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Biological Restorations in Children

Article · January 2016

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 Technique KDJ – Kerala Dental Journal

Biological restorations in children

* Seena John, ** Faizal C. Peedikayil, *** Vimal Remy

Abstract and Bianchi in 1991. It is defined as an procedure, obtaining healthy periodontal

“alternative technique that uses adhesive attachment and maintenance of the
An increasing demand for esthetics capabilities of materials in combination original tooth contours and translucence.
has led to new innovations and
with strategic placement of parts of The reattachment technique was
techniques in dental restorations in
anterior teeth. Tooth structure may human extracted teeth”2,3. first described in 1964 by Chosak
be used as an alternative to restore The technique of bonding tooth and Eidelaman. At that time, it was
fractured segments, grossly carious fragments was first proposed to repair considered as a provisional restoration
teeth etc. The tooth fragments can permanent teeth with the patient’s own due to the low bond strength values
be obtained from patients own tooth fractured crown. However, it also has achieved by the adhesive systems.
or from tooth bank. The restorations been performed to restore crowns However, the remarkable advancement
using these teeth are termed as
severely destroyed by carious disease, of the adhesive systems and resin
biological restoration. This article
discusses the different aspects of using fragments from another patient. composites has made there attachment
biological restorations. Moreover, extracted permanent teeth of tooth fragments a procedure that is
have also been employed in removable no longer a provisional restoration, but
Key words: Biological Restorations,
and fixed prostheses. Natural crowns rather a treatment offering favourable
Tooth Fragment,Paediatric Dentistry.
and roots, obtained from a tooth bank, prognosis.(Fig. 1) This procedure found
KDJ 2016 | Vol. 39 | No. 1 | Pg 30-32 have been used for several clinical and a strong argument in a conservative
laboratory procedures. 4 philosophy, since it does not require
Although the technique is simple, excessive wear of the healthy tooth
►► Introduction it requires the professional ability to structure and do not make unfeasible
Fractured tooth crowns, Primary prepare and adapt the natural crowns any other later possible restorative
teeth with extensive carious lesions are and intra canal posts. Parents must be treatment 4 - 6. J. O. Andreasen7 states
routinely observed in clinical practice. informed of, accept, and consent to the that the tooth reattachment procedure
Tooth material loss at an early age may use of teeth from a tooth bank. Teeth may importantly serve as a transitional
not only lead to establishment of neuro- from a trustworthy tooth bank must treatment alternative for pre-teens or
muscular imbalance leading to decreased be available. teenage patients to postpone definitive
masticatory efficacy but also phonetic treatment until an age where gingival
and esthetic problems, development Fragment reattachment margin contours are relatively stable.
of parafunctional, psychological Traumatic injuries most commonly Patients should be appraised of the
problems.1 To restore them is thus affect maxillary incisors. The most advantages and disadvantages and should
a challenge for the clinician. Diverse common teeth effected are central make an informed decision based on the
treatment options are available today like, incisors and lateral incisors due to their dentist’s recommended treatment
composite restorations stainless steel anterior position and protrusion caused Current adhesive agents provide
crowns, cheng crowns, dura crowns, strip by the eruptive process. Reattachment of sufficient bonding strengths to withstand
crowns, glastech crowns, pedo jacket a tooth fragment should be preferable the slow loading from masticatory
crowns etc. Out of the various treatment for restoring fractured teeth. There are stresses eventhough this bonded
options available to rehabilitate severely several advantages in this treatment interface is undeniably susceptible to the
destroyed tooth crowns, conservatively such as obtaining aesthetic in a single effects of cyclic fatigue and hydrolytic
and biologically, several authors have appointment, being a more conservative degradation over time. However, it
suggested the use of tooth structure as a
restorative material.1,2 The term biologic *PG Student, ** Professor & HOD, Department of Pedodontics and Preventive Dentistry, *** Senior Lecturer, Dept of
restoration was introduced by Santos Endodontics, Kannur Dental College, Kannur, Kerala State, India Corresponding author: Dr. Faizal C. Peedikayil,
Email drfaizalcp@gmail.com

30 KDJ – Vol. 39 • No. 1 • January 2016

 Biological restorations in children

appears that improvements in the luting and/or bonding should be followed in the human tooth bank. Collected
systems employed and a greater knowledge of the factors samples should be scaled, polished and freed of soft tissues
influencing restoration longevity should serve to enhance the and periodontal remnants. Pulps have to be removed and
potential for success of reattachment techniques in the future.8 complete biological preparation is to be done. Teeth are then
stored at 4 degree centigrade in HBSS with donor identification
Biological crowns till the time of its use. 9,10
The use of extracted teeth as biological restoration It is important that the parents are informed that the
constitutes a viable restorative alternative for teeth with tooth fragments used for biological restoration are previously
extensive coronal destruction. This technique is simple, submitted to a rigorous sterilization process that completely
provides excellent esthetics as well as preserves natural tooth eliminates any risk of contamination or disease transmission
colour compared to composite resins and stainless steel to the child receiving the fragment. Presently, secure methods
crowns, allows the preservation of sound tooth structure and of sterilization and storage are available to ensure the safety
has low cost. The enamel of the biologically restored tooth of teeth or tooth fragments coming from tooth banks Several
has physiologic wear and offers superficial smoothness and materials have been used for bonding dental fragments to
cervical adaptation compatible with those of surrounding cavities, e.g., adhesive systems, composite resins, glass ionomer
teeth. Biological restorations not only mimic the missing part cements and dual-cure resin cements. Since the Tooth fragment
of the oral structures, but are also biofunctional.5,6 which was taken was large, it was concerned that optimal
The length of each appointment is reduced because light-curing would not be achieved at the cavity gingival
natural teeth are prepared previously. Clinical chair time for margin. Thus, dual-cure resin-based cement was used to
fragment bonding procedures is relatively short, which is a enhance polymerization at this region in addition to filling
merit especially while dealing with paediatric patients Resin any possible gaps existing at tooth/fragment interface with
composite restorations do not present these advantages and composite resin only.3,4,5
can allow staining and plaque formation on their surfaces. 2,3 Biological restoration technique using tooth fragments has
Disadvantages of the biological crown restoration technique a practical clinical applicability and is a viable, cost-effective
include the difficulty in obtaining teeth with the required restorative procedure for primary teeth with severely damaged
coronal dimensions and characteristics, problems inherent to crowns. In the present case, the use of biological restoration
indirect restorations and matching fragment colour with tooth with natural crown resulted in clinical success as well as
remnant colour. Also, having teeth from other people’s teeth recovered the proper functional anatomy of the tooth. Finally
in their mouth is not a pleasant idea for some patients and the choice of restorative technique depends upon the operator
many of them refuse to receive this treatment However, all preferences, esthetic demands by the parents and child’s
these factors are not contraindications of the technique2,3,6,8. behavior that affect the ultimate outcome of whichever
Biological restoration used teeth from the Human Tooth restorative material chosen.
Bank are used as natural posts & crowns.2,7 The selected tooth
from the tooth bank is reshaped, roots strengthened by retro ►► Conclusion
filling with flowable composites and autoclaved for 30min at The constant evolution of Restorative Odontology is
121 degree centigrade and 15 lbs pressure before cementation.9 creating a new sight. In this short review represents the
Other factors of concern while using biologic restoration functional recuperation of a tooth, through the use of a
is that Universal protocol of consent, storage and sterilization endogenous dental fragment, a technique known as Biological

Fig. 1: Tooth fragment reattachment

KDJ – Vol. 39 • No. 1 • January 2016 31

 Seena John

restoration. With highly satisfactory results obtained in many 4. Saha R, Malik P. Paediatric aesthetic dentistry: a review. European
case reports, we conclude that this technique can be considered Journal of Paediatric Dentistry.2012; vol. 13(1):6-12.
as alternative to all others and can be carried out quickly and 5. Am Botelho, Kta T, Correa-Faria P1, Lns M,Viana M. Esthetic–
Functional Recovery Of Permanent Posterior Tooth Using Prima
inexpensively. Autogenous Biologica lrestoration Journal Of Indian Society
Of Pedodontics And Preventive Dentistry. 2012 Oct - Dec;
►► References 4(30):333-336.
1. Mathur S, Rahul C, Pandit I K, Srivastava N, Gugnani N. 6. Grewal N, Reeshu S.Case Report Biological restoration:An
BiologicalRestoration of a Grossly Decayed Deciduous Mandibular alternative Esthetic Treatment For Restoration Of Severly Multilated
Molar. Journal of Clinical and Diagnostic Research. 2012 Primary Anterior Teeth International Journal Of ClinicalPediatric
February;6(1): 139-141. Dentistry 2008.;1(1):42-47.
2. Sanches K, CarvalFabrício K D, FilhPaulo N,Sada A 7. Textbook and Color Atlas of Traumatic Injuries to the Teeth, 4th
F,WanderleyGarcia De Paula E S,Alexandra, Mussolino D Q. Edition, Jens O. Andreasen, FrancesM. Andreasen Lars Andersson,
Biological Restorations As A Treatment Optionfor Primary Molars July 2007, Wiley-Blackwell
With Extensive Coronal destruction - Report Of Two Casesbraz 8 Attila IO, Cenk MHA, Serdar MT.Multidisciplinary approach to the
Dent J (2007) 18(3): 248-252. rehabilitation of a crown –root fracture for immediate esthetics.
3. Das U K, Maiti N. Nature’s Own Alternative – Restoration Dent traumatol. 2006;22(1):48-52.).
With Biological Crowns. International Journal Of Pediatric 9 Habiltz S, et al. Nanoindentation and storage of teeth. J Biomech
Dentistry.2014april-June;3(2):144-149. 2002; 35(7):995 98.
10 Imparato JCP. Bank human teeth. Curitiba: Publi sher May, 2003.

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