The Journal
Treatment Protocol
1. Parental consent was obtained for the
procedure.
2. Local anesthesia was administered and
pulpectomy procedure was performed i.r.t. 51,
61 and 62 using metapex as the root canal filling
material.
3. Custom-made half omega-shaped post with
21 gauge orthodontic wire were used to provide
strength for the coronal restoration. About 5 mm
of the metapex was removed from the coronal
end of the root canal, and 1 mm of glass
ionomer cement (GIC) was placed. The incisal
end of the wire projected 3-4 mm above the
remaining root structure.
4. The root canal was etched with 35%
phosphoric acid for 20 s, followed by bonding
agent was placed and cured for 20 s.
5. Flowable composite was used for the root
canal filling along the loop. The composite was
light-cured for 40 s.
6. Crown of 51, 61 and 62 was reconstructed
using composite resin.
7. Crown of 52 was restored using composite
restoration.
8. Finishing and polishing were performed
using soflex tips after checking the occlusion.
9. Follow up was done at 3, 6 and 12 months
and the teeth were completely asymptomatic
both clinically and radiographically.
Discussion
Post-endodontic restoration of primary anterior
teeth in very young children with the severe loss
of coronal structure is a challenging task for the
pediatric dentists. There is a high rate of failure
not only because of absence of tooth structure,
poor adhesion of bonding agent to primary
teeth, limited availability of materials and
techniques, but also because the children who
require such restorations are among the
youngest and least manageable group of
patients. [4] After the successful endodontic
treatment and placement of intracanal
retainers, the remaining coronal structure can
11
be restored with indirect or direct technique or
single tooth prostheses, such as strip crown,
stainless steel crown, metal plastic crown,
porcelain veneers, polycarbonate crowns, and
[5]
acrylic resin crown.
Rifkin described restoring primary anterior teeth
with post and crown. But it was not widely
accepted because of the potential for
interference with physiologic root resorption if
the wire extends a long way into the root. In
addition, it can increase internal stresses within
the root leading to fracture if the post is forcibly
[6]
fitted into a narrow canal. There are a number
of posts available for restoration of such teeth
as omega posts, nonmetallic ceramic or glass-
fibre posts.
The most simple and effective is the use of an
omega loop which was introduced by Mortada
and King. In this technique, omega loops wire
extensions are placed at the depth of around 3-
4 mm inside pulp chamber and the projected
portion of the loop is used for retention of the
coronal restoration. The advantage of using
omega loops is that the wire does not cause any
internal stresses in the root canal since it is
incorporated in the restorative material, and the
treatment can be completed with very less chair
side time. [7] The disadvantage of ceramic and
glass-fibre posts are that they are technique
sensitive, time-consuming, expensive and
[8]
involve multiple steps. Therefore, omega
loops were chosen as posts for the restoration
of teeth. There are various case reports of use
of the same for severely mutilated primary
anterior teeth. [9-11]
Conclusion
The use of omega loops and direct composite
resin for coronal restoration provided good
retention and esthetics to the child along with
restoration of his masticatory function.
However, its long term durability and success is
yet questionable.
Vol. 14 No. 2
May-August 2018