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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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CASE REPORT
Year : 2021  |  Volume : 39  |  Issue : 3  |  Page : 325-328
 

Total crown replacement technique: A biological treatment option for grossly destructed primary molars


Department of Pediatric and Preventive Dentistry, Subharti Dental College and Hospital, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India

Date of Submission27-Sep-2020
Date of Acceptance13-Jan-2021
Date of Web Publication22-Nov-2021

Correspondence Address:
Dr. Nikhil Srivastava
Department of Pediatric and Preventive Dentistry, Subharti Dental College and Hospital, Swami Vivekanand Subharti University, Subhartipuram, NH - 58, Meerut - 250 005, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jisppd.jisppd_419_20

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   Abstract 


Background: Restoration of severely damaged primary molars with very short clinical crowns is a big challenge and often extracted due to the lack of restorative options. Total crown replacement (TCR) is a novel treatment alternative for the restoration of such teeth through bonding of the biological restorations which are the sterile decoronated crowns of the extracted human teeth, obtained from a tooth bank. Case Report: Presented here is a report of two cases restored with the TCR technique. A 9-month follow-up showed satisfactory results in terms of function, esthetics, gingival health, and morphology including occlusal wear. TCR can be a viable and economical alternative for restoration of severely decayed/damaged primary teeth, otherwise indicated for extraction.


Keywords: Biological restoration, primary teeth, total crown replacement


How to cite this article:
Srivastava N, Rana V, Pande P, Singh P. Total crown replacement technique: A biological treatment option for grossly destructed primary molars. J Indian Soc Pedod Prev Dent 2021;39:325-8

How to cite this URL:
Srivastava N, Rana V, Pande P, Singh P. Total crown replacement technique: A biological treatment option for grossly destructed primary molars. J Indian Soc Pedod Prev Dent [serial online] 2021 [cited 2021 Dec 7];39:325-8. Available from: https://www.jisppd.com/text.asp?2021/39/3/325/330711





   Introduction Top


Early childhood caries (ECCs) is the presence of one or more decayed (noncavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth in a child under the age of six.[1] ECC is a multifactorial disease[2] and can be classified as mild, moderate, and severe depending on the extent of the loss of tooth structure. If left untreated, it may result in several undesirable sequelae such as pain, swelling, difficulty in mastication, unaesthetic appearance, and untimely loss of the tooth.[3]

Caries prevalence and severity in the primary dentition of children are high, and untreated tooth decay in the primary dentition is a common and global phenomenon. Grossly decayed primary molars with very short clinical crown height are considered as nonrestorable and usually indicated for extraction even if the radicular health of these teeth appears normal. Such primary teeth can be effectively restored with a novel total crown replacement (TCR) technique which utilizes the adhesive capabilities of restorative materials to bond the sterile decoronated crowns of the extracted human primary molars (biological restorations [BRs]) of the appropriate size on the grossly destructed teeth.

This article describes the management of two cases of grossly mutilated primary molars with TCR by utilizing the BRs.


   Case Reports Top


Case 1

A 7-year-old girl reported with the chief complaint of the cavity. Oral examination revealed grossly carious and exposed tooth number 75, but two-third of root length were remaining as observed radiographically [Figure 1].
Figure 1: (a-d) Biological restoration using total crown replacement technique on tooth number 75. (a and b) Preoperative photograph and intraoral periapical radiograph. (c and d) Nine-month postoperative photograph and radiograph

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The tooth was planned for TCR using BR, and informed consent was obtained from the parents.

After pulpectomy, the pulp chamber was restored with type II glass-ionomer cement and serrations were prepared buccolingually on the surface [Figure 2]. Tooth preparation was done with supragingival margins. Then, the impression was made and casts of both the arches were obtained. The mesiodistal dimension was taken using Vernier caliper on the cast, in order to obtain a correct size of BR from the tooth bank.
Figure 2: Buccolingual serrations and supragingival margins of the prepared tooth

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The appropriate size of BR was selected from the tooth bank, decoronated at the cement-enamel junction, and the pulp chamber was excavated [Figure 3] and restored with nanohybrid composite after acid etching. The final occlusal height adjustment of BR was done on the cast without touching its occlusal surface. Buccolingual serrations were then made on the surface to be bonded.
Figure 3: Decoronation of biological restoration at cement-enamel junction

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The next step was to bond the BR to the prepared tooth. After acid etching of both the surfaces to be bonded, the bonding agent was applied and cured for 20 s. The nanocomposite was then used to attach the BR with the prepared tooth and light cured. Buccal and lingual margins were finished using 20μ finishing bur while the proximal strip was used for interproximal surfaces. Nine-month follow-up revealed good results without any unfavorable event.

Case 2

A 7-year-old girl reported with the chief complaint of a cavity and black tooth. Oral examination revealed grossly carious tooth number 55 with pulpal exposure. The radiographic examination also confirmed pulpal involvement with more than half of healthy roots.

TCR using BR was planned after obtaining informed consent from the parents.

After gross carious removal and pulpectomy, the tooth was restored with BR [Figure 4] using the same steps as described in case 1. Nine-month follow-up showed satisfactory results in terms of function, esthetics, gingival health, and occlusal wear [Figure 4].
Figure 4: (a-d) Biological restoration using total crown replacement technique on tooth number 55. (a and b) Preoperative photograph and intraoral periapical radiograph. (c and d) Nine-month postoperative photograph and radiograph

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Both the cases are still under follow-up.


   Discussion Top


The term “BR” was coined in 1991 by Santos and Bianchi[4] which refers to the technique of bonding sterile tooth fragments, obtained either from tooth bank or from the same patient, onto the teeth. The first paper publication depicting the use of extracted tooth fragments as dental restorative materials was done by Chosak and Eidelman.[5] Thereafter, several studies have been published on the BR.[6],[7],[8] Although most of the clinicians used tooth fragments for restoration, none of the studies have restored mutilated primary molars by completely replacing the crowns with BRs.

The authors have also proposed a new classification of BR [Table 1], according to which these restorations can be of four types: autogenic-homodontic, autogenic-heterodontic, allogenic-homodontic, and allogenic-heterodontic.
Table 1: Nikhil and Rana's classification of biological restoration

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The TCR technique aids in restoring and preserving the primary molars economically with the restoration of masticatory function and providing superior esthetics.[9],[10] Apart from patient and parent satisfaction, it also offers several advantages such as the establishment of perfect occlusal anatomy, physiological enamel wear, efficient plaque control, and better cervical adaptation compatible with the adjacent gingival tissues.[11],[12] However, the availability of a tooth bank, difficulty in obtaining BR with the desired coronal dimensions and color, and acceptability by some patients are some of the major drawbacks of TCR.

Disinfection of the extracted teeth to be used as BR can be done using autoclaving, glutaraldehyde, sodium hypochlorite, formalin, and ethylene oxide, however, in this study, 10% formalin was used for 7 days for disinfection as it does not adversely affect the bond strength, dentinal permeability, and other physical properties of the BR.[12]


   Conclusion Top


TCR technique is an esthetic, biofunctional, and economical alternative for the restoration of grossly mutilated primary molars which are otherwise indicated for extraction.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the parents have given their consent for images and other clinical information to be reported in the journal. The parents understands that names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
American Academy of Pediatrics: Policy on early childhood caries (ECC): Classifications, consequences, and preventive strategies. Peadiatrics 2011;35:50-3.  Back to cited text no. 1
    
2.
Sharma K, Gupta KK, Gaur A, Sharma AK, Pathania V, Thakur VB. A cross-sectional study to assess the prevalence of early childhood caries and associated risk factors in preschool children in district Mandi, Himachal Pradesh. J Indian Soc Pedod Prev Dent 2019;37:339-44.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Sudan J, Sogi GM, Veeresha LK. Assessing clinical sequelae of untreated caries among 5-, 12-, and 15-year-old school children in Ambala district: A cross-sectional study. J Indian Soc Pedod Prev Dent 2018;36:15-20.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Santos J, Bianchi J. Restoration of severely damaged teeth with resin bonding systems: Case reports. Quintessence Int 1991;22:611-5.  Back to cited text no. 4
    
5.
Chosack AB, Eidelman ED. Rehabilitation of a fractured incisor using the patient's natural crown: Case report. J Dent Child 1964;31:19-21.  Back to cited text no. 5
    
6.
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.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Botelho AM, Tavano K, Correa-Faria P, Morato L, Viana MR. Esthetic functional recovery of permanent posterior tooth using autogenous biological restoration. J Indian Soc Pedod Prev Dent 2012;30:333-6.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
John SA, Anandaraj S, George S. Biologic restoration of a traumatized maxillary central incisor in a toddler: A case report. J Indian Soc Pedod Prev Dent 2014;32:79-82.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Ehrmann EH. Restoration of a fractured incisor with exposed pulp using original tooth fragment: Report of case. J Am Dent Assoc 1989;118:183-5.  Back to cited text no. 9
    
10.
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.  Back to cited text no. 10
    
11.
Barcelos R, Neves AA, Primo L, de Souza IP. Biological restorations as an alternative treatment for primary posterior teeth. J Clin Pediatr Dent 2003;27:305-10.  Back to cited text no. 11
    
12.
de Carvalho MF, Botelho AM, Tavano KT, Fernandes VC. Biological restoration: A 4/5 crown. J Indian Soc Pedod Prev Dent 2013;31:282-5.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1]



 

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