Restorative Clinical Situation
A nineteen year old African-American male presents with tooth #10 fractured 1.5 mm above the height of the gingiva. The Review of Medical History, Review of Systems, and List of Medications, reveal no contributory factors. The Clinical Examination shows a Class 1 mutually protected occlusion with a zero DMFT. The radiographic examination shows no evidence of root fracture, bone loss or caries. Tooth #10 is fully developed with no periapical radiolucency. The patient has a high smile line that reveals 6 mm of attached maxillary anterior gingiva.
Provisional diagnosis: Complicated crown fracture #10 (time=?, pain=?, Amount of tooth structure remaining=?)
1. Identify and briefly explain the 3 most relevant physical, mechanical and/or biologic material properties that you believe should be considered when looking for evidence to guide your treatment recommendation in this case.
I. Biocompatibility of the restorative material used1,2,:
Primum non nocere - Every effort should be done to minimize the pulpal and periapical damage. The restorative materials used should be passive and chemically inert. All dental material exhibits some adverse reaction with the host tissue. This could be due to dissolution, chemical reaction, or corrosion and may contain toxic constituents, either local or systemic reactions can occur
In the present clinical scenario, biocompatibility commonly associated with obturating material, sealer, posts, luting cements, core and crown should be considered.
The toxic effects were the earliest response studied and these toxic effects are of particular concern. The dental materials in direct contact with periapical and surrounding tissue of the tooth can leach toxic constituents through marginal seal and lead to delay in healing, damage or irrtitation.
Inflammatory response may be seen in the host tissue – tissue edema, infiltration of the lymphocytes. eg- ZOE sealer, bonding agent as a pulp capping agent
Dental material may show allergic reactions, mutagenicity.
So, before using any material in the oral cavity their adverse effect must be determined. Biocompatibility is thus as important as physical and chemical features when selecting a material for endodontic therapy. Only those materials that have been proved to have an acceptable biocompatibility in a battery of in vitro and in vivo tests should be considered for use.
II.Fracture resistance of the material3,4,5:
The second most common failure of endodontically treated tooth is root fracture. Once after pulpectomy, the tooth loose most of the moisture content and becomes brittle. The loss of tooth structure due to trauma, caries and access cavity preparation, endodontically treated teeth are susceptible to fracture. The strength of an endodontically treated tooth is directly proportional to the amount of remaining sound tooth structure.
Various factors like amount of tooth structure remaining, flexural and tensile...