|Year : 2021 | Volume
| Issue : 3 | Page : 325-328
Total crown replacement technique: A biological treatment option for grossly destructed primary molars
Nikhil Srivastava, Vivek Rana, Pratik Pande, Preeti Singh
Department of Pediatric and Preventive Dentistry, Subharti Dental College and Hospital, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
|Date of Submission||27-Sep-2020|
|Date of Acceptance||13-Jan-2021|
|Date of Web Publication||22-Nov-2021|
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
Source of Support: None, Conflict of Interest: None
| 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|| |
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. ECC is a multifactorial disease 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.
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|| |
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.
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|| |
The term “BR” was coined in 1991 by Santos and Bianchi 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. Thereafter, several studies have been published on the BR.,, 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.
The TCR technique aids in restoring and preserving the primary molars economically with the restoration of masticatory function and providing superior esthetics., 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., 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.
| Conclusion|| |
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
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]