PROPOSAL OF TREATMENT WITH POLYETHYLENE FIBRES
Cirulli Nunzio (1), De Frenza Gianluca (2), Cantore Stefania (3), Grassi F. Roberto (4)
4DMD PhDProfessor at the University of Studies of Bari - Department of Odontostomatology and Surgery - Director prof. F. Grassi
DDS DH Specializing in Odontostomatological Surgery at the University of Studies of Milan Polyclinic Stomatological Institute of Milan, Director prof. Franco Santoro
DDS DH Specializing in Orthodontics at the University of Studies of Naples, Department of OdontostomatologicalDisciplines, Director prof. Adolfo Ferro
DDS MscOrtho, PhD University of Studies of Bari - Department of Odontostomatology and Surgery - Director prof. F. Roberto Grassi
Gianluca De Frenza
Department of Odontostomatology and Surgery
Address: p.zza G. Cesare 11
code: 70100 - BARI
: +39 3476628919
mail: gianluca.defrenza@poste.it
Key Word: splinting, polyethylene fibres, front section, temporal stability
ABSTRACT
Aim of this work is to evaluate different instances where to apply splinting, carried out with polyethylene fibres. The fibres used with these patients are highly crystallized fibres(InFibra® - Bioloren) which feature a particular kind of weaving which does not lose the weft and does not fray when cutting.fibres, in addition to the realization of retainers, find application in the implementation of endodontic posts, splinting, reinforcement of composite or resin handmade products, temporary teeth stabilization. The clinical application in these contexts shows that polyethylene fibres easily adapt to the tooth rim and can be manipulated during the adherence process. Moreover they feature a variable length and height, which favours an easy adaptation, as already stated, to the tooth surface and a good wettability to the composite resin used for its fixing. These featuresfavour the good clinical longevity of the materials. because fluid composite resin can be used for application onto the enamel, the splinting volume is limited to the minimum by reducing the risk of plaque deposits formation due to difficulties for patients in the normal procedures of home hygiene. , it is not necessary to remove a considerable quantity of tooth tissue, so the technique is reversible, conservative and meets the patients' aesthetical expectations. These cases show that InFibra is a promising material to be used for splinting techniques.
INTRODUCTION
Splinting is a process where teeth are joined in order to increase their resistance to masticatory loads.traditional methods are satisfactory, splinting with reinforcement of fibres impacted into the composite has gained popularity thanks to its simple and predictable methodology. treatment requires the use of composite materials which, in the most complex instances, must be used together with fibres or steel threads to improve its mechanical properties. In the dentistry field various types of fibres have been suggested to improve the mechanical and physical features of splinting: fibres, consisting of twined glass filaments in order to improve the composites' resistance. These have remarkable aesthetical properties, but they do not feature a good integration with the resiny matrix.
fibresprevent the break and the stress of composite materials, even though they are materials with a good resistance to breaks, but they have a dark colour which is aesthetically unacceptable.
fibres, consisting in aromatic polyamide, embody the evolution of polyamide nylon. They increase the composites'resistance. They are unaesthetic, therefore their use is limited.
fibresare new generation synthetic fibres, they are an excellent solution to be used in splinting, made up of aromatic polyesters. They show good resistance to abrasion and occlusal forces, but they are expensive and not very easy to use.
fibresimprove impact force, elasticity, and the flexural force of the composites used.
translucent pattern of polyethylene fibres makes them an excellent aesthetic material which can be combined with microfilled composite materials at high fluidity.main directions are: parodontal splinting, replacement of temporary prostheses attached prior to restoration of implants with prostheses, conservation treatment of the impaired tooth syndrome, realization of temporary fix prostheses with a composite resin bridge supported by natural teeth or implants, stabilization of traumatized teeth, therapy of post- orthodontic containment and application of space keepers. advantages supporting the use of such material are:
High elasticity coefficient (117 GPa)high resistance to traction (3 GPa) and distortionforce 5 times that of ironand conservative technique, as it requires the removal of a minimum quantity of dental tissueresistance, thanks to a good integration between the fibres and the compositeclinical longevity of the materials in the oral cavityof fluid composite resins which minimize the retention volumeadaptation to the gingival rimmanipulation during the various treatment proceduressimple and quick techniques, as it allows to complete the whole treatment in just one sitting
which could invalidate this kind of treatment and in particular when implementing such technique can be:
Stress concentration into the interface between these materials and the composite materialof an insufficient quantity or composite in excessretention and consequent inflammation of gingival tissues
, to sum up we can state that carbon and kevlar fibres are not very aesthetical, those in vectran feature a high cost for their kind of use, whereas polyethylene fibres, being they invisible in the resin matrix, appear to be more appropriate and aesthetical to be used together with composite materials, especially in the front section.
MATERIALS AND METHODS
The fibres used are long, unidirectional, white and highly crystallized polyethylene fibres (InFibra® - TP - Italia) which provide high mechanical properties, ideal for their employment in adhesive dentistry. fibre is weaved according to precise technical directions, so as to set up a special network of fibres with this material that allows an efficient force distribution with no particular stress by the composite material used. This kind of weaving gives InFibra® excellent features of handiness which allow its precise moulding at the level of interproximal spaces and easy adaptability to the morfology and outline of the dental arch. It features a clear cut and a complete imbibition with the majority of resin composite materials, with non- affected adhesives and with acrylic resin and, what is more, thanks to its translucence, it provides excellent aesthetical properties.
TECNIQUE USED
Further to the acquisition of the stamps of the patient's arches and successive preparation of the models to determine the exact length of the fibres to be used, a strip of foil is used of the desired length, which is previously laid onto the lingual surface of the teeth to be included in splinting. The application of the dam according to the procedures followed in conservation treatments can help the surgeon in carrying out splinting. the foil strip is placed onto a glass plate and the fibre is cut of the same length. InFibra® can be measure cut with the suitable scissors provided in the kit or with an in-the-heat lancet (blade to be heated at 160 degrees).is carried out of the lingual/ palatal part of the teeth affected by the application of splinting, with 37% orthophosphoric acid, followed by washing and drying according to the directions of the producer of the mordanting substance and of the fluid composite material employed. suggest to handle the tape portion that will be applied with clean tweezers, preventing possible glove dusts from infecting them and to avoid touching the tape with your bare hands.will then proceed to the implementation of the adhesive techniques respecting the manufacturer's directions. When InFibra® is used with a composite material it will have to be previously moistened through bonding, if instead it is used with acrylic resins it will have to be moistened with the monomer of the same resin used. employing the indirect technique, the fibre is adapted onto the previously isolated plaster model, by respecting the morphology of the dental elements, and blocked into the desired position by moistening it with bonding, and subsequently placed under a polymerizing lamp, or also by applying a light layer of liquid composite material which will cause a stiffening of the fibre into the ideal position. This kind of method will allow an easier placing of the fibre into the patient's oral cavity, since you have already provided for an appropriate shape to be given, reducing the time for application and therefore also the patient's discomfort.
prevent possible composite surplus from penetrating into the interdental spaces, it is possible to apply timber wedges prior application of the flow upon the teeth and subsequently removed. just need to apply a small layer of composite material onto the previously treated teeth surface and lay down the fibre which, thanks to a slight pressure, will be stabilized, completing the operation with the polymerization stage. Later the composite surplus will be removed, check for possible interference with the patient's normal occlusion, ending by finishing through diamond milling cutters and polishing.
CLINICAL TRIAL N. 1
Clinical trial at first visit ® section to be appliedmodel® application with elements® lingual viewtrial rehabilitated through InFibra®
CLINICAL TRIAL N. 2
Enamel mordantingdryingapplication of InFibra® through bonding and fluid composite materialstage prior to polymerizationstabilization of traumatized teeth rehabilitated through InFibra®
CLINICAL TRIAL N. 3
Enamel mordantingstage prior to polymerizationsplinting rehabilitated through InFibra®
CONCLUSIONS
In the cases treated, as you can see, the employment of InFibra® materials has allowed to rehabilitate the patients thanks to a simple procedure.addition to the simplicity of the rehabilitation carried out, it is important to highlight the particular cheapness of the treatment, that is possible to carry out with patients having a limited budget but who require a solution to an aesthetical problem. some instances the intervention of a dental technician is required for implementation through the use of acrylic resins of the absent element or elements which will have to be replaced with prosthetical dental elements available on the market, in other instances the only specialist's intervention will be necessary who will apply the fibres - where required - very easily. A careful brushing using dedicated toothbrushes like proxybrush and dental floss are important to keep a correct hygiene in the area. Checks by a specialist will be necessary every three months, also to verify the splint hold and the fibre and composite state, and in case of wear a new layer of composite material will be applied in order to avoid exposures of the fibres, in addition to guaranteeing a good level of oral hygiene.
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