Journal of Prevention and Treatment for Stomatological Diseases ›› 2021, Vol. 29 ›› Issue (7): 479-484.doi: 10.12016/j.issn.2096-1456.2021.07.008

• Prevention and Treatment Practice • Previous Articles     Next Articles

Fabrication of guide and removal of fiber post by tetrahedron positioning technology at the chair side: a case report and literature review

ZHANG Weilong(),WU Wanqi,LIAO Shanhua,ZOU Junbin,ZHAN Xuzheng,LIN Jie()   

  1. Department of VIP Dental Service, School and Hospital of Stomatology, Fujian Medical University, Fuzhou 350002, China
  • Received:2020-12-26 Revised:2021-03-07 Online:2021-07-20 Published:2021-04-19
  • Contact: Jie LIN E-mail:395711575@qq.com;linjie.dds@gmail.com
  • Supported by:
    Fujian Provincial Health Commission Middle and Young Aged Talents Training Project(2020GGA060);Fujian Province Undergraduate Training Program for Innovation and Entrepreneurship(C20182)

Abstract:

Objective To explore the technology and efficacy of fabrication of a guide and removal of a fiber post by tetrahedron positioning technology at the chair side.Methods For one patient with acute chronic periapical periodontitis of the left maxillary lateral incisor who needed to have the fiber post removed, the chair side tetrahedral positioning technique was used to make a guide plate to remove the fiber post. Cone beam CT (CBCT) data were imported into the software to design the guide plate for fiber post removal. The guide plate design on CBCT was transferred to a solid model by using tetrahedral positioning technology. The guide plate was made to guide the removal of the fiber post, and then left maxillary lateral incisor root canal was performed. We evaluated the effect of fiber post removal with tetrahedral positioning technology by reviewing the literature.Results The guide plate made by tetrahedral positioning technology can accurately locate the position and direction of fiber posts at a low cost and with high speed. After the fiber post was removed, the root canal could be dredged by using root canal preparation instruments. After root canal preparation, the root canal was filled with warm gutta-percha to complete the root canal treatment. After 3 months, the apical radiograph showed that the transmission shadow of the apical area was reduced. The results of the literature review showed that the fiber post removal with guide plates provides a predictable result and a lower risk of iatrogenic damage. Minimally invasive treatment can be carried out, and chair time can be reduced.Conclusion On the basis of CBCT data, using tetrahedral positioning technology to make fiber post removal guides can help reduce the risk of fiber post removal and has the characteristics of speed, low cost and short chair side processing. However, the accuracy comparison between tetrahedral positioning technology and 3D printing guides needs further study.

Key words: fiber post, tetrahedron positioning technology, surgical guides, cone beam CT, chair side, three-dimensional printing, accuracy, positioning technology, root canal retreatment, warm gutta-percha filling technique, minimally invasive treatment

CLC Number: 

  • R78

Figure 1

Design of guide bar and guide ring The length of the self-made cylindrical guidepost was 40.00 mm, and the diameter was 0.5 mm. There was a tip at one end and a 0.2 mm conical concave at the center of the other end, which was convenient for fixing the tip of the compass. The length and inner diameter of the self-made titanium guide ring were 7.00 mm and 0.55 mm, respectively. The self-made cylindrical guidepost, compass H2030 and gooseneck tube were combined to make a tripod compass"

Figure 2

Design of the tetrahedral positioning guide based on CBCT data a: design of the direction for removing the fiber post; b: demolition along the root canal and fiber post direction. c: fixed point and length measurement between each point by tetrahedron positioning technology. Point 2 (P2) was taken by extending 40 mm (the length of self-made cylindrical guidepost) from point 1 (P1) to the occlusal side. Point 3 (P3) and point 4 (P4) were taken from the central fossa of 16 teeth and 26 teeth, and the P2-P3 and P2-P4 distances were measured."

Figure 3

Guide fabrication and fiber post removal of 22 tooth a: the guide was made on the plaster cast, firstly, the central point of the exposed part of the fiber post was ground to a depth of 0.2 mm conical concave, which was the position corresponding to point 1 (P1), secondly, the two feet of the tripod compass were placed in the central fossa of 16 teeth and 26 teeth, which were the positions corresponding to point 3 (P3) and point 4 (P4), the length of the tripod compass and the other foot were set to the distance of point 2 (P2)-P3 and P2-P4, respectively, thirdly, the tip of the cylindrical guide bar was placed in the shallow concave, and the other end was fixed at P2 with a tripod compass, the four points were connected to form a stable tetrahedron, which could locate the direction of fiber post removal; b: after removal of the crown restoration, the fiber post hindered root canal retreatment; c: the fiber post was removed by the guide"

Figure 4

Imaging data of apical radiographs of 22 tooth a: before treatment, the apical area of the left maxillary lateral incisor showed a low-density transmission image, and the root canal filling had poor tightness; b: at the test point, after the fiber post was removed, a smooth root canal passage was prepared to drain the apical inflammation; c: root canal filling; d: return visit 3 months after root canal filling, the range of low-density transmission images of the left maxillary lateral incisor was significantly reduced"

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