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This document discusses pin retained dental restorations. It defines pin retained restorations as those requiring pins placed in dentin to provide retention and resistance form when satisfactory retention cannot otherwise be achieved. There are three main types of pins discussed - cemented pins, friction locked pins, and self-threading pins. The document outlines the indications, advantages, disadvantages, placement techniques and complications of pin retained restorations.
Исходное описание:
this presentation gives information about how to do the pin retained amalgam restoration.
This document discusses pin retained dental restorations. It defines pin retained restorations as those requiring pins placed in dentin to provide retention and resistance form when satisfactory retention cannot otherwise be achieved. There are three main types of pins discussed - cemented pins, friction locked pins, and self-threading pins. The document outlines the indications, advantages, disadvantages, placement techniques and complications of pin retained restorations.
This document discusses pin retained dental restorations. It defines pin retained restorations as those requiring pins placed in dentin to provide retention and resistance form when satisfactory retention cannot otherwise be achieved. There are three main types of pins discussed - cemented pins, friction locked pins, and self-threading pins. The document outlines the indications, advantages, disadvantages, placement techniques and complications of pin retained restorations.
1. Introduction 2. Definition 3. Indications and contra indications 4. Advantages and Disadvantages 5. Types of pin - Advantages and Disadvantages of each type - Placement techniques of pins and restorations 6. Complications of pins during treatment 7. Failure of pin amalgam restoration Definition: A pin retained restoration may be defined as any restoration requiring the placement of one or more pins in the dentin to provide adequate retention form and/or resistance form. Generally pins are used whenever satisfactory retention form cannot be achieved with undercuts, grooves or slots or by acid etch method (-for tooth coloured restorations) Indications: 1. Extensively decayed tooth: a) Fractured tooth where there is little or no coronal tooth structure. b) Extensive restoration and having questionable prognosis (Eg: Periodontally compromised condition) 2. In extended preparation: Carious lesion which dictate the outline of cavity, which extends beyond the recommended limits for restoration without support Eg: Cusp slopes, beyond line angles, wide proximal box where grooves cant be placed 3. Core Build-up: 4. Extensive class V restorations 5. Economic factor 6. Time factor 7. Teeth with questionable prognosis (Pulpally or Periodontally involved) 8. Age and health of the patient 9. Cross splinting 10. Morphological limitation. Contraindications: 1. Occlusal rehabilitation. 2. Role of tooth in the overall treatment plan. - Tooth serving as abutment to RPD. 3. Functional cusp protection. 4. Esthetics. Advantages: 1. Tooth preparation is more conservative than for other alterative restoration. 2. Time factors. 3. Economical. 4. Retention form is significantly improved with the use of amalgam. 5. Resistance form can be improved in selective cases. Disadvantages: 1. Difficult to achieve proper contact and contour. 2. Drilling pin holes and placing pins may create craze lines and fracture of dentin. It may also create internal stresses in dentin. 3. Microleakage around pins. 4. Pins do not reinforce amalgam and therefore do not increase the strength of restoration. Tensile and transverse strength are significantly decreased. 5. Retention by pins increase the risk of perforating pulp and external tooth surface. 6. Resistance form is more difficult to develop than when preparing for inlay. Functions of Pins 1. The primary function of the pin was to tie the restoration and tooth structure together and to retain the restoration in the cavity. 2. Pins in amalgam would reinforce and increase the tensile strength (not true because not possible). Types of Pins: Basically 3 types 1. Cemented pins. 2. Friction locked pins. 3. Self threaded pins or Self shearing pins. Cemented Pins: - Introduced by Dr. Markely in 1958. - The pin channel (pin hole) is larger in diameter than pin. Pin Channel diameter Pin diameter 0.027 0.025 0.021 0.020 - Cementing media Zn PO 4
or Zn polycarboxylate Advantages: 1. Does not produce internal stress or craze lines in dentin 2. Pin of choice for restoration in endodontically treated tooth. Disadvantages: 1. Microleakage. 2. It is least retentive amongst all three. 3. There will be weak point of interface between pin and cement used. Friction Locked (or) Friction Grip Pins - In 1966 by Goldstein. - Preparation of pin channel is smaller than pin diameter. Pin channel Pin diameter 0.021 0.022 - The pins are tapped into place. - Retained in tooth by resiliency of dentin - Threads are less on pins. Advantages: 1. More retentive than cemented pins 2. Used in vital teeth 3. No interface of cement Disadvantages: - Microleakage - Difficult to place in posterior teeth (DO). - Patient apprehension while placing pins - Cracks and shearing of dentin - Pulpal stress is maximal when the lateral surface of friction lock pin is adjacent to pulp. Self Threading Pins: - In 1966 by Going. - Pin channel diameter is smaller than pin - Different sizes are available - Colour coded and widely used. Pin channel diameter Pin diameter Regular 0.027 0.031 Minim 0.021 0.024 Minikin 0.017 0.019 Minuta 0.013 0.015 Four sizes of TMS pins. A. Regular, B. Minim, C. Minikin, D. Minuta Pin is retained by the threads engaging the resilient dentin as it is inserted Advantages: 1. Most retentive of the three 2. Less microleakage 3. Can be placed in posterior teeth (DO) 4. Patient apprehension is less. Disadvantages: Produce more dentinal craze Pulpal stress is more when the pins are inserted perpendicular to pulp. Most commonly used self threading pins are T.M.S - Thread mate system. AMALGAPIN: - Introduced in 1980 by Shavell - Retention for amalgam is provided by 2-3mm deep holes placed in dentin by using round ended bur No. 1156, 1157, 1158. Instead of placing pin. Amalgam is then condensed into holes and the remainder of restoration. Advantages: 1.No microleakage 2. No stress in dentin. 3. No need of pins and pin system 4. Pulp irritation is avoided Disadvantages: 1. More tooth structure is removed. 2. Shear strength of amalgam pin is less than that of pin amalgam. Factors affecting retention of pin in dentin and amalgam: 1. Type of pin: Least retentive is cemented pins. Next is friction lock. Best is self threading. 2. No. of pins used: Commonly 4-6 pins are used. General rule: In molars 1pin for each cusp missing Proximal box 2 pins. Minimum : 4 to 6 pins
As no. of pins increases, there will be 1. Crazing of dentin and potential for fracture increases 2. Minimum space for amalgam. No. bulk for amalgam leads to decreased strength fracture 3. Depth of pin in dentin: Increase in depth in dentin increases retention in cemented pins. But there is no increase in retention for friction lock and self shearing pins. Depth in dentin varies from 2-3mm 2mm for self shearing pins. 3mm for cemented pins. Sometimes 1.5-2.5mm when vertical height of crown in very less. 4.Pin length into amalgam: Pin should be long enough to retain restoration and withstand occlusal forces. 2mm of pin provide maximum required retention. When pins are placed nearer to occlusal surface as in cuspal coverage areas the pin should project only minimal into restorative material. 5. Inter pin distance: For small threaded pins: > 4mm. For larger threaded Distance increases pins and friction grip pins For cemented pin: Distance can be decreased. 6. Diameter of pin: Within the limits as diameter of pin increases, the retention in dentin and amalgam increases. 7. Surface characteristics of pins: Retention of the pin in amalgam is influenced by number and depths of the deformations on pin therefore friction locked pin is lowest followed by cemented and best is self threaded pins. Spherical and admixed have better bonding than conventional amalgam. Bonding can be improved by coating the pins with silver. 8. Orientation of pins: Factors Governing Pin Placement: 1. Knowledge of root anatomy to avoid perforation. (X-ray). 2. Pin channels should not be prepared in areas of bifurcation of roots and areas of convolution. 3. Pin channel should be parallel to that of root surface. 4. Ageing decreases the size of pulp chamber and root canal system and increases the dentin mineralization. Guidelines for pin placement: 1. Sufficient no. of pins should be used to bind the tooth and restoration. 2. Pins should be placed in areas previously occupied by cusps and marginal ridges near the line angles. 3. Pin holes must be placed in dentin 0.5mm from DEJ to prevent crazing of enamel. 4. Pin should be seated to a depth of atleast 2mm in dentin only. 5. Pin channels are made parallel to the external tooth surface to avoid perforation. 6. In keeping with tooth size the largest diameter pin should be selected for best strength and retention of the pin in the tooth surface. 7. The pin should be adjusted to a length so that it will allow enough bulk for amalgam. Placement of Pins: For self threading Pins 1. TMS hand wrenches 2. Loma Linda pin setter. 3. TMS auto clutch handpiece 4. Conventional contra angled handpiece For placement of cemented pins: Pin holes are prepared with twist drill 0.027 0.025 0.020 - The pin is cut to proper length with the wire cutter. - End is rounded with disc. - Pins are cemented with Zn PO 4 cement - Cement is carried by Lentelospirals - Bending of pins done before cementation Application of Matrix: Matrices used are 1.Toffelemiere 2.Auto matrix 3.Copper band Regardless of the type used, matrix must be stable. Matrix adaptation is tested by passing light so that no gap is there. They should be supplemented with wedges for proper contour and stabilization of matrix. Problems during pin placement: Broken drills and broken pins: Twist drill will break if it is stressed laterally or allowed to stop rotating before being removed from pin holes. Pins usually break when they are bent or if extra 1/4 th turn is given after it is seated. Treatment for both is selecting another location as removing the pin is difficult. 2. Loose pins: Self threading pins do not properly engage the dentin because of wide pin channel. Pin fails to shear and strips out of dentin. It is corrected by The pin hole is prepared with next large drill. Depth of pin hole is increased. 3. Penetration of pulp and perforation of external tooth surfaces: Pulp penetration is treated by doing direct pulp capping and changing the place of pin in safe location. External perforation is treated by surgical opening of flap and cutting of extended pin which is there in PDL after taking radiograph. Failure of pin retained restorations: 1. Within the restoration. 2. At the interface between pin and restorative material 3. Fracture within the length of pin. 4. At the interface between pin and dentin. 5. Within the dentin (Dentin can fracture).