The Clinical Applications of Fiber Reinforced Composites - PowerPoint Presentation

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The Clinical Applications of Fiber Reinforced Composites

Dr

E.

HabibiSlide2

-Fiber reinforced composites are high strength filling materials composed of

conventional composites

and fibres.Slide3

FRCs are structural materials with two distinct constituents. The reinforcing component provides stiffness and strength while the surrounding matrix supports the reinforcement and provides workability. The fibers most commonly employed in dental applications for reinforcement are

polyethylene

,

glass,

polypropylene, carbon or aramid. The matrix comprises of epoxy resinSlide4

Typically, fibers are 7 to 10 µm in diameter and span the length of the prosthesis or appliance. By comparison, the particles used in standard restorative dental composites are 1 to 5 µm in diameter, or submicron in size.Slide5
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-

Woven fiber is less technique-sensitive

, has lesser flexural strength and easier to manipulate hence conforms to the desired shape and maintains its adaptation during placement and is the ideal choice while making an appliance for rotated or

malpositioned

teeth. - Unidirectional fiber has greater flexure strength and rigidity and is the better choice for high stress situations as in

prosthodontic

frameworksSlide7

The Two Approaches have Evolved Namely Non-Impregnated and Pre-Impregnated

Non Impregnated

Pre-Impregnated FibersSlide8

How FRC Materials Work?

Types of fiber

Direction of fibersSlide9

Periodontal Splinting

Single

Visit BridgesProvisional BridgesComposite RestorationTrauma

Stabilization

Space maintainerEndodontic Post and CoresSlide10

Periodontal Splinting

Easy to Make

Esthetic Strong Durable

ProvenSlide11
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Fiber-reinforced Composite Resin BridgesSlide14

Introduction

Loss of anterior tooth may be a catastrophic event for the patientSlide15

The Fiber-Reinforced Resin-Bonded Bridge

Advantages

Cost effective

Less or zero reduction in healthy tooth structure

Takes short duration of timeHygienicNonallergenicSingle tooth replacement premolar or incisorideal indication for lower incisorsSlide16

The Fiber-Reinforced Resin-Bonded Bridge

A review of the dental literature suggests that

the

FRC prostheses have good longevity, especially those which

are made by the direct techniqueSlide17

The Fiber-Reinforced Resin-Bonded Bridge

Three forms of

pontics can be made for the FRC bridges:

natural extracted teeth,

with acrylic resin teeth using composite resin. Slide18

Natural T

ooth

Pontic

If the natural tooth is available

and if its crown is in good condition, it can be bonded easily to the adjacent teeth by using a light-cured restorative material. Using the natural tooth as a

pontic

offers the benefits of being the

right

size

, shape and

colour

, along with producing good aesthetic and

functional

results Slide19

Considerations for Utilization of a Natural Tooth Pontic 

Several factors must be taken into consideration when choosing a natural tooth

pontic as an interim provisional.

First

and foremost, the extracted tooth should possess an intact, clinical crown that is of ideal shape, contour, and shade, with intrinsic characterization that ideally matches the adjacent dentition.The functional occlusal stress on the pontic site should be minimal, and the patient's preoperative centric, working, and nonworking contacts must be assessed to determine whether displacing forces can be reduced or eliminated. Slide20

A 45-year-old female

patient

The patient was not in pain, and her primary dental concern was to remain current with her biannual prophylactic

recare

visits. A comprehensive examination including periodontal charting, intraoral photographs, and a full-mouth series of radiographs was performed. Slide21

T

ooth

No.

21

exhibited Class I to Class II mobility with all other visual findings being within normal limits (Figure 1). Dental history,

she

indicated that, as a teenager, she had an accident that displaced teeth Nos.

11

and

21

,

and tooth No.

21

had required root canal therapy after becoming

nonvital

.

Several

cracks in both teeth were observed during the visual exam with

transillumination

, but none were symptomatic.

Closer

inspection of the

periapical

radiograph

indicated

that tooth No.

21

was in a state of active internal

resorption

and the tooth was diagnosed as hopeless (Figure 2).

When

the patient was informed that the diagnosis for her maxillary left central incisor was hopeless, she was heartbroken.Slide22
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The 2-mm

Ribbond

THM ribbon was chosen for this case due to its minimal thickness, leno-weave construction, ease of adaptation to the teeth, and overall superior strength.

A

rectangular slot was prepared on the lingual aspect of the natural tooth

pontic

to secure the

Ribbond

THM and to assure that it remained out of occlusion. The finalized

pontic

with a rectangular lingual slot is shown in Figure 10Slide25

Ribbond

strands cannot be cut with conventional scissors; this most recent product includes a slimmer and more compact industrial-grade scissor, as compared to the more bulky version supplied with earlier kits.

The

manufacturer recommends the use of

Ribbond Wetting Resin (Ribbond), a product sold separately. Slide26
Slide27
Slide28

A

thin coat of

Ribbond

Securing Resin (

Ribbond) was applied to the lingual and interproximal surfaces of adjacent teeth.

The

Ribbond

THM was then seated at the desired position and adapted first with finger pressure, then with a thin IPC hand instrument. Care must be taken to ensure that the edges of the fiber are flush against the teeth, and that the material wraps slightly into the interproximal areas roughly to the previous contact area. Slide29
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Slide31

Composite pontic

A 76-year-old female patient presented with a missing mandibular left lateral incisor that had been recently extracted because of severe root caries on the distal surface that had made the tooth

unrestorable

(Figure 1). Slide32

Upon clinical and radiographic examination, it was noted that there was not enough remaining bone in the labial-lingual direction to consider an implant.

Also

, the teeth adjacent to the edentulous space, aside from having some

crestal

bone loss, were unrestored. The crown-to-root ratio and mesiodistal root diameter at the gingival crest of the mandibular left central incisor were not favorable due to the alveolar bone loss, making it a questionable abutment for a fixed partial denture. Slide33

A lingual view shows the abutment teeth that were prepared with a slot cut in the lingual surfaces to contain the imbedded fiber reinforcement to provide the "framework" to freehand the

nanocomposite

resin

pontic

in the edentulous space.Slide34

G-aenial Bond (GC America), a seventh-generation self-etching bonding agent, was dispensed into a disposable 

mixing well

.

The bonding agent was applied to all prepared surfaces using a microbrush

.The bonding agent was then light-cured for 20 secondsSlide35

The

flowable

composite resin (G-aenial Universal Flo) with an applicator tip applied to the end of the syringe; the long, narrow cannula makes precise placement very easy

.

G-aenial Universal Flo was syringed into the preparations in a thin coat. The fiber reinforcement was placed into the floor of the preparations, and they were then filled with flowable composite to the cavosurface margins and light-cured.Slide36

Next, the flowable composite was placed on the stabilized fiberglass fiber (Connect [Kerr]) to wet the surface between the teeth with composite resin. It was then light-cured for 20

seconds

This facial view shows the composite-reinforced fiberglass reinforcement in placeSlide37

Kalore AO3 was used to begin building a pontic on the fiber between the abutment teeth

.

A plastic instrument (Goldstein Flexi­thin Mini 4 [Hu-Friedy]) was used for shaping A3.5 as the base dentin for the pontic. Kalore CV (B5) was used to simulate a root form similar to the adjacent teeth.Slide38

A sable brush (Keystone No. 4 Flat [Patterson Dental]) was used to create surface texture and refine anatomic form.

Kalore DT was used to create incisal translucency.Slide39

After initial contouring with an 8-fluted carbide composite finishing bur, contouring was completed using abrasive discs (Optidisc [Kerr]).

A yellow disc (Jiffy Disc [Ultradent Products]) was then used to polish the labial surface, and to refine the reflective angles and surface texture.Slide40

Facial view of the completed fiber-reinforced direct

nanocomposite

resin bridgeSlide41
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Trauma Stabilization

Easy to make and remove

Thin, smooth, and non-irritating to the lip Easy to control the degree of rigidity

Easy maintenance of oral hygiene

Does not impinge on the gingiva Has no memory - does not move the teeth Slide46

Space maintainerSlide47

Endodontic Post and CoresSlide48

Fiber PostSlide49

Thanks for your attention