Fiber reinforced Stress Reduced Direct Composite (FR SRDC) restorations

Dr Simone Deliperi: Fiber reinforced Stress Reduced Direct Composite (FR SRDC) restorations Dr Simone Deliperi: Live patient demonstration on The Deliperi Protocol for the restoration of structurally compromised teeth. The Sardinia Dental Teaching Center, Cagliari – Italy @drsimonedeliperi From Deliperi Simone, David Alleman and David Rudo. Operative Dentistry Journal 2017 Purpose: The purpose of this work was to present a restoration technique based on an understanding of the biomechanical properties of the dentinoenamel complex (DEC) and the physical-mechanical properties of the resin-based composite including the stress generated from both polymerization shrinkage and occlusal forces. Technique Summary: The DEC is a functional interphase that provides crack tip shielding; the DEC should be preserved during restorative procedures. Dentists can design the strategic placement of restorative materials into the cavity to both resist the mode of failure and mimic the performance characteristics of the intact natural tooth. The term “wallpapering” describes a concept of covering the cavity walls with overlapping closely adapted pieces of Leno weaved ultra-high-molecular-weight polyethylene (LWUHMWPE) ribbons. The key for success is that the ribbons are adapted and polymerized as closely as possible against the contours of residual tooth substrate. The resulting thin bond line between the fibers and the tooth structure creates a “bond zone” that is more resistant to failing due to the intrinsic stress and energy absorbing mechanism of the LWUHMWPE ribbons. The formation of defects and voids, from which crack propagation may start, is also reduced. The fibers’ tight adaptation to tooth structure allows a dramatic decrease of the composite volume between the tooth structure and the fiber, thus protecting the residual weakened walls from both the stress from polymerization shrinkage and the occlusal load. Conclusion: By using a similar approach, fiber-reinforced stress-reduced direct composite restorations may be performed in the restoration of structurally compromised vital and devital teeth. Clinical Significance: When most of the DEC on the lateral and proximal walls of severely structurally compromised teeth is lost, the wallpapering of the residual cavity walls with LWUHMWPE fibers may help to both emulate the crack shielding mechanism of the DEC and absorb the stress from either polymerization shrinkage or occlusal load.