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 »  Home  »  Endodontic Articles 6  »  Stainless steel bands in endodontics: effects on cuspal flexure and fracture resistance
Stainless steel bands in endodontics: effects on cuspal flexure and fracture resistance
Discussion - References.



Discussion.
This study found that a band reduced cuspal deflection compared with the same teeth without a band. The range of cuspal deflections was large: without a band, the deflections varied from 5.8 m to 33.4 m, and after band placement the deflection was 3.6 m to 15.9 m. The variation of the deflections related to differences in tooth morphology and stiffness, and the difficulty of standardization of cavity preparation and measurement despite careful attempts. By using each tooth as its own control, however, the effect of band placement could be determined on an individual tooth basis.
The experimental design required that all teeth were tested in the same sequence: first, without a band, then with the band cemented, and then loaded to fracture. It is unlikely that teeth were damaged by loading to 100 N without a band. The load of 100 N has been used in numerous studies previously without reported damage (Reeh et al. 1989, Panitvisai & Messer 1995), and was well below the subsequently measured fracture load (minimum 469 N).
The mean deflection of both cusps in this study (8.1 m) was similar to that reported for intact teeth (11 m, Hood 1991). The band clearly acts as a barrier for extensive deflection, and the teeth reacted in much the same way as an intact tooth with continuity of the enamel (Hood 1991).
With preformed bands, the size and type of band and the quality of fit could affect the extent of outward deflection of the cusps. This study used only one band product, a universal type, and it was found that not all teeth matched the available sizes ideally. It is possible that an inward displacement could occur during cementation of a tightly fitting band. However, this study did not evaluate whether an inward displacement occurred.
For temporary restoration of a broken-down posterior tooth, amalgam restoration without cuspal coverage is not recommended. Some authors have recommended that the temporary restoration should be a pin-retained cuspal coverage amalgam restoration (Barkmeier et al. 1980), a cuspal coverage amalgam restoration (Messer & Wilson 1996), or a bonded composite or glass ionomer cement (Kahn 1982, Gutmann & Lovdahl 1997). Based on the results of this study, stainless steel bands could be recommended for teeth with an unsupported cusp present. Taking a tooth ‘out of occlusion’ by reduction of cuspal height is also recommended. The fracture resistance of a tooth with a band (this study) is greater than for a tooth with an amalgam restoration (Reeh et al. 1989). Reeh et al. (1989) found that teeth restored with an amalgam restoration fractured at a load of approximately 60 kg (588 N), which is similar to our result for teeth without a band (729 N) and less than the load needed to fracture a tooth with a band in this study (1282 N).
This study demonstrated that stainless steel bands reduced the cuspal flexure by one-half compared to teeth without bands and, furthermore, doubled the fracture strength. If these results can be applied to the clinical situation, stainless steel bands are able to provide a protective effect for teeth undergoing root canal treatment and in the immediate management of cracked–tooth syndrome.

References.

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DeLong R, Douglas WH (1983) Development of an artificial oral environment for the testing of dental restoratives: Bi-axial force and movement control. Journal of Dental Research 62, 32-6.
Ehrmann EH (1968) The use of stainless steel bands in posterior endodontics. Australian Dental Journal 13, 418-21.
Ehrmann EH, Tyas MJ (1990) Cracked tooth syndrome: Diagnosis, treatment and correlation between symptoms and postextraction findings. Australian Dental Journal 35, 105-12.
Gutmann JL, Lovdahl PE (1997) Problems encountered in restoring endodontically treated teeth. In: Gutmann JL, Dumsha TC, Lovdahl PE, Hovland EJ, eds Problem Solving in Endodontics. Prevention, Identification and Management, 3rd edn. St. Louis, MO, USA: Mosby, 326-8.
Hood JAA (1991) Biomechanics of the intact, prepared and restored tooth: some clinical implications. International Dental Journal 41, 25-32.
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Liu HH, Sidhu SK (1995) Cracked teeth-treatment rationale and case management: Case reports. Quintessence International 26, 485-92.
Messer HH, Wilson PR (1996) Preparation for restoration and temporisation. In: Walton RE, Torabinejad M, eds Principles and Practice of Endodontics, 2nd edn. Philadelphia, USA: W. B. Saunders Company, 272-4.
Morin D, Douglas WH, Cross M, Delong R (1988) Biophysical stress analysis of restored teeth: experimental strain measurement. Dental Materials 4, 41-8.
Panitvisai P, Messer HH (1995) Cuspal deflection in molars in relation to endodontic and restorative procedures. Journal of Endodontics 21, 57-61.
Pitt Ford TR (1997) Problems in endodontic treatment. In: Pitt Ford TR, ed. Harty's Endodontics in Clinical Practice, 4th edn. Oxford: Wright, 248-9.
Reeh ES, Messer HH, Douglas WH (1989) Reduction in tooth stiffness as a result of endodontic and restorative procedures. Journal of Endodontics 15, 512-6.
Weine FS (1996) Access cavity preparation and initiating treatment. In: Weine FS, ed. Endodontic Therapy, 5th edn. St. Louis, MO, USA: Mosby, 302-3.