Fibre reinforced composites

Okay so completely forgot I had this blog going but did notice some notifications that people are viewing it and even commenting. Although I am highly suspicious that these are bots it is a good reminder for me to keep posting as my dental journey after all is an ongoing one.

One treatment modality I have been able to use a few times is that of fibre reinforced composites. As far as I can recall there are many different fibres that can be utilised but the everstick bran I have used consists of glass fibres presoaked in unfilled resin for bonding. I have used non soaked fibres in the past but they are far more cumbersome to use with extra steps. I find it useful to imagine that the fibres will act as stress breakers and will strengthen the overall composite likely similar to metal scaffolding in concrete.

They are useful even in normal composite resin restorations as I can imagine that placing a net of fibres between increments will strenghten the restoration. There are composites available which have similar fibres as fillers already in the composite. I have not used these but can imagine that they may be useful in large restorations under heavy load e.g in a bruxer or in a canine with canine guidance.

I have mainly used this modality in fibre bridges. They have come in handy as:
-Splinting material for perio involved teeth
-Rebonding a lost tooth due to trauma or perio by attaching them to the adjacent tooth/teeth
-Filling a missing space with a direct or indirect composite bridge.

Important points that come to mind:
-Always check the occlusion, there will always be significant bulk on the palatal and if they have a deep bite then there will be no restorative space and the force on the bridge will be increased resulting in failure. Consider posterior buildups to compensate or a partial denture instead. In the past I have compromised by using the labial surface of the adjacent tooth as a bonding surface. Keep in mind that this will make it appear bulky unless the tooth is retroclined in the first place
-Communiation, communication, communication: I always see these as a provisional tooth replacement. Ideally if fincances will allow and implant will be placed shortly after extraction to make use of the available bone but in a pinch a resin bridge will provide a non removable, conservative replacement for some time. Recent studies indicate good survival at 5 years but not so much after that. The patient must know that this is not a permanent solution
-Use flowable as a first increment and to tack the fibres onto the tooth. Instructions indicate to use a strong flowable e.g gaenial universal flow to adhere the fibres to the tooth. I have recently been using this for the whole procedure. It is miuch easier to use than packable composite and I can handle it in thinner layers resulting in less bulk for the patient as well as a smoother finish as the surface will rearrange itself after placement.
-Use rubber dam ideally: It is a must especially if there is immediate placement post extraction. Blood will ruin your bond. The difficult part is placing a natural tooth back at the right position and angulation with the rubber dam in the way. I haven't found a way around this yet.

Hopefully I will find the time to put some effort into this blog as it is probably my longest running blog yet albeit a non personal one. If there are actually any human readers out there I do appreciate your time to read and comment and if there aren't then that's fine too.

Till next time.