Biological restoration

JOURNAL CLUB

1. JOURNAL CLUB Biological restoration: A 4/5 crown JISPPD| Oct-Dec 2013 | Vol 31| Issue 4 | Monize Ferreira Figueiredo de Carvalho, Adriana M. Botelho1, Karine T. A. Tavano1, Vanessa C. S. fernandes PRESENTED BY KARUNA SHARMA

2. Introduction Dental caries (tooth decay) is one of the most prevalent conditions in humans throughout the world , especially in childhood . Sanches K, de Carvalho FK, Nelson-Filho P, Assed S, Silva FW, de Queiroz AM. Biological restorations as a treatment option for primary molars with extensive coronal destruction –Report of two cases. Braz Dent J 2007;18:248- 52.

3. According to 1999-2004 National Health and Nutrition Examination Survey 42% of children in the age group of 2 to 11 years have had dental caries in their primary teeth.

4. The aim of restorative dentistry is to recreate the anatomy of the affected tooth through the replacement of the lost tissue, thereby reestablishing shape, chewing function, speech and esthetics. 1 . Sanches K, de Carvalho FK, Nelson-Filho P, Assed S, Silva FW, de Queiroz AM. Biological restorations as a treatment option for primary molars with extensive coronal destruction – Report of two cases. Braz Dent J 2007;18:248-52. 2 . Raghu R, Srinivasan R. Optimizing tooth form with direct posterior composite restorations. J Conserv Dent 2011;14:330- 6.

5. A variety of materials have been employed in the restoration of teeth with considerable decay, such as amalgam , composite resin, ceramic, metalloplastic , metalloceramic and forged metal . Reis A, Lourguercio AD. Tooth fragment reattachment current treatment concepst . Pract Period Aesthet Dent 2004;16:739-40.

6. However, no synthetic material is capable of replicating the esthetic characteristics or color stability of natural teeth. Grewal N, Seth R. Comparative in vivo evaluation of restoring severely mutilated primary anterior teeth with biological post and crown preparation and reinforced composite restoration. J Indian Soc Pedod Prev Dent 2008;26:141-8

7. Thus, a number of researchers have suggested the use of fragments from the natural teeth as an effective restorative method. Corrêa-Faria P, Alcântara CE, Caldas-Diniz MV, Botelho AM, Tavano KT. “Biological restoration”: Root canal and coronal reconstruction. J Esthet Restor Dent 2010;22:168-77. This procedure is known as “biological restoration.” Cavity preparation should be non-retentive and the fragment is retained with adhesive materials.

8. The expression “biological restoration” was coined by Santos and Bianchi in 1991. Santos J, Bianchi J. Restoration of severely damaged teeth with resin bonding systems: case reports. Quintessence Int 1991;22:611-615.

9. The concept of biological restoration is based on the use of material from a tooth bank or a duly donated tooth for the purposes of reconstruction.

10. The aim is to ensure the best physical and mechanical properties, such as shape, surface texture, biocompatibility, resistance to wear and a linear thermal expansion coefficient similar to that of the sound dental tissue as well as an excellent emotional response on the part of the patient to the resulting esthetics. Tavano KT, Botelho AM, Motta TP, Paes TM. Biological restoration: Total crown anterior. Dent Traumatol 2009;25:535-40.

11. Nonetheless, a number of limitations are inherent to this technique, such as the difficulty in finding a tooth with a similar color and shape to the damaged tooth and the patient’s refusal to accept a tooth from another individual. Busato AL, Loguercio AD, Barbosa AN, Sanseverino Mdo C, Macedo RP, Baldissera RA. Biological restorations using tooth fragments. Am J Dent 1998;11:46-9.

12. The first paper reporting the use of fragments of extracted teeth as dental restorative materials was published in 1964 by Chosak and Eidelman . Chosack ABDS, Eidelman EDO. Rehabilitation of a fractured incisor using the patient’s natural crown - case report. J Dent Child 1964;31:19-21.

13. Ramires-Romito et al used teeth from the human tooth bank of Sao Paulo University Dental School to be used as natural posts and crowns to fit into the roots and replace the crowns as well . Ramires Romito ACD., Wanderley MT, Oliveira MDM, Imparto JCP, Pires Correa MSN. Biologic restoration of primary anterior teeth. Quint Int 2000; 31: 405-11.

14. This paper describes a clinical case demonstrating the quality and functionality of a biological restoration performed to reestablish function and esthetics to a posterior tooth.

15. Case Report A 26-years-old female patient visited the dental clinic of the Universidade Federal dos Vales do Jequitinhonha e Mucuri (Brazil) seeking treatment for an esthetically compromised tooth (#24). The clinical exam revealed fracture of the entire vestibular face, terminating in the enamel of the cervical face [Figure 1].

16. Figure 1: Clinical Exam and prepared 4/5 crown

17. The radiographic exam revealed that the tooth in question exhibited satisfactory endodontic treatment. The treatment options were then presented to the patient and biological restoration was selected as the procedure of choice . The patient then signed a statement of informed consent.

18. The technique consisted of the regularization of the tooth and the subsequent creation of a filling nucleus with photopolymerizable composite resin. The cavity was then prepared for an inverted 4/5 crown due to the involvement of the vestibular face [Figure 1].

19. A cast was made of the arches and the position of the maxilla in maximum intercuspation was recorded to facilitate the cutting and adjustment of the tooth fragment. A temporary restoration was then performed.

20. A duly donated extracted tooth 24 with similar color and dimensions to the damaged tooth was then selected and sterilized in an autoclave at 121°C for 15 min. Corrêa-Faria P, Alcântara CE, Caldas-Diniz MV, Botelho AM, Tavano KT. “Biological restoration”: Root canal and coronal reconstruction. J Esthet Restor Dent 2010;22:168-77. With the aid of a thickness gauge, a number of cuts were made to donated tooth with diamond-tip burs under intense refrigeration until achieving a fragment similar in shape to the prepared cavity.

21. Figure 2: Extracted tooth selected

22. Once the fragment was adequately adapted to the cast [Figure 3], the initial occlusal adjustments were made on the articulated model to facilitate the procedure [Figure 4].

23. Figure 3: Tooth fragment adapted to the cast

24. Figure 4: Occlusal adjustments on model and tested on oral cavity

25. The dental fragment was then tested on the prepared tooth in the oral cavity [Figure 4]. Following absolute isolation of the operating fi eld , the tooth and fragment were both etched with a 37% phosphoric acid solution for 30 s on the enamel and 15 s on the dentin. The etched regions were then rinsed and dried. The primer was applied to both substrates and photopolymerized for 20 s.

26. The fragment was then bonded using a duo resin cement. Prior to photopolymerization , the excess cement was removed and the final occlusal adjustments were made. Further clinical and radiographic exams were performed after a 12 months period [Figure 6]. The restoration was stable, with no signs of caries, migration of the fragment or marginal infiltration.

27. Figure 5: Clinical and radiographic immediately aspect

28. Figure 6: Clinical and radiographic aspect after 12-months

29. Discussion The use of a donated tooth fragment for biological restorations is often viable for teeth with extensive crown damage. Sanches K, de Carvalho FK, Nelson-Filho P, Assed S, Silva FW, de Queiroz AM. Biological restorations as a treatment option for primary molars with extensive coronal destruction –Report of two cases. Braz Dent J 2007;18:248-52.

30. This method replaces the lost dental tissue and reestablishes function, natural anatomic characteristics and esthetics. 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. Moreover, the low cost allows the use of this technique in public oral health-care. Corrêa-Faria P, Alcântara CE, Caldas-Diniz MV, Botelho AM, Tavano KT. “Biological restoration”: Root canal and coronal reconstruction. J Esthet Restor Dent 2010;22:168-77.

31. Biological restoration is an alternative to complex restorations with amalgam, composite resin and porcelain. Santos JFF, Bianchi J. Restoration of severely damage teeth a with resin bonding systems: Case Report. Oper Dent 1999;22:611-15.

32. Although the synthetic restorative materials have achieved a high degree of development and stability, none completely satisfies the requirements for the replacement of the lost dental tissue in terms of function and esthetics. Pegoraro CN, Domingues LA, Trassi PMMM. Biological onlay : An alternative technique for restoration of severely damaged posterior tooth. A case report. Rev Dent Press Estét 2006;3:114-5.

33. As biological restoration is a homogeneous technique, changes are not expected as those found in composite resin restorations, such as discoloration of the restorative material over time in comparison to the surrounding tooth. Grewal N, Seth R. Comparative in vivo evaluation of restoring severely mutilated primary anterior teeth with biological post and crown preparation and reinforced composite restoration. J Indian Soc Pedod Prev Dent 2008;26:141-8.

34. The main difficulty regarding biological restoration consists of selecting a tooth with comparable color, shape and size to the tooth to be restored. Compatible teeth can be acquired from a tooth bank or a legally donated extracted tooth that has been appropriately stored. Reis A, Kraul A, Francci C, Assis TGR, Crivelli DD, Oda M, Loguercio AD. Re-attachment of anterior fractured teeth: Fracture strength using different materials. Oper Dent 2002;27:621-7.

35. The donated tooth should be submitted to a rigorous sterilization process to completely eliminate the risk of contamination and the transmission of diseases. Cru E, Carpenter WM. Extracted teeth — descontamination , disposal and use. J Cal Dent Assoc 1997;25:801-4 . A number of safe sterilization and storage methods are currently available.

36. Sterilization can be performed with the use of an autoclave, 10% formalin, thymol , ethylene oxide and radiation and the tooth can be stored in 10% formalin, thymol , sodium hypochlorite, glutaraldehyde or sodium azide . Kumar M, Sequeira P, Peter S, Bhat G. Sterilisation of extracted human teeth for educational use. Ind J of Med Microb 2005;23:256-8. Lolayekar NV, Bhat SS. Disinfection methods of extracted human teeth. J Oral Health Comm Dent 2007;1:27-9.

37. For the execution of a biological restoration in posterior teeth, the cavity to be prepared must be expulsive and must terminate in the enamel. Casting is necessary after the preparation of the cavity. As with any indirect restoration, the laboratory phase is a critical step. The cutting of the fragment requires professional experience for the adequate adaptation to the plaster model and subsequent placement on the tooth to be restored.

38. Several materials have been used for bonding dental fragments to cavities, e.g., adhesive systems, composite resins, glass ionomer cements and dual- cure resin cements . Busato ALS, Loguercio AD, Barbosa NA, Sanseverino MCS, Macedo RP, Baldissera RA. Biological restorations using tooth fragments. Am J Dent 1998;11:46-48.

39. The use of fragments from extracted natural teeth is viable for situations in which restorative materials with adequate physical properties are desired for the reestablishment of function and esthetics in teeth having lost a large amount of tissue. While, biological restorations have considerable clinical applicability and offer the advantages of a superior esthetic outcome as well as indisputable psychological and social impacts, such restorations do not replace existing restorative techniques.

40. Thus, biological restoration cannot be considered the best option, only the most biological option and should be well planned considering each case on an individual basis. Pegoraro CN, Domingues LA, Trassi PMMM. Biological onlay : An alternative technique for restoration of severely damaged posterior tooth. A case report. Rev Dent Press Estét 2006;3:114-5.

41. Conclusion The purpose of this case report was to show readers that biological restoration is a viable alternative for reestablishing function and esthetics to damaged/decayed teeth.

42. REFERENCES 1. Sanches K, de Carvalho FK, Nelson-Filho P, Assed S, Silva FW, de Queiroz AM. Biological restorations as a treatment option for primary molars with extensive coronal destruction – Report of two cases. Braz Dent J 2007;18:248- 52. 2. Raghu R, Srinivasan R. Optimizing tooth form with direct posterior composite restorations. J Conserv Dent 2011;14:330-6. 3. Reis A, Lourguercio AD. Tooth fragment reattachment current treatment concepst . Pract Period Aesthet Dent 2004;16:739-40.

43. 4. Grewal N, Seth R. Comparative in vivo evaluation of restoring severely mutilated primary anterior teeth with biological post and crown preparation and reinforced composite restoration. J Indian Soc Pedod Prev Dent 2008;26:141-8. 5. Corrêa-Faria P, Alcântara CE, Caldas-Diniz MV, Botelho AM, Tavano KT. “Biological restoration”: Root canal and coronal reconstruction. J Esthet Restor Dent 2010;22:168-77. 6. Tavano KT, Botelho AM, Motta TP, Paes TM. Biological restoration: Total crown anterior. Dent Traumatol 2009;25:535-40.

44. 7. Busato AL, Loguercio AD, Barbosa AN, Sanseverino Mdo C, Macedo RP, Baldissera RA. Biological restorations using tooth fragments. Am J Dent 1998;11:46-9. 8. 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. 9. Santos JFF, Bianchi J. Restoration of severely damage teeth a with resin bonding systems: Case Report. Oper Dent 1999;22:611-15.

45. 10. Pegoraro CN, Domingues LA, Trassi PMMM. Biological onlay : An alternative technique for restoration of severely damaged posterior tooth. A case report. Rev Dent Press Estét 2006;3:114-5. 11. Reis A, Kraul A, Francci C, Assis TGR, Crivelli DD, Oda M, Loguercio AD. Re-attachment of anterior Fractured teeth: Fracture strength using different materials. Oper Dent 2002;27:621-7. 12. Cru E, Carpenter WM. Extracted teeth- descontamination , disposal and use. J Cal Dent Assoc 1997;25:801-4.

46. 13. Kumar M, Sequeira P, Peter S, Bhat G. Sterilisation of extracted human teeth for educational use. Ind J of Med Microb 2005;23:256-8. 14. Lolayekar NV, Bhat SS. Disinfection methods of extracted human teeth. J Oral Health Comm Dent 2007;1:27-9. 15. Imparato JCP, Bonecker MJS, Duarte DA, Guedes Pinto AC. Restorations in anterior primary teeth: an alternative technique

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