Pediatric Dentistry

Resin composite restoration in primary anterior teeth using

short-post technique and strip crowns: A case report
Fausto Medeiros Mendes, DDS, MSD1/Monique Saveriano de Benedetto, DDS, MSD1/
Cristina Giovannetti del Conde Zardetto, DDS, MSD1/Marcia Turolla Wanderley, DDS, MSD2/
Maria Salete Nahs Pires Corra, DDS, MSD, PhD3
A case report using a technique for the restoration of endodontically treated primary maxillary incisors with
resin composite short posts and celluloid strip crowns is described in a 3-year-old girl. The technique offers the advantages of using one restorative material, improving esthetics, and reducing chair time and
costs. (Quintessence Int 2004;35:xxxxxx)
Key words: esthetics, pediatric dentistry, primary teeth, strip crown, short post

[Au: Please provide a short clinical relevance statement]

espite considerable advances in the prevention of

dental caries, pediatric clinicians still deal with
cases of total destruction of the primary teeth. In very
young children, severe tooth destruction is often associated with frequent and prolonged exposure to cariogenic substances in the nursing bottle, compounded by
lack of adequate hygiene habits. The teeth most often
involved are the maxillary central and lateral incisors
and the maxillary and mandibular primary first mo-

Graduate Student, Pediatric Dentistry, University of So Paulo, So Paulo,

Brazil.

Professor of Pediatric Dentistry, Department of Orthodontics and Pediatric

Dentistry, University of So Paulo, So Paulo, Brazil.

Professor of Pediatric Dentistry, Department of Orthodontics and Pediatric

Dentistry, and Coordinator, Clinic of Pediatric Dentistry, University of So
Paulo, So Paulo, Brazil.

Reprint requests: Dr Fausto Medeiros Mendes, Faculdade de

Odontologia da Universidade de So Paulo, Departamento de Ortodontia e
Odontopediatria, Av. Prof. Lineu Prestes, 2227, CEP 05508-900 So
Paulo, Brasil. E-mail: medeirosmendes @uol.com.br

Quintessence International

lars, while the mandibular primary incisors are relatively unaffected. Maxillary incisors are the most severely involved, and the lesions can lead to total destruction of the crowns.14
Dental destruction may lead to development of parafunctional habits (tongue thrusting, [Au: Speech problems?]), psychologic problems, reduced masticatory efficiency, and loss of vertical dimension of occlusion.510
It is important to restore crowns destroyed by caries to
preserve the integrity of the primary dentition until its
exfoliation and eruption of the permanent teeth.5
In cases of severely carious teeth, endodontic treatment associated with the use of intracanal posts becomes necessary prior to restoration of the crowns. In
primary teeth, intracanal retention can be achieved by
several techniques: directly building up a resin composite post 11 ; preparing an inverted mushroomshaped undercut in the root canal prior to resin composite short post [Au: placement?]12; using alpha- or
omega-shaped orthodontic wire,13,14 stainless steel prefabricated posts,7,15 nickel-chromium (Ni-Cr) cast posts
with macroretentive elements,9 natural teeth from a
tooth bank,10 and reinforcement fiber.16
Casellato et al17 reported in an in vitro study that
threaded posts (F KG [Au: Is this the brand of
threaded post? Or is this the manufacturer? Please
specify]), Ni-Cr posts with macroretentions, alphashaped orthodontic wire, biologic posts, and root
1

Mendes et al

incisors (Fig 1). The patient was submitted to clinical

and radiographic evaluation in order to establish a
treatment plan.

TREATMENT

Fig 1 Frontal view of carious maxillary incisors.

canal filled with resin composite showed similar fracture resistance values when submitted to shear bond
strength tests.
Perrela et al18 described that threaded posts (FKG)
and alpha-shaped orthodontic wire showed an average success rate of 76.47% after 10 months of clinical
and radiographic follow-up when used in primary anterior teeth [Au: Edits to previous sentence OK?].
Restorative modalities used to treat primary anterior crowns include stainless steel crowns,19,20 polycarbonate crowns,5 resin composite,6 indirect resin composite crowns,9 and biologic restoration with natural
tooth.10 Resin composites, used directly or indirectly,
have been an excellent choice for severely carious
teeth due to their adhesive bonding and esthetic appearance.20,22 [Au: You did not cite reference 21.
Please do so or it will be deleted from the references
section] Preformed, indirect resin composite crowns
have recently become available in the form of resin
composite shells for primary teeth.23 Preparation of acetate crown forms on a stone cast prior to the appointment saves treatment time and produces desirable results.11,12,15,20,22,24 In light of these advantages,
techniques that save treatment time are favorable in
very young children.20
The purpose of this report was to demonstrate the
rehabilitation of primary anterior teeth in a 3-year-old
girl with early-onset carious lesions. The endodontically treated teeth were reinforced using a resin composite short-post technique12 and restored with celluloid strip crown formers.

PATIENT HISTORY AND ORAL HEALTH FINDINGS

A 3-year-old boy [Au: Is the patient a boy or a girl?
You said it was a girl in the article abstract] presented with nursing-bottle caries lesions on the occlusal surfaces of his primary molars [Au: Maxillary
or mandibular?] and incisal surfaces of the maxillary
2

After restoring the primary molars with resin composite, the maxillary primary central incisors were submitted to a pulpectomy technique (Fig 2). The root canals
were obturated with an iodoform-based paste to two
thirds their length, and a thin layer of resin-modified
glass-ionomer [Au: Cement?] (Vitremer, 3M) was
placed to isolate the root canal filling material. The
teeth were then cleaned, etched for 15 seconds with a
37% phosphoric acid solution (Fig 3), rinsed with
water, and air dried. A lightcured bonding agent
(Single Bond, 3M) was brushed on the etched surfaces
and thinned by a compressed air blast. Next, light-cured
resin composite (Z250, 3M), shade B2, was placed in
several steps into the root canal and in the crown region to form the superstructure of the post (Fig 4).
During the next visit, celluloid strip crowns were
used to build up the teeth (Pedo-form Strip Crowns,
3M). The celluloid crowns have been previously selected based on the mesial-distal width of the teeth
(Fig 5). The crowns were trimmed with scissors to
achieve a good fit gingivally to the prepared incisors
(Fig 6). The resin composite posts were etched for 15
seconds with a 37% phosphoric acid solution (Fig 7),
rinsed with water, and air dried. The lightcured
bonding agent (Single Bond, 3M) was brushed on the
resin composite posts. A hole was punched in the
palatal surface of the strip crowns using a sharp explorer point to act as a vent when placing the resin
compositefilled crown. The celluloid crown forms
were filled with shade B1 resin composite resin (Z
250, 3M) and inserted with pressure onto the incisor
and post (Fig 8). After polymerization on the buccal
and palatal surfaces, a sharp tip of the explorer was inserted at the gingival margin between the celluloid
crown form and the polymerized resin composite to
remove the crown form. (Fig 9) Finishing, polishing,
and occlusal adjustments were performed using diamond burs (KG Sorensen), Sof Lex discs (3M), and
polishing strips (Figs 10 to13).
The lateral maxillary incisors were also restored
with celluloid strip crowns but without endodontic
therapy. In order to improve esthetics, a bevel at cavosurface margins was done on the facial surface of
these teeth.
The child and parents were once again instructed
about proper dietary and oral hygiene habits. The importance of periodic visits in order to preserve the primary dentition was also emphasized.
Volume 35, Number 9, 2004

Mendes et al

Fig 2 Preparation of root canals for resin

composite post after endodontic treatment.

Fig 3 Etching of root canals for 15 seconds with 37% phosphoric acid.

Fig 4 Resin composite placed on the coronary portion following the resin composite
post.

Fig 5 Different sizes of strip crowns

(Pedoform Strip Crown).

Fig 6 Selection of the strip crowns based

on the mesial-distal width of the teeth.

Fig 7 Etching of resin composite posts for

15 seconds with 37% phosphoric acid.

Fig 8 Crown filled with resin composite

and inserted onto the prepared incisor. Note
the excess resin on the palatal surface extruding through the vent.

Fig 9 An explorer tip was used to remove

the strip crown from the incisor leaving the
resin composite crown in place.

Fig 10 Primary incisors restored with strip

crowns before finishing and polishing,
showing the esthetic appearance of the restored teeth.

Fig 11 Finishing with diamond stone on a

high-speed handpiece.

Fig 12

Polishing of proximal areas.

Fig 13 Final radiograph showing endodontic treatment, resin composite short posts,
and primary incisors restored. [Au: The
image shows the complete filing of one
canal and two thirds of a second canal.
This is not consistent with the statement
in the text of two-thirds length. Please
correct discrepancy]

Quintessence International

Mendes et al
Fig 14 (left) Anterior view of maxillary incisors before crown rehabilitation.
Fig 15 (right) Final anterior view. Follow-up
of the anterior rehabilitation after a period of
4 months.

TREATMENT RATIONALE
The technique described restored esthetics and function while eliminating laboratory processing and reducing costs. Chairtime was greatly reduced as the
resin composite posts were prepared directly in the
root canal as opposed to adapting prefabricated or
dentin posts. Furthermore, the technique involved
using one cohesive material in the canal and crown
(resin composite), while eliminating the cementation
of the post. Also, resin short posts offered better esthetic results since they do not require a layer of
opaque material as used in metal posts. This technique
represents an alternative to other prosthodontic
restorations in children in the absence of occlusal interferences [Au: Ok to delete ...in the absence of occlusal interferences.?].
The use of celluloid strip crowns with resin composite short posts reduces operatory chairtime. The
technique does require selection and adaptation of
strip crowns on the cervical margins of the teeth and
the reduction of excess resin composite around the
gingival margin.
The technique described can be used to restore severely carious primary anterior teeth in two appointments. The celluloid crown is filled with a resin composite, which is the same material used in fabricating
the post. In addition, the celluloid crown produces a
glossy finish, thereby minimizing polishing.
The described technique is simple and can be used
to restore severely carious or fractured primary anterior teeth, reestablishing function, shape, and esthetics
in young children (Figs 14 and 15).

[AU: PLEASE MAKE A PORTION OF THE TEXT INTO

THE CONCLUSION OR PLEASE PROVIDE A SHORT

CONCLUSION]

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