatment
• So, these restorations or filling materials must provide an
adequate seal against ingress of bacteria, fluids and organic
materials from oral cavity to root-canal system, and at the
same time prevent seepage of intracanal medicaments
Abbott PV.Factors associated with continuing pain in endodontics.Aust Dent journal;1994
:jun 39(3);157-161.

• The clinical longevity of endodonticaly treated posterior teeth
is significantly improved with coronal coverage
• The evidences strongly supports that placement of a crown to
encircle the tooth can increase the resistance of posterior teeth
to fracture as high incidence of failure for posterior
endodonticaly treated teeth without cusp coverage has been
reported.
• Sorensen, J.A. and J.T. Martinoff, Intracoronal reinforcement and coronal coverage: a study of endodontically
treated teeth. J Prosthet Dent, 1984. 51: p. 780-784.
• Nagasari, R. and S. Chitmongkolsuk, Long-term survival of endodontically treated molars without crown
coverage: a retrospective cohort study. J Prosthet Dent, 2005. 93: p. 164-170.

• In a retrospective study of uncrowned endodontically treated
teeth, the overall survival rates of molars without crowns at 1,
2, and 5 years were 96%, 88% and 36% respectively
• The amount of remaining tooth structure was a significant
factor in tooth survival
• Aqualina et al found that endodontically treated teeth without
crowns failed at a 6 times greater rate than uncrowned teeth
• Aqualina, S.A. and D.J. Caplan, Relationship between crown placement and the survival of
endodontically treated teeth. J Prosthet Dent, 2002. 87: p. 256-263.
• Nagasari, R. and S. Chitmongkolsuk, Long-term survival of endodontically treated molars without
crown coverage: a retrospective cohort study. J Prosthet Dent, 2005. 93: p. 164-170.

Causes For Alteration In Endodontically
Treated Teeth
• Presence of carious lesions
• Previously performed restorative treatment
• Eventual fractures and traumas, as well as the endodontic
therapy itself
7

1. RESISTANCE LOSS AND FRACTURE RISK
2. COLOR CHANGES AND DECREASED TRANLUCENCY
Effects Of Endodontic Treatment On Tooth
Structure
8

1. RESISTANCE LOSS AND FRACTURE RISK:
“ Teeth undergoing endodontic treatment have smaller resistance
and higher fracture risk”
the increase of fracture susceptibility does not directly depend on
the endodontic treatment itself
9
Carla Castiglia Gonzaga,Edson Alves de Campos, Flares Baratto-Filho; Restoration of endodontically
treated teeth;RSBO. 2011 Jul-Sep;8(3):e33-46

• Other factors can effectively contribute, for example:-
1. Loss of crown structure
2. Dentin dehydration
3. Deleterious effects of irrigant solutions and Intracanal
medications on dentin
4. Reduction of propioceptive response
Carla Castiglia Gonzaga,Edson Alves de Campos, Flares Baratto-Filho; Restoration of
endodontically treated teeth;RSBO. 2011 Jul-Sep;8(3):e33-46
10

`1. Loss of crown structure:
• Great volume loss mainly occurs due to caries, previous
endodontic treatments or restorations
• Additionally to volume loss, during more extensive carious
lesions removal, important tooth-reinforcing structures are also
lost
• e.g., marginal ridges and pulp chamber roof
11

2. Dentin dehydration :
Dentin’s moisture content of endodontically treated teeth
is about 9% smaller than that of vital teeth
• The increase of endodontically treated teeth’s fracture
susceptibility has been attributed to the increase of dentinal
fragility due to humidity loss
12

• During endodontic treatment,
1. Pulp tissue (which presents hydrophilic features) is removed
2. Root canal lumen and dentinal tubules are disinfected and
dehydrated prior to obturation
• Therefore, the loss of pulp tissue’s water content and free
water of root dentinal surface, dentinal porosities and tubules
may contribute to increase the biomechanical impairment of
13

3. Deleterious effects of irrigant solution and Intracanal
medications on dentin
The intensive use of irrigant solutions at high concentrations and
some intracanal medications can deleteriously affect dentin’s
physicochemical properties (flexural strength, modulus of
elasticity, and microhardness), which may lead to dentinal
substrate weakening, locally
14

• Sodium hypochlorite is commonly used as irrigant solution during
endodontic therapy to pulp tissue dissolution and root canal
disinfection.
• To assure a fast and complete disinfection, some clinicians alter
the concentration, volume, and flow rate of irrigant solutions.
• Such alterations aggravate sodium hypochlorite’s side effects on
root canal dentin, increasing the possibility of damages.
15

• Ethylenediaminetetraacetic acid (EDTA) is also an endodontic
irrigant solution used to remove the smear layer formed after
root canal instrumentation.
• EDTA is also capable of affecting dentin by decreasing its
hardness
16

4.Reduction of propioceptive response :
• In vital teeth, proprioceptive sensibility limits the load applied
on dental elements.
• Pulpless teeth show reduced levels of proprioception,
consequently result in decreasing of normal protection reflex.
• This can contribute to increase the susceptibility to cracks and
fractures.
17

2. COLOR CHANGES AND DECREASED TRANSLUCENCY:
• Endodontically treated teeth frequently show color alterations
• It is mainly caused by restorative materials left inside pulp
chamber, after endodontic treatment.
• To prevent tooth darkening, any filling material should be carefully
removed from pulp chamber and from 2 mm short of enamel-
cementum junction.
18
Carla Castiglia Gonzaga,Edson Alves de Campos, Flares Baratto-Filho; Restoration of endodontically
treated teeth;RSBO. 2011 Jul-Sep;8(3):e33-46

Restorative treatment planning of
Restorative treatment of endodontically treated teeth may vary,
ranging from a relatively small direct restoration to more
complex indirect restorations involving the placement of an
intraradicular post and core or indirect restoration itself
• The tooth’s periodontal and supporting tissues status should be
checked
19

Restoration Of Endodontically Treated Teeth
• The best period to perform the restoration of endodontically
treated teeth is a very controversial issue mainly those
presenting a periapical lesion.
• The restorative treatment can be performed immediately after
endodontic treatment ending
• Also after a certain time period to wait the regression of
periapical lesions.
20

• Some studies evaluated the time influence on definitive restorations
of endodontically treated teeth.
• It was observed that, the prognosis of teeth with permanent
restorations (direct amalgam or composite resin restorations and
indirect restorations with or without intraradicular post and core)
placed immediately after endodontic treatment ending was better
than tooth receiving temporary restorations (zinc oxide and
eugenol cements, plaster-based materials).
21
Kishen A. Mechanisms and risk factors for fracture predilection in endodontically treated teeth.
Endodontic Topics. 2006;13:57-83.

• It was also reported that marginal microleakage of teeth with
temporary restorations is higher than teeth with definitive
restorations, suggesting that
definitive restoration should be performed as soon as possible
after endodontic therapy
22
Celik EU, Yapar AG, Ateş M, Sen BH. Bacterial microleakage of barrier materials in obturated
root canals. J Endod. 2006;32(11):1074-6.

• Some recent studies have indicated that either coronal
restoration or apical sealing microleakage negatively affects
the endodontic treatment success. Coronal sealing importance
has been increasingly recognized by literature.
• Currently, it has been suggested that apical microleakage may
not be the most important factor for endodontic treatment
failure and that coronal microleakage is the most likely cause
and the key factor for endodontic and restorative treatment
success or failure

Benefits Of Restoration
1. Removing cavitations or defects to eliminate areas that are
susceptible to caries
2. Stopping the progression of tooth demineralization
3. Restoring the integrity of tooth structure
4. Preventing the shifting of teeth due to loss of tooth structure
5. Prevent bacterial contamination
Guideline on restorative dentistry; AMERICAN ACADEMY OF PEDIATRIC DENTISTRY; V 37/
NO6 15/16 24

Risk Of Restorative Therapy
1. Lessening the longevity of teeth by making them more susceptible
to fracture
2. Recurrent lesions
3. Restoration failure
4. Iatrogenic damage to adjacent teeth
Lenters M, van Amerongen WE, Mandari GJ. Iatrogenic damage to the adjacent surface of primary
molars in three different ways of cavity preparation. Eur Archives Paed Dent 2006;1(1):6-10.
Ricketts D, Lamont T, Innes NPT, Kidd E, Clarkson JE. Techniques for managing decay in teeth. The
Cochrane Summaries, March 28, 2013.
Hickel R, Kaaden C, Paschos E, Buerkle V, García-Godoy F, Manhart J. Longevity of occlusally-stressed
restorations in posterior primary teeth Am J Dent 2005;18:198-211. 25

Restoration of endodontically treated teeth:
1. Temporary restoration after endodontic treatment
2. Definitive restoration after endodontic treatment
i. Teeth exhibiting little or no coronal remnant
ii. Teeth with intermediary coronal remnant
iii. Teeth with great coronal remnant
26

Temporary restoration after endodontic
treatment
• Temporary restorative materials are used for restoring the tooth
temporarily until permanent restoration can be given. It covers the
prepared part of the tooth, in order to maintain the occlusal space as
well as the contact points
Abbott PV. Factors associated with continuing pain in endodontics.
Aust Dent J. 1994;39:157–61
28

• Functions of temporary restoration
• Provide an adequate seal against ingress of bacteria, fluids and
organic materials from the oral cavity to the root-canal system.
• Prevent seepage of intracanal medicaments
• Adhere to tooth structure
29

• It reproduces the tooth contours to allow ease of cleaning and also
to maintain space
• Insulates the pulpal tissue and maintains the periodontal
relationship
Van Nieuwenhuysen JP, D'Hoore W, Carvalho J, Qvist V (2003)."Long-term evaluation of
extensive restorations in permanent teeth".Journal of Dentistry 31 1979;(6)395–405.
Balto H, Al-Nahan S, Al-Mansour K, Al-Otaibi M, Siddiqu Y (2005) Microbial leakage of
Cavit, IRM, and Temp Bond in postprepared root canals using two methods of guttapercha
removal: An in vitro study. The Journal of Contemporary Dental Practice 6,1955;1–8. 30

Objectives of temporary restorations
• Protection of the dentin-pulp organ
• Sedation of the dentin-pulp organ
• Restoration of occlusion
• Protection of the periodontium
• Putting the tooth into function
• Protecting the tooth from fracture

• Ideal requirements of temporary restorative materials:
According to Anusavice (1996)
1. High mechanical resistance
2. Good marginal sealing
3. Low solubility
4. Thermal expansion coefficient close to tooth tissues
5. Aesthetics
32

6. easy handling, insertion and removal from the preparation.
7. Radiopaque
8. Should have sedative effect to the tooth and promote pulp healing.
9. Adhere to stainless steel if a band is being used
33

10. Have a long shelf life
11. Require only minimal tooth preparation prior to placement
Although many materials are available, no material has been
found that fulfils all or most of the properties for ideal temporary
filling material
Anusavice K. Phillips′ Science of Dental Materials. Philadelphia: W.B. Saunders Company;
1996. 34

Manipulation goals
• Ease of use
• Ease of placement, shaping and removal.
• Ease of repair
• Efficient reaction with no or little exothermic heat
• Fast setting

Physiologic goals
• Protection of both hard and soft tissues.
• Therapeutic actions (sedative - anticarigenic potential -
bactericidal effect)
• Patient comfort
• As functional as possible to facilitate chewing.

Materials performance goals
• Good fracture and wear resistance (high strength).
• Good biocompatibility (no sensitivity or toxicity reactions).
• Good aesthetics ( good color matching and stain resistance).
• No or little solubility and disintegration.
• Radio-opaque.

Post temporization goals
• No interference with the setting reaction of the permanent
restoration

• CLASSIFICATION OF TEMPORARY RESTORATIVE
MATERIALS :-
Based on composition :-
1) Zinc oxide eugenol based materials
2) Calcium sulfate based materials
3) Glass ionomer materials
4) Zinc phosphate cement
5) Polycarboxylate cement
39

Factors affect choosing material
• The age of the child
• Caries risk
• Cooperation of child
• Type of material
• Type of tooth

• According to the time period of their placement they can be
divided into three categories:
A. Short term temporary restorations (placed for 1-2 weeks)
B. Medium term temporary restorations (placed for several
weeks)
C. Long term temporary restorations (placed for 6 months)

1) Zinc Oxide Eugenol Based Materials:
Zinc oxide powder + Eugenol liquid
Composition :-
• The chemical composition of ZOE is typically
Powder:-
• Zinc oxide:-69.0wt%
• White rosin:-29.3wt%
• Zinc acetate:-1.0wt%(improves strength)
• Zinc stearate:-0.7wt% (acts as accelerator)
Liquid :-
• Eugenol-85wt%
• Olive oil:-15wt%
42

• Plain ZOE with a powder to liquid ratio of 4:1 (g/ml) as commonly
used
• This results in a poor initial seal, which shows some improvement
after 1 week
• A lower powder to liquid ratio of 2:1 gives better initial seal but
this seal may slightly deteriorate with time.
• Pashley EL, Tao L, Pashley DH. The sealing properties of temporary
filling materials. J Prosthet Dent. 1988;60:292–7
43

• Simple ZOE temporary cement was found less effective in
precluding radioactive tracer leakage when compared to Cavit and
Temp-Seal, but superior to zinc phosphate cement, IRM and
polycarboxylate cement
Marosky JE, Patterson SS, Swartz M. Marginal leakage of temporary sealing materials used
between endodontic appointments and assessed by calcium 45: An in vitro study. J
Endod. 1977;3:110–3. 44

• Kalzinol is a ZOE-based cement reinforced with 2% by weight
polystyrene polymer to double its compressive strength.
• Using an electrochemical technique to test microleakage,
Lim et al.(1990) reported that this cement provided better
sealing properties when compared to Cavit-W and was almost
equal to glass-ionomer cement used in unconditioned cavities
Lim KC. Microleakage of intermediate restorative materials. J Endod. 1990;16:116–8.45

Advantages:
• Low concentrations of eugenol exert anti-inflammatory and
local anesthetic effects on the dental pulp.
• Facilitate pulpal healing
• Eugenol liquid provides an obtundent effect which help the
pulp to relax after trauma from tooth preparation.
• It is sedative
Devika warrier E, dr.Jayalakshmi; A Review On Temporary Restorative Materials;
IJPSR; Jul 2016; vol. 7
46

• Disadvantages:
1. High eugenol concentrations are cytotoxic
2. Direct application of eugenol to pulp tissue may result in
extensive tissue damage
Tronstad L, Asbjornsen K, Doving L, Pedersen I, Eriksen HM. Influence of coronal
restorations on the periapical health of endodontically treated teeth. Endod Dent
Traumatol. 2000;16(5):218-21. 47

• Modifications of zinc oxide eugenol based materials are IRM and
EBA.
1. INTERMEDIATE RESTORATIVE MATERIAL (IRM):
• IRM is a ZOE cement reinforced with polymethyl methacrylate
• Advantages:
1. Improved compressive strength
2. Improved abrasion resistance
3. Improved hardness
Friedman S,Shani J, Stabholz A, Kaplawi : Comparative sealing ability of temporary filling
materials evaluated by leakage of radio sodium. Int Endod J. 1986; 19: 187-93. 48

• Disadvantages:
1. The leakage of IRM is increased when subjected to thermal stress
2. This can attribute to its dimensional instability
Al-Nazhan S, Sapounas G, and Spangberg LSW : In vitro study of the toxicity of a composite
resin, silver amalgam and cavit. J Endod. 1988; 14: 236-8.
49

2. EBA :-
• Main component is ethoxy benzoic acid
• It is designed to produce a mechanical interlocking effect upon
hardening inside the mouth
• These cements usually consist of a basic powder (zinc oxide,
aluminum oxide) and an acidic liquid (ethoxy benzoic acid)
• These are mixed together in a viscous paste immediately before
use, setting to a hard mass.
50

• Ethoxy benzoic acid cements have proper thermal and
chemical resistance in the oral environment
• This material is resistant to dissolution in oral fluids
• Also non-irritating to pulp and gingiva
Mitchell, David F:The Irritational Qualities of Dental materials. j Am Dent Assoc
1959; 59: 954. 51

2) Zinc oxide/Calcium Sulfate Based Materials:
 CAVIT:
• Cavit is a premixed temporary filling material that contains zinc
oxide, calcium sulphate, zinc sulphate, glycol acetate,
polyvinylacetate resins, polyvinyl chloride acetate, triethanolamine
and pigments.
• Cavit is soft when placed in the tooth
52

• It subsequently undergoes a hygroscopic set after permeation with
water, giving a high linear expansion (18%).
• Its linear expansion is almost double that of ZOE
• This explains its excellent marginal sealing ability
Webber RT, del Rio CE, Brady JM, Segall RO. Sealing quality of a temporary filling
material. Oral Surg Oral Med Oral Pathol. 1978;46:123–30 53

• Cavit’s compressive strength is approximately half that of
ZOE, so there is a need for sufficient bulk to overcome poor
strength qualities and provide an adequate seal
• Temperature fluctuations did not influence the seal ability of
Cavit products, indicating good dimensional stability
The physical and biologic properties of Cavit.Widerman F.H., Eames W.B., Serene
T.P.(1971) Journal of the American Dental Association (1939), 82 (2) , pp. 378-382.

• Webber et al. (1978) tested the thickness of Cavit required to
prevent methylene blue dye leakage.
• It was found that at least 3.5 mm of the material was required to
prevent dye leakage
• A 4 mm thickness of cavit provides the best seal over a 3 week
temporization period when compared to IRM (Beach et al. 1996).
1. Webber RT, del Rio CE, Brady JM, Segall RO. Sealing quality of a temporary filling
material. Oral Surg Oral Med Oral Pathol. 1978;46:123–30
2. Beach CW, Calhoun JC, Bramwell JD, Hutter JW, Miller GA. Clinical evaluation of
bacterial leakage of endodontic temporary filling materials. J Endod. 1996;22:459–62 55

• Cavit has been shown to exhibit minor leakage.
• It is found to be soluble and quickly disintegrates in tissue fluids.
• Biocompatibility studies with Cavit are in conflict, showing it to be
both toxic and nontoxic.
1. Bhargava S, Chandra S, Chandra S : A comparison of tissue reactions to potential
retrograde root filling materials. Endodontology 1999; 11: 8-13.
2. McDonald NJ, Dumsha TC : A comparative retrofill leakage study utilizing a dentin
bonding material. J Endod 1987; 13: 224-8.
3. Danin J, Linder L, Sund ML, Stromberg T, Torstenson B, Zetterqvist L : Quantitative
radioactive analysis of microleakage of four different retrograde fillings. Int Endod J. 1992;
25:183-188. 56

• Cavit-G and Cavit-W are varieties of Cavit
• These differ in the content of resin and their resulting hardness and
setting
• The hardness and dimensional stability of Cavit, Cavit-W and Cavit-
G decrease respectively
• It was found that Cavit and Cavit-W provided almost equal water
tight seals
• This seal was significantly superior than Cavit G
Jacquot BM, Panighi MM, Steinmetz PG, Sell C. Microleakage of Cavit, Cavit W, Cavit G and
IRM by impedance spectroscopy. Int Endod J. 1996;29:256–61 57

 CAVIDENTIN: (Laszlo Laboratories, Netania, Israel):
• It is a ready-to-use CaSO4-based temporary filling material
• It has a similar composition as that to Cavit but there is an addition
of potassium aluminium sulphide as catalysts and thymol as an
antiseptic.
Rud J, Munksgaard EC, Andreasen JO, Rud V, Asmussen E :Retro grade filling with a
composite and a dentin bonding agent. I.Endont Dent Traumatol 1991. 58

• In an in vitro study, it was reported that a 5 mm thickness of
Cavidentin provided superior sealing ability compared with that
of IRM, Kalzinol (a reinforced ZOE preparation) and Cavit.
• Cavidentin and Cavit G were almost equally effective.
1. Lehtinen R : Tissue reaction of a glass ionomer cement in the rat: a possible material
for apicectomy using retrograde filling. Int J Oral Surg 1985; 14: 105. 59

COLTOSOL:
• It is a zinc oxide, zinc sulphate and calcium sulphate
hemihydrate-based material.
• Its surface hardens within 20-30 min when in contact with
moisture
• The filling can be subjected to mastication pressure after 2-3
hours.
• This material is designed for short term temporization not
exceeding 2 weeks.
60

• Advantages of Zinc oxide/Calcium Sulfate Based Materials:
1. Ease of manipulation
2. Availability in premixed paste
3. Being easily removed from access cavities after setting
4. Provide adequate seal of an access cavity between
appointments
61

• Disadvantages:
1. Less hardness
2. Wear resistance
3. Slow-setting reaction and deterioration with time
62

• To overcome these disadvantages,
 A double seal using Cavit as an inner layer and IRM as an outer
layer has been recommended
 This compensate for the undesirable physical properties of Cavit
 Also, this combination showed better dentine adaptation when
compared to IRM alone.
Pai SF, Yang SF, Sue WL, Chueh LH, Rivera EM. Microleakage between endodontic
temporary restorative materials placed at different times. J Endod. 1999;25:453–6.63

3) Glass-ionomer cement (Wilson & Kent 1972)
• These materials as a temporary restoration during endodontic
therapy has been investigated in a number of studies with
favourable results.
• In one study of Bobotis et al. using the fluid filtration method,
glass ionomer cement microleakage values did not differ
significantly from the intact crown values after 8 weeks
Bobotis HG, Anderson RW, Pashley DH, Pantera EA., Jr A microleakage study of temporary
restorative materials used in endodontics. J Endod. 1989;15:569–72. 64

• In another in vitro study, by Lim et al. using an electrochemical
technique, glass ionomer cement placed in unconditioned cavities
was almost equally effective compared to Kalzinol and superior to
Cavit-W after a 1 month experiment period
Lim KC. Microleakage of intermediate restorative materials. J Endod. 1990;16:116–8. 65

• In a study Barthel et al. glass ionomer cement alone or on top
of an IRM base provided a significantly superior seal against
penetration of Streptococcus mutans when compared to Cavit,
IRM and glass ionomer cement on a Cavit base, over a one-
month period).
Barthel CR, Strobach A, Briedigkeit H, Göbel UB, Roulet JF. Leakage in roots
coronally sealed with different temporary fillings.J Endod. 1999;25:731–4. 66

• The adhesion mechanisms of glass ionomer cements explains
their acceptable sealing ability
• Also, they possess antibacterial properties against many
bacterial strains (Heling and Chandler, Herrera et al.)
1.Heling I, Chandler NP. The antimicrobial effect within dentinal tubules of four root
canal sealers. J Endod. 1996;22:257–9.
2. Herrera M, Castillo A, Baca P, Carrión P. Antibacterial activity of glass-ionomer
restorative cements exposed to cavity-producing microorganisms. Oper
Dent. 1999;24:286–91 67

• The antibacterial activity of the material is attributed to:
1. The release of fluoride
2. Low pH
68

• Problems associated with GIC
 The cost
 Speed of setting
 The difficulty in differentiating glass ionomers from the
surrounding tooth structure during removal
69

4) Zinc Phosphate Cement:
• Introduced by Pierce in 1879
• Studies have shown controversial results concerning the sealing
ability of zinc phosphate cement.
• Krakow et al. showed in a in vivo study, Access cavities
temporized with this material showed no leakage in more than two-
thirds tests
Krakow AA, de Stoppelaar JD, Gron P. In vivo study of temporary filling materials used in
endodontics in anterior teeth. Oral Surg Oral Med Oral Pathol. 1977;43:615–20
70

• In another study by Bobotis et al. using the fluid filtration
method to test microleakage, zinc phosphate cement did not
show significant microleakage when compared to the intact
crown, but visible leakage was observed in some of the
samples temporized with this material
Bobotis HG, Anderson RW, Pashley DH, Pantera EA., Jr A microleakage study of
temporary restorative materials used in endodontics. J Endod. 1989;15:569–72. 71

4) Polycarboxylate Cement:
• Introduced by Smith in 1968
• These cements, have the strength and manipulative properties
comparable to phosphate cements
• Also, low irritant potential under suitable conditions.
• Its adhesive quality is good
72

• Marosky et al. found polycarboxylate cement to provide the least
desirable seal when compared to temp-seal, cavit, ZOE, zinc
phosphate cement and intermediate restorative material
• Marosky JE, Patterson SS, Swartz M. Marginal leakage of temporary sealing materials
used between endodontic appointments and assessed by calcium 45: An in vitro
study. J Endod. 1977;3:110–3.
73

• Pashley et al. using a fluid filtration method found that
polycarboxylate cement at a powder to liquid ratio 2:4 was not
significantly different from Cavit-G, even after thermocycling.
• Cannot be recommended, as its clinical effectiveness for
endodontic temporization does not appear to have been well
established.
Pashley EL, Tao L, Pashley DH. The sealing properties of temporary filling materials. J
Prosthet Dent. 1988;60:292–7. 74

Cement Advantages Disadvantages
ZOE Cement • Anti-inflammatory and local
anesthetic
• Facilitate pulpal healing
• Provides an obtundent effect
• It is sedative
• Cytotoxic
• Extensive tissue damage
IRM • Improved compressive strength
• Improved abrasion resistance
• Improved hardness
• The leakage when subjected
to thermal stress
• Attribute to its dimensional
instability
EBA • Thermal and chemical resistance
• Non-irritating to pulp
• Low strength
Cavit W • Dimensional stability
• Harder
• water tight seal
• Low compressive strength
• Soluble and distingrate in
oral fluid
Cavit G Efficient seal Less dimensional stability
Less harder

Cement Advantages Disadvantages
Cavidentin • Ready to use material
• Antiseptic properties
• Provided greater sealing
ability
Less dimensional stability
Coltisol • Ease of manipulation
• Availability in premixed
paste
• Being easily removed from
access cavities after setting
• Provide adequate seal of an
access cavity between
appointments
• Less hardness
• Wear resistance
• Slow-setting reaction and
deterioration with time
Zinc phosphate cement • Great insulator
• Poor thermal conductor
• Highly acidic
Zinc polycarboxylate • Short working time
• Short setting time
• No pulpal response
• No Release of fluoride
• Low compressive strength

• Definitive restoration of endodontically treated teeth aims not
only to promote coronal sealing and avoid microleakage/
contamination, but also to replace the lost tooth structure and
protect the remnant tooth structure, mainly against fractures.
• This restorative stage may involve the placement of one or more
of the following elements: intraradicular post and core and
coronal restoration itself.
82

i. Teeth exhibiting little or no coronal remnant:
• Teeth exhibiting little or no coronal remnant require the use of
intraradicular post and core to retain the coronal restoration
• Intraradicular post and core employment is dependent on the tooth
type
83
Cheung W. A review of the management of endodontically treated teeth. Post, core and
the final restoration. J Am Dent Assoc. 2005;136(5):611-9.

Endodontically treated molars do not require an intraradicular
post and core because :
a) They show more coronal remnant
b) A larger pulp chamber to retain a filler core
c) They are more subject to vertical forces, due to their dental
arch position and functional movements, which can lead to a lower
necessity of intraradicular post and core.
84

• But when it is required, intraradicular post and core should be
placed at the largest and more straight root canal to avoid root
weakening during preparation, as well as perforation of curved
root canals.
• Mostly, Indicated roots are:
a) Lower molars ---------- Distal canal
b) Upper molars----------- Palatal canal
85

• This may also not be required in endodontically treated
anterior teeth, as these teeth could be restored directly through
bonding technique and composite resin.
• If there is a need of a full crown placement, intraradicular post
and core will be required.
86

 INTRARADICULAR POSTS:
• The post, the core and their luting or bonding agents together form
a foundation restoration to support a coronal restoration for the
endodontically treated tooth.
CROWN
CORE
POST
87

 POST:
• It is a relatively rigid material placed in the root of a non vital
tooth
• It extends coronally to anchor the core material which supports
the crown
C Gorraci & M Ferrari;Current perspective of post system: a literature review,
Australian Dental Journal,2011;56(1) 88

Should be easy to
place in and retrieved
from the canal
Provide maximum
retention to the core
and crown
IT SHOULD BE
RESORBABLE
Provide maximum
resistance to the root
to resist root fracture
Should have high
strength and fatigue
resistance
Should be less
technique sensitive
Should be visible
radiographically
Should be
biocompatible
Should be easily
available and
economical
IDEAL PROPERTIES:
89

INDICATION OF USING POST IN PRIMARY TEETH
1. ½ crown structure lost- indicated
2. At least 1 mm of tooth structure supragingivally
3. Reduced crown tooth structure
4. The main reason for using a post is to re-establish the shape
and form of a severely decayed or fractured maxillary anterior
tooth crown while it provides support for the final restoration
Wanderley MT, Ferreira SLM, Rodrigues CRMD, Filho LER. Pdmary antedor tooth restoration
using posts with macroretentive elements. Quintessencent 30:432-436, 1999.
Guimaraes CS, Ribeiro SC, Biffi JCG, Mota AS. Comparative analysis of retention in
prefabdcated and fixed intracanal posts with differetit cement agents. RPG Rev Pos Grad
6:354-360, 1999 90

PROBLEMS WHILE PLACEMENT OF POST IN PRIMARY
TEETH
• The morphology and histology of primary teeth present a less
surface area for bonding, relatively large pulp chamber, and
aprismatic enamel which is difficult to etch
• The destruction of the tooth structure frequently involves the entire
crown leaving just the root dentine for bonding of the restorative
material and thus increasing the failure rate
1. MortadaA,King NM. A simplified technique for the restoration of severely mutilated
primary anterior teeth. J ClinPediatr Dent 2004;28:187-92.
2. Papathanasiou AG, Curzon ME, Fairpo CG. The influence of restorative material on the
survival rate of the restorations in primary molars.Pediatr Dent1994;16:282-8
91

EXTENSION OF POST IN THE PRIMARY ROOT CANAL
• Innovations for short retentive posts are needed in primary
dentition due to the physiological resorption that occurs in
primary dentition, unlike the post and core used in adult
dentition.
• Intra-canal placement is around 3mm that is the cervical one-
third of the canal so it does not interfere with deciduous tooth
root resorption and permanent tooth eruption
Kapur A, Chawla HS, Goyal A, Gaube K. An esthetic point of view in very young
children. J Clin Pediatr Dent 2005;30:99-103.
92

DIFFICULTIES OF POST IN PRIMARY TEETH:
• Difficulty in extension of post length due to short length of
primary roots & primary tooth roots can resorb over a period
of time
• Due to short post length, Retention is compromised
• Chances of loss of crown due to trauma
93

• CLASSIFICATION OF POST USED IN PRIMARY
TEETH:
Post which are used in primary teeth can be classified based on-
1. Based on types of post space design
2. Based on material used
3. Based on post design
4. Based on fabrication
5. Based on retention
Swara S, Seema B, Anuradha, N P; Posts In Primary Teeth-a Sile For Better Smile;
Journal of Advanced Medical and Dental Sciences Research; January-February
2016; |Vol. 4|Issue 1|
94

1. Based on post space design
• Mushroom shaped
• Tapered shaped
• Onion shaped
2. Based on material used-
• Metallic
• Non metallic
95

Alpha post Nickel chromium post
Gamma post Cast metal post
Omega post Reverse metal post
Half omega post Modified anchor shaped post
Metal post
a) Metal post
96

Composite post Glass fibre post
Biologic post Glass fibre reinforced composite post
Fibre post Ribbond
Polyethylene post Carbon fibre
Kevlar fibres Vectran fibre
b) Non metallic
97

3. Based on post design-
• Alpha
• Half omega shaped
• Omega shaped
• Modified anchor shaped
• Gamma shaped
• Smooth
• Tapered
• Serrated
• Parallel side
98

4. Based on fabrication
a) Custom made
• Omega post and its modifications
• Alpha post
• Gamma post
• Modified anchor shaped post
b) Prefabricated post
• Metal post
• Reverse metal post
99

5. Based on retention
a)ACTIVE POST:
• Mechanically engage the canal walls
• Retentive in nature
• But generates stresses during their placement and functional
loading
b)PASSIVE POST:
• Do not mechanically engage to the canal
• Less retentive in nature
• Generates less stress during their placement and functional
loading
100

CANAL PREPARATION FOR POST AND CORE IN
PRIMARY TEETH
• About 4 mm of root canal filling material is removed from the
canal.
• 1 mm of cement is placed over the filling material of the canal.
• The rest 3 mm canal space is used for the placement of post.
101

• For that Glass Ionomer Cement can be used as a 1 mm GIC
button over the filling material. (Kumar R, 2014) Other than
GIC, Zinc Polycarboxylate cement can also be used.
(Shrinivas N CH, 2011)
Swara S, Seema B, Anuradha, N P; Posts In Primary Teeth-a Sile For Better Smile;
Journal of Advanced Medical and Dental Sciences Research; January-February
2016; |Vol. 4|Issue 1| 102

POST SPACE DESIGNS
Mushroom-shaped Post Space
• It is introduced by Ludd PL et al. in 1990
• Technique has unpractical approach since anatomical features
of root of incisor is tapered in apical direction.
• Needs removal of deep dentin to create heal of mushroom at
wall of root which may leads to stress induction and weakening
of root

• Taper-shaped Post Space
• It is developed by Grosso in 1992
• It is less retentive since it is short; generate
stress concentration in the root around them
as occlusal forces are transmitted outward
in a wedge-like fashion

• Onion-shaped Post Space
• It is developed to minimize stress generating
effect from the occlusal force and derives
optimal retentive features with maximum
strength to support restoration.
• Round bur is used to create onion-shaped
bottom of post space.
• This technique is relatively simple and less
time consuming

1. Metal posts:
• Metal posts are made up of stainless steel wire of 22 gauge/0.7
mm.
• They are rigid but not esthetic.
• Retention can be increased with addition of serration in the post.
• They may interfere with physiologic root resorption if they are
placed beyond 3 mm in the canal.
106

2. Omega post:
• Was introduced by Mortada and King as intracanal retainer in the
year 2004
• Total of 5 mm long post is used in primary teeth.
• Both 3mm long free ends of post is placed inside the canal.
• Remaining 2 mm of omega post provides retention to the coronal
restoration.
Mortada A and King NM, “A simplified technique for the restoration of severely mutilated
primary anterior teeth,” Journal of Clinical Pediatric Dentistry, vol. 28, no. 3, pp.
187–192, 2004.
107

Advantages:-
• Quick process
• Wire does not cause any internal stresses in the root canal as it is
incorporated in the restorative material mainly
• It can be done with minimal chair side time.
• Coronal extension provides retention to coronal restoration
Kumar R, Sinha A. Restoration of primary anterior teeth affected by early childhood caries
using modified omega loops – A case report. Annals of Dental, 2014; 2(4): 24-6. 108

Disadvantages:-
• The adhesion between Omega wire and dentinal wall is
mechanical.
• The wire adaptation to the internal walls is inadequate,
leading to dislodgement of the wire and radicular fracture
due to excessive masticatory forces.
109

3. HALF OMEGA POST:
• Stainless steel wire is bent to half omega shaped to make the post
• Serrations are added to increase the potential surface area for
attachment of the restorative material and consequently increase
the long-term stability of an esthetic restoration
• Modification in the original technique has been done by
Aminabadi and Farahani (2009)
110

Advantages:
1. Greater retention
2. Greater resistance of restoration
3. After placement into the canal, the wire exhibit higher stability
4. Also reduces risk of dislodgement subsequent to application
and manipulation of the restorative material
111

Disadvantages:
1. Wire do not adapt adequately to the canal because it is not the
exact copy of the canal
2. When forcibly fitted into the narrow canal, it increases the
internal stress in the root and may lead to fracture
Srinivas N CH, Jayanthi M. Post Endodontic Restoration of Severely Decayed Primary
Dentition: A Challenge to Pediatric Dental Surgeon. World Journal of Dentistry,
January-March 2011; 2(1):67- 69. 112

4. MODIFIED ANCHOR SHAPED POST:
• A 19-gauge orthodontic wire, 1.5 inch in length, is bent using a
universal plier
• For post fabrication of the arms of wire is bent downwards and
turned it to the opposite side
• Repeat the same procedure for the other arm
• Bend the free end of the arms towards the curved end
113

• By compressing the curved end, the free end opens up to adapt
to the walls of the root thereby giving extra mechanical
retention.
114

Advantages over Omega post-
• The free end has two arms crisscrossing to the opposite side
which adapt to the walls of the root- extra retention
• The curved end provides strength to the coronal structure
• Adaptation can be enhanced by compressing at the curved
end which opens up the arms at the free end.
• Hence it is a simpler, easier, and inexpensive technique for
treating severely damaged teeth.
Rajesh R, Baroudi K, Reddy BK, Praveen BH,Kumar VS,Amit S. Modified Anchor
Shaped Post Core Design for Primary Anterior Teeth. Case Reports in Dentistry,
2014: 1-4. 115

5. CAST METAL POSTS
• They are fabricated by using indirect method of fabrication.
• They have disadvantages like they are expensive and require an
additional laboratory stage for preparation of post
• They could pose problems during the natural tooth exfoliation.
Motisuki C, Santos-Pinto L, Giro EM. Restoration of severely decayed primary incisors
using indirect composite resin restoration technique. Int J Paediatr Dent
2005;15:282-6. 15.
McDonald RE, Avery DR. Restorative dentistry. In: McDonald RE, Avery DR, Dean JA,
editors. Dentistry for the chil and adolescent. 8th ed. St. Louis: Mosby; 2004. p. 376.116

6. REVERSE METAL POST:
• Short prefabricated metal post is used as reverse metal post.
• The post is inserted upside down so that the 3-mm head into
the canal
• The remaining 5 mm of the threaded section was positioned
out of the canal as a core for coronal restoration.
• Bevelling should be done to reduce the stress concentrated at
the dentinal walls and then the head of the post was try-fitted
with the coronal 3 mm of the canal.
117

Advantages
• Easy-to-perform and economical procedure with adequate
retention and good aesthetic.
Disadvantages
• The possibility of cracked root subsequent to long-term function,
especially in children with heavy occlusion or parafunctional
habits.
Eshghi A, Esfahan RK, Khoroushi M. A simple method for reconstruction of severely
damaged primary anterior teeth. Dental Research Journal, Oct 2011; 8(4): 221-25.118

7. FIBRE BASED POST:
• Fibre based posts are available in various diameter & length.
• Types:
a. Polyethylene fibre post
b. Polyethylene fibre reinforced composite post (rebbond)
c. Glass fibre post
d. Glass fibre reinforced composite resin Post (GFRP)
e. Carbon fibre post
Asmussen E, Peutzfeldt A, Heitmann T. Stiffness, elastic limit and strength of newer
types of endodontic posts. J Dent 1999; 27: 275-278. 119

Advantages
• High tensile strength
• Increased fatigue resistance and inherent rigidity
• Increased resistance to corrosion biocompatibility to different
core materials
• Good chemical bonding to Bis-GMA resins
• A young modulus of elasticity approaching that of dentin
Alessandro V, Simone G, Marco F. Comparison between two clinical procedures for
bonding fiber posts into a root canal: A microscopic investigation. J Endod 2002; 28:
355-360.
Gesi A, Magnolfi S, Goracci C, Ferrari M. Comparison of two techniques for removing
fiber posts. J Endod 2003; 29(9): 580-582 120

a) Polyethelene Fibre posts
• These posts are preferred as they improve the impact strength,
modulus of elasticity & flexural strength.
• They are almost invisible in resin matrix, in contrast to glass
fibers, which fail to stick to resin matrix.
• For the step wise preparation of this post system first removal of
2 mm of the coronal portion of the root filling should be done.
• Jain M, Singla S, Bhushan BAK, Kumar S, Bhushan A. Esthetic rehabilitation of
anterior primary teeth using polyethylene fiber with two different approaches. J Ind
SociPedodPrevet Dent, 2011; 29(4): 327-32. 121

• Coronal structures and pulp chamber were etched and
conditioned properly.
• Polyethylene fibers conditioned with bonding agent, placed in
the slot of the root canal, are stabilized with composite
material.
• Polyethylene fibers, 2 – 3 mm in length, are maintained above
the crown to reinforce the coronal structure
122

b) Ribbond fibres
• These fibres have adequate translucency for cases with great
aesthetic appeal because they can be camouflaged inside the
resin composite structure
• They have advantages of easy to manipulate,
• Dual cure resin cement is used with ribbond fibres
• Final restoration is done with composite resin.
Oliveira Rocha R, Das Neves LT, Marotti NR. Wanderley MT, Pires Correa MSN.
Intracanal reinforcement fiber in pédiatrie dentistry: A case report.Quintessence Int
2004:35:263-268.
123

c) Glass fibre post:
• They are composed of unidirectional glass fibres embedded in
resin matrix
• They have advantage of stress distribution over broad surface
area
• Disadvantage of this post system are failure to stick to the
resinous matrix which interferes with the aesthetics and interfere
with resorption if extended beyond 3 mm.
Mehra M, Grover R. Glassfibre post: An alternative for restoring grossly decayed primary
tooth. Int J clinPeadiat dent 2012; 5(2): 159-62.
Abd El-Rahman AM, El-Kateb MA: Evaluation of a method for restoring severely decayed
primary anterior teeth. Al-Azhar Dent J 7(4): 875-894, 1992. 124

d) Glass fibre reinforced composite resin posts
• They are new generation of fiber posts composed of densely
packed silanated glass fibers in light cure gel matrix
• The fibers are of 7 to 10 μm in diameter
• Its flexural strength is 1280 Mpa which is closer to dentin
• They have greater ease of handling
• Can be used in high stress bearing areas
125

• They are invisible in resin matrix so are the most suitable for
esthetic needs.
• The GFRC post cured for 20 seconds in order to gain rigidity,
before insertion into the post space.
• Light cured flowable composite resin is used into the canal
chamber after which the GFRC post is inserted
Abd El-Rahman AM, El-Kateb MA: Evaluation of a method for restoring severely decayed
primary anterior teeth. Al-Azhar Dent J 7(4): 875-894, 1992. 126

8.Biologic post
• The term biological restoration was introduced by Santos and
Bianchi (1991)
• Ramires-Romitoet al (2000), used teeth from the Human Tooth
Bank of Sao Paulo University Dental School
• Was used as natural posts and crowns to fit into the roots and
replace the crowns as well
1. Santos J, Bianchi J. Restoration of severely damaged teeth with resin bonding systems.
Quintessence Int 1991; 22: 611-5.
2. Ramires-Romito AC, Wanderley MT, Oliveria MD, Imparto JC, Pires Correa MS.
Biological restoration of primary anterior teeth. Quintessence Int 2000; 35: 405-11. 127

• Tooth bank procedure
• The collected samples of extracted teeth are thoroughly scaled,
polished, and freed of soft tissues and periodontal remnants.
• The pulps are removed from root canals and complete
biological preparation is done.
128

• All the sample teeth are placed in the ultrasonic tank operating
at 42GHz and 100 W output, at five working cycles in 6%
H2O2.
• Each tooth are sonicated for 30 minutes.
• Teeth are stored at 4 degree C in Hank’s balanced salt solution
(HBSS) with donor identification till the time it is used
129

• Preparation of biological restoration
• Teeth selected from the tooth bank are reshaped to be used as
natural post and crown using crown preparation kit .
• The roots that are shaped to function as posts are strengthened
by flowable composite material.
• Tooth selected and prepared for use as biological restoration is
then autoclaved for 30 minutes at 121 degree C and 15lbs
pressure before cementation.
• The tooth is then tried for fit and adjustments to be done.
130

• Advantages
• Natural tooth obtained from patient or from tooth bank
• Easy to perform
• Economical
• Disadvantages
• Not acceptable by many patients
• Need of tooth bank
• Donor & recipient acceptance & cross infection make this
treatment option largely impractical
131

• Comparison of different post:
GFRCR V/s OMEGA WIRE
 Gujjar et al, 2010 - Glass fiber posts showed greater
dislodging strength, followed by orthodontic "γ" wire posts
Gujjar, Kumar R., Indushekar, K.R.; Comparison of the Retentive Strength of 3
Different Posts in Restoring Badly Broken Primary Maxillary Incisors; Journal of
Dentistry for Children; Volume 77, Number 1, January-April 2010, pp. 17-24(8) 133

GFRCR POSTS V/s OMEGA WIRE EXTENSION POSTS
 Sainil et al, 2011 –
• The high cost of glass fibre reinforced composite resin post
limits its use.
• Considering the socioeconomic status of the patient, a
custom-made post using an orthodontic wire followed by strip
crowns was used.
• It is technique sensitive and requires parent's and child’s
cooperation.
• Also, there is a chance of loss of restoration due to trauma or
biting on hard food, so the parents were instructed to teach the
child to avoid hard food.
134

BIOLOGICAL RESTORATIONS V/s OMEGA WIRE POSTS
 Grewal N and Seth in 2008 concluded that biologic restoration
presented as a cost effective, clinical friendly, less technique
sensitive and aesthetic alternative to commercially available
restorative materials used for restoring deciduous teeth affected
by early childhood caries.
Grewal N and Seth; Comparative in vivo evaluation of restoring severely mutilated
primary anterior teeth with biological post and crown preparation and reinforced
composite restoration; JISPPD; Year : 2008 | Volume : 26 | Issue : 4 | Page : 141-148135

Luting agent Suggested by
Zinc phosphate cement for
revere metal post
Eshghi A, Esfahan RK,
Khoroushi M (2011, 2014)
Glass ionomer cement for
Omega (Metal post)
Ganesh R et al (2012)
Flowable composite- for
Metal as well as Fibre
posts
Shrinivasan CH (2011)- half
omega post
Kumar R Gajjar (2010)-
gamma post
Mehra M (2012)- glass fibre
post
Yusuf K (2011)- GFRC
Dual cure resin- for
Metal as well as Fibre
posts
Wanderley MT (1999)- Ni-
Cr post with macroretentive
element
Luting of post
136

CASE REPORT 1
• A 3 years old male patient reported to the department of
Pedodontics and Preventive dentistry, Rohtak, Haryana with
chief complaint of his parents about the unaesthetic
appearance due to grossly carious front upper teeth.
Intraoral examination revealed grossly carious 51,52,61,62.
• Pulpectomy was done with respect to 51, 52, 61, 62 and
post space of 4mm length was made with the help of
tapered fissured bur. The post-space was air dried &1 mm
base of GIC placed to isolate the obturated material from
the rest of post space
• Prefabricated Metal Post is then cemented into the canal
using flowable composite. The coronary portion was
restored with strip crowns. Follow up was done after 3,6
and 9 months and the restorations were intact

CASE REPORT 2
• A three and half year old male patient reported with chief complaint
of severe and spontaneous pain in the 51. Intraoral examination
revealed grossly carious 51,52,61,62 and sinus with respect to 51.
• Pulpectomy was performed with respect to 51, 52, 61, 62. After 2
weeks, the sinus with respect to 51 was healed clinically. The
intracanal restoration with the help of prefabricated glass fibre post
was planned. A Post space of 4mm length was made with the help of
tapered fissured bur. The post-space was air dried & 1 mm base of
GIC placed to isolate the obturated material from the rest of post
space.
• Prefabricated glass fibre post is then cemented into the canal using
flowable composite. Post is inserted into the canal space with cotton
plier to avoid the contamination with the gloves. The coronary portion
was restored with strip crowns

CASE REPORT 3
• A five year old male patient reported with grossly carious 51,52,61,62
and root stumps with respect to 54 and 64.
• Pulpectomy was done with respect to 51, 52, 61, 62 and extraction was
done with respect to 54 and 64.
• During second appointment, prefabricated bands were adapted with
respect to 55 and 65 and alginate impression was taken and bands were
transfer from mouth to impression and cast was made. The band and
loop space maintainer was fabricated and cemented. Custom made
modified omega wire loop post was made using 0.7mm stainless steel
wire manipulated by using no. 130 orthodontic plier into omega shape to
hold restorative material for core build up. The rest of the procedure is
as same as previous cases.

Coronal restorations after post placement:
• Remaining coronal structure can be restored with direct or
indirect technique or with single tooth prostheses like-
1. Strip crowns
2. Stainless steel crowns
3. Polycarbonate crowns
143

1. Stainless Steel Crowns:
• Rocky Mountain Company
introduced them in 1947
• Familiarized by Humphrey in 1950s.
• Stainless steel is composed of iron,
carbon, chromium, nickel,
manganese and other metals.
145

Advantages
• These crowns are far superior to multisurface amalgam
restorations with respect to life span, replacement, retention
and resistance.
• They are accepted both by patient and dentist
• They are also more cost effective
• Can be completed in a single appointment
146

• Less time consuming than cast restorations
• No need for laboratory procedures
• Less sensitive to moisture
• Less prone to fractures
• Longevity
• Durable as compared to multi-surface restorations
Disadvantages
Aesthetics are extremely poor.
147

2. Zirconia crown
• It is the next generation in pediatric restorative technology and
represents the perfect balance of art and science.
• Made from zirconia ceramic.
• Anterior and posterior primary teeth.
149

• Advantages of Zirconia Crown:
1) Esthetic.
2) Strength
3) Biocompatible
4) Decreased Chair time
5) No impression: only 1 visit
• Disadvantages:
1) No crimping, tooth must prepared to fit the crown
2) Saliva an hemorrhage must be controlled
3) Limited colure
4) Cost
150

3. Strip crown:
• Composite strip crowns are composite
filled celluloid crowns forms.
• Advantages
• It provides superior aesthetics
• The cost of materials are reasonable
• The time for placement is reasonable
151

Disadvantages
• It is extremely technique sensitive
• It is not as durable or retentive as stainless steel/open faced
crowns, pre-veneered crowns or zirconia crowns and is not
recommended on patients with a bruxism habit or a deep bite
• Adequate moisture control might be difficult on an
uncooperative patient.
152

ii. Teeth with intermediary coronal remnant:
• In some cases when tooth-reinforcing structures, such as marginal
ridges, are still present and the tooth displays a deep pulp
chamber, a definitive composite resin restoration only, without the
need of an intraradicular post can be chosen.
153

iii. Teeth with great coronal remnant:
• In some situations, the endodontically treated tooth does not
undergo a great coronal structure loss
• In these cases, which the tooth shows a great conservation of
the coronal structure remnant, the risk of fracture is low and
the restorative treatment includes only the execution of direct
composite resin or GIC or amalgam restorations to close the
endodontic access, with very good prognosis.
154

• Definitive restorative materials:
1. Amalgam
2. Glass ionomer cement
3. Composite
155

1. Amalgam:
• Dental amalgam has been the most commonly used restorative
material in posterior teeth for over 150 years
• It is still widely used throughout the world today
• Beazoglou T, Eklund S, Heffley D, Meiers, J, Brown LJ, Bailit H. Economic impact of
regulating the use of amal-gam restorations. Public Health Rep 2007;122(5):657-63.156

• In 1999, the NHMRC recommended amalgam should not be
placed in, or removed from, the dentitions of children.
• However, there is still no clear scientific evidence linking
amalgam restorations and systemic diseases or chronic illness
1.National Health and Medicine Research Council. Dental Amalgam and Mercury in
Dentistry: A report of a NHMRC working party. NHMRC: Canberra, 1999.
2 .Dodes JE. The amalgam controversy. An evidence-based analysis.J Am Dent Assoc
2001;132:348-356.
3. Meskin LH. Do no harm. J Am Dent Assoc 2001;132:1200- 1201.
157

• Advantages:
1. Ease of manipulation
2. Durability
3. Lower cost
4. Reduced microleakage with time
5. Reduced technique sensitivity compared to other restorative
materials.
• Lambert RL. Amalgam Restorations. In: Baum L, editor. Advanced Restorative
Dentistry Modern Materials and Technique. 1st ed. London: W.B Saunders
Company; 1979. p. 73-87. 158

Disadvantages:
1. Health effects of mercury vapour
2. Environmental concerns from its mercury content
3. Increased demand for aesthetic alternatives
159

• Recent Advancements
a) Mercury – free direct filling amalgam alloys:
• Mercury – free direct filling amalgam alloys consist of silver –
coated silver – tin (Ag - Sn) alloy particles
• This can be cold welded to form a compaction to form a
restoration
• A fluoroboric acid solution is used to keep the surface of the
alloy particles clean
• These alloys can be condensed into the prepared cavity similar to
the compaction of direct guide
160

• Advantage
• Easy to condense
• Disadvantage
• Alloy hardens rapidly

b) Gallium based alloys:
• Puttkammer (1928), suggested the use of gallium in dental
restoration
• Attempts to develop satisfactory gallium restorative materials
were unsuccessful until Smith et al in 1956, showed that
improved Pd-Ga and Ag-Ga materials has physical and
mechanical properties that were similar to or even better than
those of silver amalgam
• This alloy can be triturated with high copper amalgam alloy to
produce similar handling characteristics as conventional amalgam
Bader JD, Shugars DA. Understanding dentists’ restora-tive treatment decisions. J Pub
Health Dent 1992;52(2):102-11. 162

ADVANTAGES
• Rapid solidification
• Good marginal seal by expanding on solidification
• Heat resistant
• The compressive and tensile strength increases with time
comparable with silver amalgam
• It sets early so polishing can be carried out the same day
• They expand after setting therefore provides better marginal
seal

Disadvantages
• Surface roughness
• Marginal discoloration
• Setting expansion leads to fracture of cusps and post operative
sensitivity.
• Expensive

2.Glass ionomer cement:
• Glass ionomers cements have been used in dentistry since the
early 1970s
Conventional glass ionomer cement:
Advantages:
• Biocompatible
• Adhesive
• Aesthetic
• Fluoride leaching
• Material with favourable thermal expansion
and contraction properties
Berg JH. The continuum of restorative materials in pediatric dentistry—a review for the
clinician. Pediatr Dent 1998;20:93- 100. 165

Disadvantages:
• It is brittle,
• Radiolucent
• Susceptible to erosion and wear and
• Such restorations in primary dentitions are significantly more
likely to require replacement than amalgam restorations.
1.Cameron AC, Widmer RP, eds. Handbook of Paediatric Dentistry. London: Mosby-
Wolfe, 1995:62-63.
2.Milsom KM, Tickle M, Blinkhorn A. The prescription and relative outcomes of different
materials used in general dental practice in the northwest region of England to restore the
primary dentition. J Dent 2002;30:77-82. 166

• Recent Advancements:
a) Anhydrous:
• In this modification the liquid is delivered in a freeze dried form
that is then incorporated into the powder.
• The liquid to be used is clean water only, and this may enhance
shelf-life and facilitate mixing.
b) Resin – Modified:
• These are materials which have a small quantity of a resin into
the liquid formula.
• Less than 1% of photoinitiators are allowed for the setting
reaction to be initiated by light of the correct wavelength.
167

c) Nano-Ionomer:
• The Nano-Ionomer delivers greater wear resistance, esthetics and
polish compared to other glass ionomers, offers fluoride release
similar to conventional and resin-modified glass ionomer.
d) Compomer:
• This is the term developed by the manufacturer with a term to
incorporate some of the properties of glass ionomer with a
composite resins.
• A compomer is a composite resin that uses an ionomer glass which
is the major constituent of a glass ionomer as the filler.
168

e) Ceramic reinforced glass ionomer: Ceramic reinforced posterior
GIC features stronger compressive, flexural and tensile strengths as
compared to amalgam.
• RMGIC is more caries preventive than composite resin with or
without fluoride.
1.Toh SL, Messer LB. Evidence-based assessment of tooth-colored restorations in proximal
lesions of primary molars. Pediatr Dent 2007;29(1):8-15.
169

3.Composite restoration:
• Resin-based composite restorations were introduced in dentistry
about a half century ago as an aesthetic restorative material
1. Leinfelder KF. Posterior composite resins. J Am Dent Assoc 1988;117(4):21E-26E.
2. Minguez N, Ellacuria J, Soler JI, Triana R, Ibaseta G. Advances in the history of
composite resins. J Hist Dent 2003;51(3):103-5. 170

• Types of Composite
a) Traditional composites
b) Small particle composites
c) Microfilled composite resins
d) Hybrid composite
171

• Advantages
• Aesthetics
• Conserve tooth structure
• Adhesion
• Low thermal conductivity
• Universal application
• Ease of manipulation
• Repairable
• Can be polished at the same appointment
172

• Disadvantages
• Polymerization shrinkage
• Technique sensitivity
• Time – consuming and expensive
• Difficult to finish and polish
• Increased coefficient of thermal expansion
173

• Recent Advancements
a) Packable/Condensable or Polymeric Rigid Inorganic
Matrix Material (PRIMM)This system is composed of a
resin matrix and an inorganic ceramic component
b) Flowable Composite: Flowable composites were developed
mainly in response to fulfill special handling properties for
composite resins rather than any clinical performance criteria
174

c) Nanocomposites: Nanoparticle filled composites exhibit
outstanding esthetics. They are easy to polish and possess an
enhanced wear
d) Antimicrobial Materials: Antimicrobial properties of
composites may be accomplished by introducing agents such as
silver or one or more antibiotics into the material
175

Authors
and Years
Aim Study design Results Conclusion
R.
Liberma
n, , A.
Ben-
Amar, ,
E.
Frayberg,
, I.
Abramov
itz, , and
Z.
Metzger.
In 2001
Effect of
Repeated
Vertical
Loads on
Microleakage
of IRM and
Calcium
Sulfate-
Based
Temporary
Fillings.
IRM and Cavidentin were selected to
represent two widely used groups of
temporary filling materials. The first is
a reinforced zinc oxide-eugenol
preparation that is mixed at chairside,
whereas the second is a ready-to-use
calcium sulfate-based material that
gained popularity due to its convenience
of application. The seal provided by the
aforementioned materials was studied
using a radioactive tracer quantitative
assay. When compared as passive
temporary filling, the two provided a
similar quality of seal. However, when
subjected to repetitive “occlusal” cyclic
loading of 4 kg, IRM was clearly
superior to the calcium sulfate-based
material. Whereas IRM maintained a
reasonable seal, the calcium sulfate-
based fillings deteriorated and lost
the ability to seal.
These results
suggest that
even
though
calcium
sulfate-based
materials
may be
useful when
not subjected
to any
occlusal
forces,
IRM should
be preferred
whenever
occlusal
loads
may be
applied.
testing
such
materials
for
microleaka
ge with
no
reference
to
masticatio
n forces
may be of
limited
value.
Temporary

Authors
and Years
Robert R.
Galvan,
Jr., Lesley
A. West,
Frederick
R.
Liewehr,
and
David H.
Pashley in
2002.
The purpose of
this study was
to quantitatively
compare the
sealing
effectiveness of
five restorative
materials that
were used to
create an
intracoronal
double seal.
Fifty-two extracted mandibular
molars were randomly divided
into five groups of 10 teeth and
one positive and one negative
control tooth. The crowns were
removed and the pulpal floor and
canal orifices were sealed with 3
mm of one of the following
materials: Amalgabond, C&B
Metabond, One-Step Dentin
Adhesive with eliteflo composite,
One-Step with Palfique composite
or intermediate restorative
material (IRM). Each tooth was a
fixed to a fluid filtration device
and the seal was evaluated at 0, 1,
7, 30, and 90 days.
The results
showed a
significant
difference in
leakage
between the
materials. At
7 days, IRM,
eliteflo, and
Palfique
leaked
significantly
more than
Amalgabond
or C&B
Metabond.
Amalgabond
consistently
produced the
best seal
of all the
materials
throughout
the duration
of the study.

Authors
and Years
Rapepha
n
Nagasiri
, and
Somsak
Chitmon
in 2004
The aims
of this
cohort
study
were to
evaluate
the
survival
rate for
endodonti
cally
treated
molars
without
crown
coverage
and to
identify
possible
related
factors
A total of 220 endodontically
treated permanent molar teeth
in 203 subjects on a waiting
list for fixed prosthodontic
treatment were included.
Follow-up data were derived
from a clinical examination
and review of the dental record
and radiographs. The outcome
evaluated was defined as a
failure if there were negative
findings in the condition of a
tooth that required a
restoration, tooth repair, or
extraction. The independent
variables assessed were patient
age, gender, location (maxilla
or mandible), the existence of
an opposing dentition and
adjacent teeth, remaining tooth
structure, and types of
restorative material.
Overall survival rates of
endodontically treated
molars without crowns at
1, 2, and 5 years were
96%,88%, and 36%,
respectively. With greater
amounts of coronal tooth
structure remaining, the
survival
probabilityincreased.
Molar teeth with
maximum tooth structure
remaining after
endodontic treatment had
a survival rate of 78% at
5 years. Restorations with
direct composite had a
better survival rate than
conventional amalgam
and reinforced zinc oxide
and eugenol with
polymethacrylate
Within the
limitations
of this
study, the
amount of
remaining
tooth
structure
and types
of
restorative
material
have
significant
association
with the
longevity of
endodontic
ally treated
molars
without
crown

Authors
and Years
Hanan
balto,
Saad Al-
Nazhan,
Khulood
Al
Mansour,
Moneera
Al-Otibi,
Yunus
Siddique
in 2005
The aim of this
study was to
evaluate the
integrity of the
coronal seal of
Temp-Bond and
compare it to Cavit
and IRM after post
space preparation
using S. faecalis as
a microbial tracer.
In addition, the
affect of two
methods of gutta
percha removal on
the apical seal of
root canal fillings
was also evaluated.
40 extracted human single rooted teeth
were prepared chemomechanically
and obturated with gutta percha and
AH26 sealer cement using the lateral
cold condensation technique to a
standardized working length of 15mm.
About 10 mm of the coronal gutta-
percha was removed. The roots were
divided into three experimental groups
of 10 roots and a control group. Each
experimental group was subdivided
equally into two groups of 15 each
according to the method of post space
preparation. Cavit,
IRM, and Temp-Bond were used to
seal the access opening. Each root was
fixed in a cuvette containing Tryptic
Soya Broth which, covered 2 mm of
the root apex. Bacterial suspension
was introduced through
pipette. Fresh bacterial suspension
was added every week, and the system
was monitored daily for the growth of
microorganisms for a period of one
month.
The results
showed there
was no
significant
difference in
terms
of coronal
leakage
between the
three coronal
materials used
but the
methods of
gutta-percha
removal did
have an impact
on the apical
leakage
the temporary
type of coronal
seal of
endodontically
treated teeth
will not
prevent
coronal
leakage if
left for a long
period of time.
In addition,
permanent
cementation of
the post with
the coronal
restoration
should
be carried out
as soon as
possible to
prevent
recontaminatio
n of the root
canal

Authors and
Years
Dong-Ho
Jung, Young-
Sin Noh,
Hae-Doo
Lee, Hoon-
Sang Chang,
Hyun-Wook
Ryu, Kyung-
San Min in
2008
The purpose of
this study was
to compare the
sealing
abilities of four
endodontic
temporary
restorative
materials using
a methylene
blue dye
penetration test
under dynamic
loading
Standardized access cavities
were prepared in forty-four
intact human permanent molar
teeth and the cavities were
restored with Caviton, MD-
Temp, IRM, or ZOE. After
thermocycling, an intermittent
load of 98 N at 1 Hz was
applied for 1,000 cycles to the
long axis of the functional cusp
of each of the teeth, which were
immersed in a 1% methylene
blue solution. The teeth were
split in half, and the linear
depth of dye penetration was
evaluated according to the
criteria.
The results
were
analyzed
using one-way
ANOVA and
Duncan’s
multiple range
test. The
results
demonstrated
that Caviton
and MD-
Temp showed
significantly
lower
microleakage
than IRM and
ZOE
It
was
concluded
that Caviton
and MD-
Temp
exhibited
better sealing
ability than
IRM and
ZOE under
dynamic
loading

Authors
and
Years
GREWA
L N.,
SETH R.
in 2008
This study was
designed to
compare the
success rate of
biological and
composite
restorations when
used to replace
structural loss of
primary anterior
teeth using
intracanal post for
radicular support
of the restoration.
Forty-two patients aged between
3–5 years presenting with early
childhood caries (ECC) received
atleast one or more composite
and biological restorations for
comparative evaluation. A total of
150 restorations were done
(75biological restorations and 75
composite restorations). The
restorations were evaluated
single-blind according to a
modified USPHS system.
Assessment of the patient’s
response in accepting a biological
restoration, psychological impact
of the restorations, view of the
parents, and peer group reviews,
etc. were recorded in a response
sheet in presence of the child and
the parents.
In vivo clinical
performance of
biological post and
crown restorations and
intracanal reinforced
composite
restorations was
comparable with
respect to shade
match, marginal
discoloration,
marginal integrity,
surface fi nish,
gingival health,
retention, and
recurrent carious
lesions. The cost
effectiveness of
biological restorations
was certainly a
positive attribute.
The biological
restoration
presented as a
cost effective,
clinician
friendly, less-
technique
sensitive, and
esthetic
alternative to
commercially
available
restorative
materials used
for restoring
deciduous
teeth affected
by ECC.

Authors and
Years
Natasha
Capitani
Symanski
Paola
Juber
Renata
Dornelles
Morgental
Roberta
Kochenbor
ger
Scarparo
Fabiana
Vieira
Vier-
Pelisser in
2013
To
evaluating
which
temporary
restorative
materials are
recommende
d by
Brazilian
Dental
Schools
(BDS),
during and
after
endodontic
treatment
completion.
A questionnaire was
distributed to all 191
BDS, and returned
by 55 (28.8%)
schools. Topics of
interest included:
which temporary
restorative materials
are advised in
different remaining
dental conditions
and different
permanence periods
in the mouth,
minimum material
thickness,
intermediate
Material application,
use of matrix band
and factors
influencing material
selection.
The answers showed that the
remaining coronal tooth
structure significantly
interferes with the choice of
temporary restorative materials.
On the other hand, time between
appointments does not have
significant influence on material
selection. Glass ionomer cement
(GIC) is the most commonly
used material in long periods,
especially for access cavities
involving proximal surfaces or
fractured cusps. The utilization
of an intermediate material is
very variable and some schools
do not advocate any material.
Most BDS recommend a
minimum thickness of 3 mm for
temporary restorations
and the use of matrix band in
proximal surfaces
BDS
choices
with
respect to
coronal
sealing
materials
are driven
especially
by
remaining
dental
conditions

Authors
and Years
Khyaati
Gidwani,
Prashanthi
Sampath
Madhyasth
a, Khyaati
Gidwani,
N. Srikant,
Ethel
Suman,
Ravindra
Kotian in
2014
To compare
the sealing
ability and
antimicrobi
al activity
of three
temporary
sealing
materials:
Caviton,
MD Temp
and IRM
In the present in vitro
study, sealing
ability (dye
penetration method
using 2% methylene
blue) was measured
with class I cavities on
human
molars restored using
test materials. The
antimicrobial activity
(agar diffusion test) of
the materials was
evaluated against
Streptococcus mutans
(MTCC 497 and
clinical isolate) and
Candida albicans
(ATCC
60193 and clinical
isolate)
IRM produced best
marginal sealing and was
also associated with higher
antimicrobial activity in
comparison to Caviton and
MD Temp. The inferior
properties of MD temp can
be attributed to thermal
instability demonstrated
by MD Temp leading to an
inadequate seal, and also
failed to produce a zone of
inhibition. IRM proved
effective and superior to
Caviton and MD Temp in
both these aspects.
The success of
an endodontic
treatment
depends on the
effective seal
achieved
following
debridement.
This study
stresses the
need for
an adequate
marginal seal
along with
satisfactory
antibacterial
potential for a
temporary
sealing
material.

Authors
and Years
Neeti
Mittal,
Hind Pal
Bhatia,
Khushtar
Haider in
2015
To assess how the
various methods of
intracanal
reinforcement (short
root canal posts)
performed in their
clinical and
radiographic
outcomes for
restoring grossly
broken down primary
anterior teeth after
pulpectomy for 1 year
or longer follow-up
period.
Literature search of
electronic databases (Sept
2013) and various
journals (1980-Sept 2013)
using medical subject
headings and free text
terms was conducted. For
inclusion in quality
assessment, prespecified
inclusion criteria were
applied. Quality
assessment was
performed by using ‘The
Cochrane collaboration’s
tool for assessing risk of
bias’.
Seven
relevant
papers were
selected for
full text
evaluation.
After applying
the inclusion
criteria, only
two trials
could be
considered for
quality
assessment.
Both of these
were
classified as
having high
risk of bias.
The evidence
to support any
method of
intracanal
reinforcement
for restoring
grossly
broken down
anterior teeth
is presently
lacking.
Further trials
with well-
defined
methodology
are needed.

Author
s and
Years
Igor
Kriznar
a, Katja
Seme
b, Ales
Fidler
in 2016
to assess
bacterial
microleakage
of materials
used for
short- and
long-term
temporization
One hundred and twenty-eight
human upper-third molars
were divided into six
experimental groups and two
control groups: negative and
positive . The standardized
access cavities were prepared
and filled with: (1) Cavit;
(2) Fuji II LC (3) Fuji IX (4)
Voco Clip (5) AdheSE and
Tetric EvoCeram (6) Excite
and Tetric EvoCeram. The
crown of each tooth was
sectioned to obtain 5.5-mm-
high disks, which were
assembled in a standard setup
for bacterial microleakage
studies using Streptococcus
mutans.The monitoring lasted
90 days.
The lowest amount of leaking
samples was found in AdheSE
and Tetric EvoCeram (31.3%),
Cavit (33.3%), and Excite and
Tetric EvoCeram groups
(35.3%), followed by Fuji II LC
(66.7%), Voco Clip (83.3%).
and Fuji IX (88.2%) groups.
According to the day of
microleakage, materials could
be classified in three groups . In
the first group were Cavit (70
days), AdheSE and Tetric
EvoCeram (68 days),
and Excite and Tetric
EvoCeram (65 days), in the
second group were Voco Clip
(44 days) and
Fuji II LC (43 days), and in the
third group was Fuji IX (21
days)
None of the
tested
materials
were able to
completely
prevent
bacterial
microleakage
.
Adhesively
bonded
composites
and Cavit
offer better
sealing
compared
with glass
ionomer

Authors
and Years
S.
Deepak,
M. S.
Nivedhit
ha in
2017
The aim of this
in vitro study
was to
compare the
coronal seal of
three
temporary
filling
materials
(Cavit-G, zinc
oxide eugenol
[ZOE], and
Intermediate
Restorative
Material
[IRM]) by
methylene blue
dye penetration
test
In this study, 34 extracted with no
decay mandibular and maxillary molar
teeth were used. The teeth were divided
into three groups of 10 teeth and two
positive and negative control groups of
4 teeth. In the experimental group, 4 × 4
mm endodontic access cavity was
created on the occlusal surface, and in
each group, the teeth were filled with
Cavit-G, ZOE, and IRM. In the positive
control group, access cavity was
prepared, but the restorative material
was not used. In the negative control
group, access cavity was not prepared.
Experimental groups (teeth) were
placed in normal saline for 2 h and then
immersed in methylene blue dye for 1
week. Following which longitudinal
sectioning of tooth was done with
diamond disc and dye penetration was
measured using a periodontal probe.
ZOE
showed
significantl
y more
(micro)
leakage
than Cavit-
G and IRM.
No
statistically
significant
difference
between
Cavit-G
and IRM.
According
to the
findings of
the present
in vitro
study, low
microleaka
ge and
canal
contaminati
on were
found for
Cavit-G
and IRM
temporary
restorative
materials in
comparison
to ZOE

Conclusion
“ Primary teeth are a temporary dentition with known life
expectancies of each tooth. By matching the ‘right’ restoration
with the expected lifespan of the tooth, we can succeed in
providing a ‘permanent’ restoration that will never have to be
replaced.”
188

References
1. McDonald RE, Avery DR. Restorative dentistry. Dean JA,
editors. Dentistry for the child and adolescent. 8th ed. St.
Louis: Mosby; 2004. p. 376.
2. Prashant Babaji. Crowns in pediatric ddentistry; 5th Edition;
2015
3. Nikhil Marwah.Textbook of Pediatric Dentistry; 3rd edition.
4. Shobha Tandon. Textbook of Pedodontics, 2nd edition
5. Pinkham, Casamassimo, Fields, McTIGUE,NOWAK;
Pediatric Dentistry infancy through adolescence, 4th edition

6. Carla Castiglia Gonzaga,Edson Alves de Campos, Flares
Baratto-Filho; Restoration of endodontically treated teeth; RSBO.
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damage to the adjacent surface of primary molars in three
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10. Pashley EL, Tao L, Pashley DH. The sealing properties of
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12. Mayer T, Eickholz P. Microleakage of temporary restorations
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14. Jacquot BM, Panighi MM, Steinmetz PG, Sell C. Microleakage
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15. Rud J, Munksgaard EC, Andreasen JO, Rud V, Asmussen E :
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16. Lehtinen R : Tissue reaction of a glass ionomer cement in the
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