ORIGINAL RESEARCH |
https://doi.org/10.5005/jp-journals-10005-2722 |
Clinical Performance of Composite Resin Restorations of Primary Incisors with Extensive Carious Lesions Retained by Glass Fiber Post or Biological Post
1Department of Pedodontics & Preventive Dentistry, Maharana Pratap College Dentistry & Research Centre, Gwalior, India
2Department of Pedodontics & Preventive Dentistry, Dental Institute, Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India
3Department of Paediatrics & Preventive Dentistry, Rungta College of Dental Sciences & Research, Bhilai, Chhattisgarh, India
4–6Department of Pedodontics and Preventive Dentistry, Teerthanker Mahaveer Dental College & Research Centre (TMDC & RC), Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India
Corresponding Author: Nishita Garg, Department of Pedodontics & Preventive Dentistry, Dental Institute, Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India, Phone: +91 7060774863, e-mail: doctornish2210@gmail.com
ABSTRACT
Aim: Intracanal posts enhance the resistance of the restoration to mechanical loads and masticatory forces in primary teeth with extensive carious breakdown. This study was done to investigate the clinical performance of composite resin restoration retained by either glass fiber post or biological post in the restoration of primary anterior teeth with extensive carious lesions.
Materials and methods: A total of 21 children (with 82 primary anterior teeth) who met the inclusion criteria were involved in the study. The 82 primary maxillary incisors were randomly allocated into two equal groups: groups I (glass fiber post) and II (biological post). All the teeth underwent pulpectomy, followed by glass fiber post or biological post, followed by celluloid strip crown restoration. Clinical analysis of all the teeth in the two groups was performed at 1, 3, 6, 9, and 12 months to assess the success of treatment procedures. Statistical Package for the Social Sciences (SPSS) software version “17” was used for statistical analysis. Pearson’s Chi-squared test and Fisher’s exact test were utilized to evaluate the success of both treatment procedures. The significance level was predetermined at p < 0.05.
Results: At the end of the 12-month follow-up period, 89.4 and 84.2% of composite resin restorations of primary incisors with extensive carious lesions were retained by glass fiber and biological posts, respectively. The intergroup comparison revealed no statistically significant differences pertaining to retention loss, marginal discoloration, and marginal adaptation at all follow-up intervals (p > 0.05).
Conclusion and clinical significance: Since biological posts are inexpensive and economical, they may replace the commercial post systems available to pediatric dentists.
How to cite this article: Jaiswal N, Garg N, Pathivada L, et al. Clinical Performance of Composite Resin Restorations of Primary Incisors with Extensive Carious Lesions Retained by Glass Fiber Post or Biological Post. Int J Clin Pediatr Dent 2023;16(6):850–857.
Source of support: Nil
Conflict of interest: None
Keywords: Biological posts, Composite resin restorations, Glass fiber post
INTRODUCTION
The occurrence of caries in the deciduous maxillary anterior is regularly identified with breast or bottle feeding at night, unsatisfactory oral hygiene, and consumption of a refined carbohydrate-rich diet after weaning.1 Badly destroyed anterior teeth may lead to speech difficulty, diminished chewing efficiency, malocclusion due to improper movement of the tongue, and decreased confidence.2 Therefore, saving the integrity of the deciduous dentition is critically important until they exfoliate normally.
Treatment of extensively broken down primary anterior teeth in children with limited cooperation is considered a formidable task for a pediatric dentist.3 Since there is a scarcity of adequate tooth structure to provide adhesive reinforcement for restoration in such teeth, pulpectomy and use of intracanal posts may be required prior to restoration. The intracanal posts enhance the resistance of the restoration to mechanical loads to masticatory forces.4 Various materials used for intracanal retention include resin composite posts,5–12 orthodontic wires,5,8,10,13–16 prefabricated metal posts,17 nickel chromium cast posts with macro-retentive features,18 biologic posts,10,19–21 and reinforced fibers.4,22–26
Glass fiber posts allow for the raised passing of light through the root and the overlying gingival tissues. Additionally, they help in getting rid of corrosion that can happen with prefabricated metal posts. One of their key attributes is the elastic modulus, which is almost the same as that of dentin, resin cements, and core materials.10
Fiberglass posts have shown better retentive properties and greater displacement strength compared to orthodontic wire γ-posts and better retentive features than composite posts.26,27 Motisuki et al.24 observed that after a 1-year period, fiberglass posts supported composite restorations provided better retention and good esthetic results. Sharaf22 noticed that rehabilitation completed on mostly broken down deciduous anteriors utilizing glass fiber posts remained retained.
Biological posts have been utilized as a substitute for intracanal metal posts and as biological restorations for deciduous teeth.20 The biological post with crown restoration is a cheaper option and helps to preserve the internal dentin wall of the tooth root canal, furnishing the tooth with increased strength and retention.28 These dentin posts have shown promising outcomes in a few reported cases.19,29 These are inherently resorbed and can be preferred when contrasted to metallic or composite posts.10 Biological posts have all the physical properties of compressive strength, thermal expansion, and elasticity as natural teeth.29 Yet, there is deficient proof in the available scientific data regarding the utilization of dentin posts in deciduous teeth. Hence, this experiment was undertaken to investigate the clinical performance of composite resin restoration supported by either glass fiber post or biological post in the restoration of primary anterior teeth with widespread carious lesions.
MATERIALS AND METHODS
The investigation protocol was endorsed through the Institutional Ethics Committee, and before the commencement of the study, informed consent was obtained from legally responsible persons or parents of the sorted-out subjects to participate in the study. All the parents/legal guardians were presented with the pros and cons of the biological post. They were intimated that the biological post would be prepared using extracted natural teeth after standard sterilization protocol. Only those parents who consented to this protocol were included in this study. A total of 158 children from the outpatient Department of Pediatric and Preventive Dentistry were screened, and 21 children (with 82 primary anterior teeth) who fulfilled the inclusion criteria were involved in the experiment. A total of 82 primary anterior teeth were equally divided after randomization into two groups, group I (n = 41) receiving glass fiber post and group II (n = 41) receiving biological post. Primary anterior teeth with early childhood caries or endodontically treated primary anterior teeth with sound root structure, having two-thirds part of the root structure present in radiographs (one-third external root resorption at the most, compared with adjacent teeth) were included in the study. Only 1 week after the completion of the pulpectomy, the post space was prepared. Only 4 mm of the obturating material was removed from the root canal, and a 1 mm thick layer of glass ionomer cement was placed over the remaining obturating material to prevent hindrance with the polymerization of composite resin restoration and make it ready for post placement. The prepared space for the post was irrigated with normal saline, then dried with paper points, and finally etched with 37% phosphoric acid for 15 seconds. A bonding agent was brushed on the etched surface, uniformly dispersed, and cured for 20 seconds. In group I, after trying a fiberglass post (DM Post, Germany) of appropriate size for correct fit and depth, the fiber post was reduced with a diamond bur along with a water-cooling system till the desired length corresponding to the depth of the canal and also the height of the future composite restoration was achieved. It was then cemented using a dual cure resin cement (RelyX™ U200 3M ESPE, Germany) (Fig. 1). For group II, extracted caries-free teeth with no morphological defects, restorations or cracks were selected for post preparation and obtained from the Department of Pediatric and Preventive Dentistry. The guardians of patients undergoing extraction for various reasons were informed regarding the future use of their teeth, and consent was obtained. Only healthy donors with no adverse medical history were considered. The collected teeth were cleaned with an ultrasonic scaler to remove all soft tissues and periodontal remnants and then polished. The pulp tissue was extirpated from the canals, and root canal irrigation was done with sodium hypochlorite, hydrogen peroxide (H2O2), and saline. With the help of a diamond disk, the coronal part of the included extracted teeth was detached from the root. The root was reshaped into a post according to the canal diameter. The flowable composite material was filled to reinforce the prepared root structure. Then, all the biological posts were sonicated for 30 minutes in an ultrasonic tank, which was operating at 42 GHz and 100 W output at five working cycles in 6% H2O2. Before cementation, the prepared biological post was autoclaved for 30 minutes at 121°C and 15 lbs pressure (Fig. 2). After evaluating for proper fit and adjustment; the post was cemented utilizing dual cure resin cement (Fig. 3). After the post cementation in both the groups, a strip crown (strip crown form; Pedo 3M ESPE, Germany) restoration was done using appropriate shade of composite resin. After removing the interferences, the restorations were finished and polished with the help of a polishing disk. All the teeth were then assessed clinically at 1-, 3-, 6-, 9-, and 12-month time breaks to analyze the success of composite resin restorations supported by either post using modified Ryge’s criteria (Table 1).30
Fig. 1: Clinical procedure in group I (glass fiber post)
Fig. 2: Steps in the preparation of biological post
Fig. 3: Clinical procedure in group II (biological post)
| Rating | Evaluation of retention |
| α (A) | Complete crown retention |
| Bravo (B) | Loss of composite |
| Charlie (C) | Complete restoration loss (post and composite) |
| Rating | Marginal discoloration |
| α (A) | No discoloration anywhere along the margin between the restoration and the tooth structure |
| Bravo (B) | Slight discoloration along the margin between the restoration and the tooth structure, but the discoloration has not penetrated along the margin in a pulpal direction |
| Charlie (C) | Discoloration with penetration in pulpal direction |
| Rating | Marginal adaptation |
| α (A) | No visible evidence of a crevice |
| Bravo (B) | Visible evidence of crevice, therefore dentin isn’t exposed |
| Charlie (C) | The explorer penetrates into the crevice; dentin is exposed |
| δ (D) | Restoration fractured or lost |
Statistical Analysis
The collected data was tabulated, and statistical analysis was applied using the Statistical Package for the Social Sciences (SPSS) (SPSS Inc., Chicago, Illinois, United States of America) version 17 for Windows. For intergroup comparison pertaining to parameters of Modified Ryge’s criteria at all time intervals, Pearson’s Chi-squared test and Fisher’s exact test were applied. The significance level was predetermined at p < 0.05.
RESULTS
A total of 21 children took part in the study. The average age of participants was calculated to be 4.35 ± 0.68 years. There were 18 maxillary central incisors, 20 lateral incisors, and three canines in each group. A total of 41 teeth were accessible in each group at the 1st month follow-up interval and declined to 40 teeth at the 3rd month follow-up period. Further, at 6 months of follow-up, 38 teeth were available in both groups and at 9 and 12 months, the samples available further declined to 36 and 35 teeth in group I and 35 and 33 teeth in group II, respectively. Tables 2 to 4 represent the intergroup comparison of retention loss, marginal discoloration, and marginal adaptation in both groups at the follow-up interval of 1, 3, 6, 9, and 12 months. The intergroup comparison revealed no statistically significant differences pertaining to retention loss, marginal discoloration, and marginal adaptation at all follow-up intervals. Table 5 represents the aggregate failures and survival rates for two treatment methods evaluated after 1, 3, 6, 9, and 12 months. The risk difference between the two study groups was statistically nonsignificant (p > 0.05) for all time intervals.
| Group I | Group II | Total | Chi-square | p-value | ||
|---|---|---|---|---|---|---|
| 1 month | α | 41 (100%) | 41 (100%) | 82 (100%) | NA | NA |
| Bravo | 0 (0%) | 0 (0%) | 0 (0%) | |||
| Total | 41 (100%) | 41 (100%) | 82 (100%) | |||
| 3 months | α | 40 (100%) | 40 (100%) | 80 (100%) | NA | NA |
| Bravo | 0 (0%) | 0 (0%) | 0 (0%) | |||
| Total | 40 (100%) | 40 (100%) | 80 (100%) | |||
| 6 months | α | 36 (94.7%) | 35 (92.1%) | 71 (93.4%) | 0.214 (NS) |
1.000 (NS) |
| Bravo | 2 (5.3%) | 3 (7.9%) | 5 (6.6%) | |||
| Total | 38 (100%) | 38 (100%) | 76 (100%) | |||
| 9 months | α | 35 (97.2%) | 33 (94.3%) | 68 (95.8%) | 0.378 (NS) |
0.614 (NS) |
| Bravo | 1 (2.8%) | 2 (5.7%) | 3 (4.2%) | |||
| Total | 36 (100%) | 35 (100%) | 71 (100%) | |||
| 12 months | α | 34 (97.1%) | 32 (97%) | 66 (97.1%) | 0.002 (NS) |
1.000 (NS) |
| Bravo | 1 (2.9%) | 1 (3%) | 2 (2.9%) | |||
| Total | 35 (100%) | 33 (100%) | 68 (100%) |
NA, not applicable; NS, not significant
| Group I | Group II | Total | Chi-square | p-value | ||
|---|---|---|---|---|---|---|
| 1 month | α | 41 (100%) | 41 (100%) | 82 (100%) | NA | NA |
| Bravo | 0 (0%) | 0 (0%) | 0 (0%) | |||
| Total | 41 (100%) | 41 (100%) | 82 (100%) | |||
| 3 months | α | 40 (100%) | 40 (100%) | 80 (100%) | NA | NA |
| Bravo | 0 (0%) | 0 (0%) | 0 (0%) | |||
| Total | 40 (100%) | 40 (100%) | 80 (100%) | |||
| 6 months | α | 36 (94.7%) | 35 (92.1%) | 71 (93.4%) | 0.214 (NS) |
1.000 (NS) |
| Charlie | 2 (5.3%) | 3 (7.9%) | 5 (6.6%) | |||
| Total | 38 (100%) | 38 (100%) | 76 (100%) | |||
| 9 months | α | 29 (80.6%) | 27 (77.1%) | 56 (78.9%) | 0.391 (NS) |
0.904 (NS) |
| Bravo | 6 (16.7%) | 6 (17.1%) | 12 (16.9%) | |||
| Charlie | 1 (2.7%) | 2 (5.8%) | 3 (4.2%) | |||
| Total | 36 (100%) | 35 (100%) | 71 (100%) | |||
| 12 months | α | 28 (80%) | 26 (78.8%) | 54 (79.4%) | 0.015 (NS) |
1.000 (NS) |
| Bravo | 6 (17.1%) | 6 (18.2%) | 12 (17.7%) | |||
| Charlie | 1 (2.9%) | 1 (3%) | 2 (2.9%) | |||
| Total | 35 (100%) | 33 (100%) | 68 (100%) |
NA, not applicable; NS, not significant
| Group I | Group II | Total | Chi-square | p-value | ||
|---|---|---|---|---|---|---|
| 1 month | α | 41 (100%) | 41 (100%) | 82 (100%) | NA | NA |
| Bravo | 0 (0%) | 0 (0%) | 0 (0%) | |||
| Total | 41 (100%) | 41 (100%) | 82 (100%) | |||
| 3 months | α | 40 (100%) | 40 (100%) | 80 (100%) | NA | NA |
| Bravo | 0 (0%) | 0 (0%) | 0 (0%) | |||
| Total | 40 (100%) | 40 (100%) | 80 (100%) | |||
| 6 months | α | 36 (94.7%) | 35 (92.1%) | 71 (93.4%) | 0.214 (NS) |
1.000 (NS) |
| D | 2 (5.3%) | 3 (7.9%) | 5 (6.6%) | |||
| Total | 38 (100%) | 38 (100%) | 76 (100%) | |||
| 9 months | α | 34 (94.4%) | 32 (91.4%) | 66 (92%) | 0.380 (NS) |
0.804 (NS) |
| Bravo | 1 (2.8%) | 1 (2.9%) | 2 (2.8%) | |||
| D | 1 (2.8%) | 2 (5.7%) | 3 (4.2%) | |||
| Total | 36 (100%) | 35 (100%) | 71 (100%) | |||
| 12 months | α | 33 (94.2%) | 31 (94%) | 64 (94.2%) | 0.004 (NS) |
1.000 (NS) |
| Bravo | 1 (2.9%) | 1 (3%) | 2 (2.9%) | |||
| D | 1 (2.9%) | 1 (3%) | 2 (2.9%) | |||
| Total | 35 (100%) | 33 (100%) | 68 (100%) |
NA, not applicable; NS, not significant
| Group I | Group II | Risk difference | p-value | ||
|---|---|---|---|---|---|
| 1 month | Failures | 0/38 | 0/38 | 0% | N/A |
| Success | 100% | 100% | |||
| 3 months | Failures | 0/38 | 0/38 | 0% | N/A |
| Success | 100% | 100% | |||
| 6 months | Failures | 2/38 | 3/38 | 2.6% | 0.643 (NS) |
| Success | 94.7% | 92.1% | |||
| 9 months | Failures | 3/38 | 5/38 | 5.2% | 0.455 (NS) |
| Success | 92.1% | 86.9% | |||
| 12 months | Failures | 4/38 | 6/38 | 5.2% | 0.497 (NS) |
| Success | 89.4% | 84.2% | |||
NA, not applicable; NS, not significant
DISCUSSION
Glass Ⴁber-reinforced composite resin posts are a fairly recent development in pediatric dentistry to be used as an alternative to the other post systems. The quality of Ⴁber-reinforced posts is based on the matrix, Ⴁbers, interface strength, and geometry of reinforcement. This material has several advantages as compared to previous Ⴁbers, including greater flexural strength (1280 MPa), easier handling, ability to be used in stress-bearing areas, and better bonding with various composites. Analysis done under scanning electron microscopic evaluation revealed the formation of a hybrid layer, resin tags, and an adhesive lateral branch. Adequate bonding reduces the wedging effect of the post within the root canal. This, in turn, reduces the amount of dentin to be removed to fit a shorter and leaner post, which reduces the susceptibility of the tooth to fracture. To avoid interference with the eruption of permanent teeth, glass fiber posts are usually placed in one-third of the cervical root canals.31 They are not visible in the resinous matrix when compared to other fibers. Therefore, they are considered the most suitable and the best esthetic strengtheners of composite materials.32
The ideal requirements of intracanal posts for primary anterior teeth include biocompatibility, being readily available, easy to apply, having good esthetics, and being able to withstand masticatory forces. Biological posts have these properties along with an extra advantage in that they can be resorbed as a part of the natural shedding process and are cheaper than other post systems.33 Traditionally, biological posts were prepared using primary root dentin,12,19,33 but difficulty in procuring intact, resorption-free primary root led to the use of premolar root dentin as a substitute. It is the most common tooth extracted for orthodontic reasons and is usually found in sound condition.33 This technique may be unacceptable to many guardians, and they should be reassured regarding its benefits while explaining its unharmful nature.
In the present study, the clinical performance of composite restorations of primary maxillary anterior teeth with extensive carious lesions based on a new retentive method—a glass fiber post was compared with a biological post over a 12-month period.
A major clinical sign of resin composite restoration failure is marginal discoloration. It can occur due to extra or deficient filling material at the margin, gap formation, and also leaching of pigments from beverages to foods into the adhesive layer, causing seepage or leakage of oral fluids into the restoration-tooth interface.34,35 The observations from the present experiment showed that the glass fiber post was superior to the biological post in relation to discoloration scores (17.1 and 18.2%), but this difference was not significant till the 12-month follow-up. Considering the retention loss of the material, excellent clinical scores were exhibited by a total of 94.7% of glass fiber post restorations and 92.1% of biological post restorations. Regarding marginal adaptation, approximately 2.9% of glass fiber posts and 3% of biological posts exhibited a marginal gap at the 12-month interval.
Even though the survival rate of the composite restoration done over fiber and biological post after 12 months was 89.4 and 84.2%, respectively, the risk difference (5.2%) was not statistically significant between the two groups. Similar results were reported by Eshghi et al.;36 84% of fiber posts and 90% of reversed metal posts were reliable for maxillary primary incisor restoration after 12 months, according to the evaluation criteria of their study. The rate of restoration retention was observed to be 100 and 90% for reversed metal post and fiber post treatment groups, respectively. The success rate of restoration survival after 9 months was 92.1% for glass fiber posts and 86.9% for biological posts without a statistically significant difference. The reason for complete (post along with composite) or partial loss of composite restoration was due either to trauma and/or biting on hard foods. Although related studies8,10 found no statistically significant difference, an analysis of the present study also showed no statistical difference. Pinheiro et al.10 found no statistically significant differences in bond strength between composite posts, 0.7 mm α-shaped orthodontic wire, and dentin posts.
Pithan et al.,8 in their study between composite posts, orthodontic “y” wire posts, and glass fiber posts, reported higher retentive strength with composite posts, followed by orthodontic “y” wire posts and glass fiber posts, with no statistically significant differences in tensile strength values between the three techniques used.
Conversely, in a previous study by Gujjar et al.,27 glass fiber posts showed higher retentive strength values, followed by orthodontic “y” wire posts and composite posts, with a statistically significant difference in retentive strength values among the three techniques used. Findings of the study by Vafaei et al.37 for the survival of composite restoration using either glass-fiber post or reversed-metal post showed a success rate of 74.4% for fiber post as compared to 89.7% for a metal post after a 1-year follow-up. The success rate of fiber post restorations is slightly higher in the present study (89.4%) compared to their findings. Mehra et al.38 showed a higher retention rate for glass fiber post composite restoration as compared to the present study. They exhibited a 93% retention rate as opposed to 89.4% in the present study.
Subramaniam et al.25 reported a 79% retention rate of glass fiber posts as compared to a 52% retention of Ω-shaped wire posts. The high success rate reported in our study may have resulted from the superior adhesive system used as compared to the previous research. Previous studies reported debonding as the main source of restoration loss while using fiber-reinforced composite posts.26,33 This source of debonding is usually an inefficient adhesive system. Studies suggest that self-bonding cements have an impaired ability to diffuse into the underlying dentin and effectively decalcify it, leading to improper bonding. It is reported that dual-cure resin cements usually have improved adhesion compared to self-adhesive resin cements. They produce a more constant confluence in comparison to self-adhesive systems. To achieve maximum retention, dual cure resin cement (RelyX™ 3M ESPE, Germany) was used for the cementation of the posts. Before the cementation of the glass fiber posts, it was ensured that the fibers were completely covered with cement to prevent porosity. After curing, the adhesive, dual cure cement (RelyX™ 3M ESPE, Germany), and fiber post formed a single unit.
The availability of recent restorative materials with enhanced adhesive properties has not only made them expensive and technique-sensitive but also created a need for expert handling by the operator. 9,18,24 In recent times, none of the commercially available posts seem to meet all the ideal biological and mechanical properties. In this regard a “biological post” presents several advantages regarding regaining tooth function and esthetics.39
The use of extracted natural teeth for biological restorations helps to preserve the integrity of the patient’s natural dentition. Successful esthetic and functional recovery of extensively damaged maxillary central incisors with the help of biological posts and crowns was reported by Correa-Faria et al.39 They fabricated the dentin posts using an acrylic resin pattern of the canals from a plaster model technique for shaping the dentin post. Additionally, Mandroli20 and Ramires-Romito et al.19 have also reported a high success rate in the management of grossly destroyed primary teeth in children with the use of biological posts and crowns. The procedure is simple, albeit it requires professional expertise to prepare and adapt the biological posts.
Posts created from extracted teeth permit a close adaptation to the root canal and prevent the development of stress to the dentin as they possess the same biomechanical properties as the teeth being restored.39 The bond between the dentin post, adhesive material, and the tooth produces a monoblock system with materials that are compatible together.40
Dentinal tissue has a complicated microstructure. Its modulus of elasticity varies throughout, which may prevent crack propagation in dentin.41 The almost identical elasticity of a dentin post to root dentin permits flexion of the post to mirror that of the tooth, which leads to the post acting as a shock absorber while transmitting only a fraction of the stresses placed on the tooth to the dentinal walls.29 Other physical properties of biological posts, like compressive strength, viscoelastic behavior,42 thermal expansion, etc., resemble that of root dentin, and its fracture toughness has been found to be better than most restorative materials. Therefore, biological posts form a micromechanically homogenous unit with the root dentin that helps in uniform stress distribution.43
In a previous study, Kurthukoti et al.44 revealed lower fracture resistance of Zirconia posts compared to biological and fiber-reinforced composite posts supported restorations. The mean fracture resistance values of fiber-reinforced composite post group were lower than the biological post group but higher than the zirconia post group.
Due to a handful of cases being reported in the literature, the success rate of biological dentin posts cannot be appropriately evaluated. However, in vitro studies by Kathuria et al.29 and Ambica et al.45 have demonstrated that dentin posts showed higher fracture resistance than carbon fiber posts and glass fiber posts. Therefore, this new post technique utilizing root dentin can be used as a favorable alternative to various commercially available post systems in permanent as well as primary dentition.
The presented study is different from the previous study by Grewal and Seth,12 who compared and evaluated the success of biological and composite restorations in treating primary anterior teeth with great structural loss using intracanal posts. The study revealed that while the clinical performance of biological post and crown restorations and intracanal reinforced composite restorations was almost the same in regard to marginal discoloration, shade matching, marginal integrity, surface Ⴁnish, retention, gingival health, and recurrent carious lesions, the biological restorations were comparatively cost-effective. There is no study available in the literature that has evaluated the clinical performance of composite resin restorations of primary incisors with extensive carious lesions retained by glass fiber post and biological post in relation to retention loss, marginal discoloration, and marginal adaptation.
There are a few limitations when using natural, extracted teeth as alternative to commercially available posts. Firstly, procuring teeth with a similar color and shape to that of the damaged tooth is difficult. Secondly, the patient may refuse to accept a foreign tooth structure obtained from another patient. Thirdly, there is an ethical aspect that necessitates explaining to the patient and/or his parents or guardian that the post is made from donations to properly sterilize extracted teeth to prevent any biosecurity risks.46
In the present study, the biological post proved to be an alternate post for primary anterior teeth that has physical properties comparable to that of root dentin and is also more economical than existing synthetic posts. Future clinical studies are required to evaluate the use of dentin posts before they can be used as viable alternatives to the currently available commercial post systems.
ORCID
Nishita Garg https://orcid.org/0000-0001-6594-9098
Ramakrishna Yeluri https://orcid.org/0000-0002-0320-2105
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