Dentaltown August 2018 - 83

by Dr. Isaias Íñiguez
Dr. Isaias Íñiguez graduated from La Universidad
Autónoma de Baja California and went on to
complete a postgraduate program in aesthetic
dentistry from Baylor College of Dentistry in
Dallas. Íñiguez was the first Latin American
dentist accredited by the American Academy of
Cosmetic Dentistry (AACD) in 1998; he continues
to be the only accredited member of the AACD
with a practice in Mexico. Íñiguez is also an active
member of the American Dental Association, the
California Dental Association and the Asociación Dental Mexicana.

Can We Fix It?
An in-depth look at cusp replacement using
composite, pins and polyethylene fibers
Introduction

Clinical significance

This article suggests blending two different techniques-
titanium pins with high-strength polyethylene fibers-within
one procedure. Using the different reinforcing architectures
is beneficial to matching substrate properties and ensures
retention of restorative material. They reduce stress and
provide an even distribution of force throughout mastication.

Posterior cavities needing a cusp replacement are usually
treated with laboratory-fabricated onlays, direct/indirect
restorations, or crowns. This case demonstrates immediate
cuspid reconstruction, optimizing the potential of direct
posterior composite restorations. When used correctly, this
has many advantages over other restorative methods.
For more than four decades, composites have been used in
posterior teeth; unfortunately, the initial clinical performance
of the first posterior composites weren't ideal.1 These days,
composites have improved their physical, mechanical and
adhesive properties,2 but wear and marginal leakage remain a
concern.3 Recent long-term clinical evaluations demonstrate
that composites are an acceptable alternative for posterior
teeth within certain clinical parameters.4,5 If clinicians are
adequately skilled and familiar with most of the adhesive
dentistry secrets, then they will extend the indication for
direct restorations into a more destroyed tooth.6
The placement of a Class II composite restoration is
often associated with undesirable effects of shrinkage such
as an interfacial gap formation.7,8 Sometimes, because of
composite shrinkage, the material pulls away from the
cavity wall during polymerization.9,10 This may contribute
to a microgap formation, which permits the entry of bacteria
and oral fluid11,12 and results in hypersensitivity and staining
of the margins and recurrent caries.13

Case study No. 1
A 55-year-old male patient had chief complaints of a
broken tooth and hypersensitivity in the mandibular lower
right side. He also presented a fractured amalgam with a
missing distobuccal cusp of the first molar. He requested to
have the restoration done within one appointment.

Materials, methods and results
To provide the adequate strength to sustain the masticatory forces and fractures, a titanium pin was inserted
following the adhesive procedures. To reduce microleakage,
a composite was incrementally placed, with reinforcement of
the polyethylene fiber layers well adapted between increments.
When the patient returned a year later, the restoration
was in very good condition. In this particular situation, a
direct reinforced composite restoration was the optimal
choice because it may have some advantages over other
conventional approaches.

dentaltown.com \\ AUGUST 2018

http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown August 2018