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.The basic aim of dentistry today is to preserve& protect oral structures. State of the art tech-niques, instruments & materials have nowmade it possible to save teeth that seeminglyhave no hope of survival. One of the bestexamples that elicits an excellent responsefrom patients is the preservation of their ante-rior teeth.Anterior teeth are quite susceptible to traumaas they are relatively unprotected when com-pared to the posteriors. Most broken anteriorsmay be kept in place following successfulendodontic treatment, but the challenge lies insuccessful reconstruction.
In such instancesposts have become an asset to the phase ofrehabilitation.Posts are indicated in two situations, onewhere the post is used to reinforce existingcoronal tooth structure & the second where inthe absence of sufficient coronal tooth struc-ture the post & a core around it replace themissing tooth structure. Posts are available invarious forms. They may be tapered (smoothor threaded) or parallel (smooth or threaded).Smooth posts are also referred to as passiveposts because their retention is solely basedon intimate contact & the cementing mediumused. Threaded posts actively engage into thedentine by way of their threads. Current con-cepts concentrate on minimizing the amountof stress generated by the post on the remain-ing tooth & on restoration designs that impartoverall strength to the restoration. Parallelposts generate less stress than tapered ones& a smooth surface is sometimes preferred tothe threaded. The design of the restoration &the way the post is placed should allow dissi-pation of stresses rather than concentration atany point to prevent the possibility of fracture.Non-metallic posts have gained popularity inrecent years for two reasons.
Glass fiber postsblend in well if the restoration is either com-posite alone or if an all-ceramic crown is to beplaced subsequently. Carbon fiber posts arestronger and are chosen if the restoration is tobe a metal ceramic restoration.Described below is a clinical technique forrestoring an incisor using Glassix posts (Har-ald Nordin SA, Switzerland).1. Of prime importance is the first step ofdiagnosis & treatment planning. One mustcheck for vitality of the tooth & periapicalhealth.
In the absence of secondary verti-cal fractures a decision for endodontictreatment is made in the absence of vitali-ty or occasionally if the existing coronalportion of tooth is insufficient for restora-tion as in extremely worn out anteriors.2. Any system of root canal treatment maybe followed. Of the presently availableengine driven instruments Light speed(Lightspeed technology Inc., Texas, U.S.A)lends itself well for the purpose of posttechniques because the NiTi instrumentshave perfectly matched obturation tips(Simplifill) that allow a 5 mm long apicalgutta percha plug to be placed as anapical obturation. In the Simplifill tech-nique an Apical GP Plug that correspondsto the Master Apical Rotary Lightspeedinstrument used for biomechanical prepa-ration is chosen. Sealer is applied to theplug & it is inserted with firm apical pres-sure after which a counterclockwise twistdisengages the stainless steel shaft of thecarrier. On removal of the flexible stainlesssteel carrier shaft the remaining space isready for post placement.
In most othertechniques obturation is carried out afterwhich the required amount of gutta perchais either removed with a heated plugger orpeeso reamers. Glassix posts come in 3sizes (the most commonly required diam-eters of 1.2, 1.35 & 1.5 mm).
Reamers aresupplied by the manufacturer to aid inpreparing the internal canal walls toreceive the post.3. Currently recommended sealers are eithersilicone or epoxy based.
If eugenol basedsealers are used care must be taken toclean up the canal to prevent the possibil-ity of eugenol interfering with the setting ofresin based luting agents.4. The internal canal walls are prepared usingthe supplied reamer & the glass fiber postis trial fitted with gentle apical force afterthorough irrigation to remove debris.
Glas-six posts are slightly longer than requiredto ensure ease of handling & to ensure thatthe post reinforces the core material rightup to the coronal tip. Gross excess inlenght may be adjusted with a diamonddisc after verification of post length spacewith a file in canal.5. A resin based luting agent is preferred.
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Anexample is 3M s Relyx ARC. Etchant gel isapplied to the insides of the canal with aninterdental brusch (Oral B interdental set,U.S.A). After 15 seconds rinse & dry withpaper points. 3M single bond adhesive isapplied & excess removed with a paperpoint. After drying for 5 seconds, light curefor 10 seconds. The cement is now dis-pensed onto a pad & transferred to thecanal with a periodontal probe or a lentu-lospiral.
A little cement is applied to thesurface of the post & the post is seated.Postponing tooth loss - an emerging trendDr. Prakash, M.D.S. (Reader in Prosthodontics), Dr.
Subadhra Prakash, B.D.S.Excess cement that extrudes coronally isremoved & then the cement is light curedfor 40 seconds from an occlusal direction.Glass fiber posts transmit a certainamount of light apically but areas notexposed to light will set via the self-curingreaction of the cement.6. If the amount of tooth damage is minimal,for example the access opening plus aproximal lesion, composite build up to fulltooth shape will sometimes suffice withthe post reinforcing the coronal portion ofthe tooth. In most other instances a crownis preferred for protection. Prior to build upall unsupported enamel is removed & theouter edge or periphery of the remainingcoronal portion of the tooth is sloped out-wards. This feature called a contra bevel isplaced with a flame shaped diamond forthe purpose of providing a strengtheningmetal collar in the crown that is to be fab-ricated.7. The tooth is now ready to receive the corebuld up with composite.
There are twoways of building up the core. One is to usethe composite in increments to build upthe tooth to its entire form & shape afterwhich tooth reduction is carried out.
Thesecond is to directly build up the shape tothat of a prepared tooth. The secondapproach minimizes time spent & wastageof material but requires patient planning &experience.8. After the core has been built up judiciousreduction is carried out such keeping inmind that preservation of remaining toothstructure greatly increases the treatmentsuccess. It is of paramount importance toensure that the final finish margin of thetooth is carried apical to the core - toothjunction so that the metal of the crownencircles sound tooth thus providingstrength to the final restoration.
Invariablythis will mean carrying the margin subgin-givally. This also helps improve the finalesthetic result but the patient must beinstructed of the importance of mainte-nance of periodontal health.9. The impression is made with non-aqueouselastomeric impression material. The putty- light body technique is either carried outin two steps by a single operator or bothsteps are carried out simultaneously bythe doctor & assistant working in tandem.In the two-stage technique it is alwaysadvisable to make the putty impressionprior to gingival retraction. Gingival retrac-tion is then performed.
Create escapegrooves & necessary relief with a Bardparker blade in the putty. Light body mate-rial is mixed & loaded into the tray & alsointo a syringe.
The material is injectedaround the preparation from the baseupwards after removing the retraction cord& the tray is seated over the teeth withgentle pressure to prevent a rebound ofthe putty during the setting process.Excess pressure causes the putty to becompressed. When the putty relaxes afterthe setting of the light body the resultantcast will have smaller teeth and the crownfabricated will therefore have a tighter fitthan required.10. The steps required in the fabrication of thecrown may now be carried out as with anyother tooth. A temporary crown is fabricat-ed using a polycarbonate crown. Thepolycarbonate crown is filled with self-cur-ing tooth colored acrylic & the fit is adjust-ed on a cast of the prepared toothobtained from an alginate impression. Thefinished temporary is cemented with aneugenol free temporary cement (e.g.:Freegenol Temporary Pack - eugenol freetemporary cement, GC Corporation,Tokyo, Japan).
Eugenol is said to cause asoftening of the acrylic of the temporarycrown.Conclusion: With the advent of newer materi-als & improvements of age old techniquesprecision & quality are easier to achieveclinically. This essentially means that pro-cedures earlier throught of as complex cannow be performed with relative ease withpredictable results improving the chancesof saving many teeth from the ultimate fateof extraction.References1.
Christensen G.J., Posts & cores: State of theart. JADA 129: 96-98, 1998.2. Deutsch A.S., Musikant B.L., Cavallari J., Lep-ley J.B. Prefabricated dowels: A literaturereview.3. Goerig A.C., Mueninghoff, L.A. Managementof the endodontically treated tooth. Part I:Concept for restorative designs.
ProsthetDent 49: 340-345, 1983.4. Goerig A.C., Mueninghoff, L.A.
Managementof the endodontically treated tooth. Part II:Technique.
Prosthet Dent 49: 491-497, 1983.5. Hudis S.I., Goldstein G.R. Restoration ofendodontically treated teeth: A review of litera-ture. Prosthet Dent 55: 33-42, 1986.6.
An evaluation of the retentive prop-erties of various permanent crown posts. J.Prosthet Dent 49: 633-635, 1983.7. Mendoza D.B., Eakle W.S., Kahl E.A., Ho R.Root Reinforcement with a resin bonded per-formed post. Prosthet Dent 78: 10-14, 1997.8. Shillingburg H.T., Hobo S.
Whitsett L.D.
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After application of the Anderson-Darling normality test, data were analyzed. Crack Stoll M1 Plus Download there. Rabin and Post compared the evaluation by manual methods and isokinetic instrumental evaluation of the bending momentum and external rotator of the shoulder before and after surgery.How to download biomecanica basica del sistema musculoesqueletico files to my device? Datalogic Skorpio X3 Usb Driver.
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Comparative studies involving muscle strength as well as considerations about the dominance and non-dominance ratio have been studied by many researchers. Nordin biomecanica pdf descargar. By understanding that the gain of muscular strength improve the functionality of the patient, it is important that muscle strength measurement methods are accurate and reliable.Here you can download biomecanica basica del sistema musculoesqueletico Shared files found Uploaded on TraDownload and all major free file sharing websites like 4shared.If you found that any of above biomecanica basica del sistema musculoesqueletico files may have been subject to copyright protection. The rupture of the muscle-tendon units of the rotator cuff determines conditions of pain, instability or a combination of both simptons.According to the recommendations of The American Society of Exercise Physiologists ASEPstandardized instructions to individuals were given aiming to reduce the margin of error during testing.