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CONTENTS
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Introduction Definition Indications and contraindications Advantages and disadvantages Pins types and designs Pin placement factors Techniques for inserting pins Cavity preparations Complications and failures
INTRODUCTION
Most of the teeth can be restored with amalgam and composite but when the tooth preparation is extensive due to caries or other reason the remaining tooth structure is very less, it becomes difficult to achieve optimal resistance and retention form. In such cases dentin lock and slots are prepared in dentin
But when these retention features are insufficient to provide desired retention then pin supported restorations are used In these cases pins support the restorative materials and resist their dislodgment in severely damaged tooth
HISTORY
In 1958, Dr. Miles Markley introduced a practical instrumentation for the use of a stainless steel cemented pin that resulted in the extensive use of cemented pins in dentistry
DEFINITION
Pin retained restoration is defined as any restoration which requires the placement of pin/pins in dentin in order to provide retention and/or resistance form to the restoration
INDICATIONS
Extensive tooth loss Questionable prognosis As a foundation Economics Age and health of the patient
CONTRAINDICATIONS
Occlusal problems Esthetics Access difficulties
ADVANTAGES
Conservation of tooth structure Appointment time Resistance and retention form Economics
DISADVANTAGES
Dentinal micro fractures Lowered fractured resistance Strength of amalgam restoration is reduced Micro leakage Perforations Difficulty to achieve proper contours
TYPES OF PINS
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CEMENTED PINS
Developed by Dr. Markley to retain large amalgam restorations Made of Stainless Steel They are used to build foundation after endodontic treatment as they produce the least amount of stress Offer less resistance than the other pins
Developed by Dr. Goldstein in 1966 Made of stainless steel More retentive than cemented pins Used in vital teeth with good access and ease of tapping the pins Cause craze lines or cracks
Developed by Dr. Going in 1966 Most popular type among all the different type of pins and extensively used Made of stainless steel or titanium pins Provide maximum retention among all types of pins Cause craze lines Used in vital teeth
CEMENTED PINS
Stainless steel with Stainless steel with threads or serrations threads Pin channel [0.020 to 0.32] larger than pin size [0.018 to 0.30] Luted with standard luting agents Ease of placement
Pin channel is 0.001 Pin channel is 0.015 smaller than pin size to 0.004 smaller than pin size Taped into place with Placed by hand mallet wrench or contra angle hand piece Pin placement is difficult Pin placement is easy
CEMENTED PINS
Least retentive
REGULAR
MINIM
MINIKIN
MINUTA
Largest diameter pins Causes maximal stress Causes maximum dentinal crazing Rarely used
Next smaller diameter pins Lesser stress are created Lesser dentinal crazing Good retention
Diameter is lesser than minim pins Very less risk of dentinal crazing Good retention MINIM AND MINIKIN ARE COMMONLY USED SIZES OF TMS SYSTEM
SMALLEST SIZE of pins They are too small to provide adequate retention Not widely used
PIN DESIGNS
Standard design
7mm long They have flattened heads to fit into the hand wrench or handpiece chuck After placement the pin is reversed 1/4th turn to reduce stresses on dentin Pin height can be adjusted appropriately Avaliable in varying lengths They have flattened heads to fit into the hand wrench or handpiece chuck During pin placement when the pin reaches the bottom of the pin hole, the head automatically shears off, leaving a portion projecting from dentin It consists of 2 pins connected by means of a joint which serves as a shear line for peripheral pin Total length is 9mm and 2 pins are about 4mm each They have flattened heads to fit into the hand wrench or handpiece chuck The handpiece need not be reloaded during insertion of more than 1 pin
They have a plastic sleeve that fits into the latch type contra angle handpiece or a special plastic hand wrench Self shearing Pin engages the dentin and the plastic sleeve can be discarded Can align well into pin channels
Similar to link series design Self shearing Avaliable as single or 2 in 1 pins The major difference in this pin design is that pins have sharper threads and a tapered tip to decrease dentinal stresses while seating
Versatile design Wide range of pin sizes Color coding allows ease of use Gold plating eliminates corrosion Good retention
PIN PLACEMENT
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MECHANICAL ASPECTS
[PINS AND TOOTH STRUCTURE] A] Stressing capabilities of pins Type of pins
Diameter of pins Pin depth and dentinal engagement Bulk of dentin Type of dentin
Shape of pin channels Loose pins Irregularly shaped dentinal end of pins Ratio of dentinal engagement : pin protrusion [ideal 2:1] Number of pins in one tooth
Drill its use and function Stresses induced during shortening pins Retentive features Inserting pins in stress concentration area of tooth
Type of pin Pin depth and dentinal engagement Pin channel circumferential shape relative to that of pin Inter pin distance
Type of cement Ratio of dentinal engagement : pin protrusion [ideal 2:1] Type of involved dentin Surface roughness of the pins Mode of shortening of pins after insertion of pins Bulk of dentin around the pin
C] MICROCRACKING AND CRAZING Type of pin Proximity of pin to DEJ Induced stresses in involved dentin Type of dentin
Type of pin Pin diameter Inter pin distance Pin length in restorative material Proximity of restorative material with the pin surface Surface material of pins
ANATOMICAL ASPECTS
Knowledge of anatomy Radiograph Outer surface of tooth Amount of dentin
Anatomical features Tooth alignment Cavity extent Effect of age or relative age on the pulp chamber
Ideal technique for a sclerotized / tertiary / calcific barrier / highly demineralized / dehydrated dentin For class IV restorations When there is limited bulk of dentin
PROCEDURE Preparation of pin channel Checking the surface irregularities of pins Slow setting phosphate / polycarboxylate introduced by perio explorer tip or lenticulo spiral at slow speed Placement of pin using lock in or magnetised tweezer or hemostat
Large amalgam plugger is needed to check the complete seating of the pin In case of class IV restorations, bending of the pins is to be done before cementation of the pin channel
THREADED PIN TECHNIQUE INDICATIONS Vital teeth Dentin to engage the pin is either primary or secondary Minimum avaliable location is 1.5mm from DEJ If minimum pins are needed for the restoration
PROCEDURE Preparation of pin channel Pin is engaged to a driving device and pin is continuously threaded into the pin channel until it offer resistance initiated by the pin channel floor Desired length of the pin can be cut using small bur and high speed handpiece in the direction of threading and with light intermittent touches Surface irregularities are corrected No bending should be performed
FRICTION GRIP PIN TECHNIQUE INDICATIONS For vital teeth When bulk of dentin is present [min 4mm in all 3 dimensions] Only in the accessible areas
PROCEDURE Pin channel is prepared Checking the surface irregularities of pins Put a colored mark on the pin to indicate the exact depth of the pin channel using a measuring probe Pin is held in its place at the entrance of the cavity Concave headed seater is placed on the pin
With the hammer light strokes are given until that colored mark Remove all the holding devices Check for cracks, chipped pieces or grossed fractures
CAVITY PREPARATION
Remove all carious and weakened tooth structure Initial cavity is prepared with dovetails, boxes, grooves etc Facial and lingual walls are kept parallel wherever possible Margins are placed supragingivally
Areas to receive pins should be flat and perpendicular to long axis of the tooth. There must be enough dentin for pin placement Weakened cusps should be reduced and occlusal contour should follow the normal contour of the unreduced tooth PULP PROTECTION
CLASS II DESIGN
Pins should be put in apically deepest and most peripheral parts of the cavity Pin should not be placed below the cusp Decreasing the stress concentration on the pin Use of minimum number of pins with less diameter Placement of the pin should be such that theres enough restorative material around it
CLASS IV For unilateral class IV, L shaped cemented pin is sufficient For bilateral class IV, U shaped cemented pin is used
CLASS V DESIGN
Pins are placed axially parallel to the adjacent proximal surface Pin protrusion should be minimal Deep retentive grooves are placed Pins should be placed midway in the preparation but as close to gingival wall as possible
RESTORATIO N
COMPLICATIONS
Drill breakage Pin breakage Loose pins Heat generation Dentinal cracks Perforation into pulpal space or external tooth surface
FAILURES
CONCLUSION
The prognosis of the involved tooth and its role in overall treatment plan helps to decide the restoration to be placed If amalgam is selected as the restorative material to be placed, pins placed in dentin improve the retention of the restoration Pins have been extensively used in the past to restore such badly broken
REFERENCES
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Principles and practices of Operative Dentistry Gerald T Charbeneau Text book of Operative Dentistry Nisha Garg Text book of Operative Dentistry Vimal K Sikri Operative Dentistry Modern theory and practice M A Marzouk Sturdevents Art and Science of Operative Dentistry Clinical Operative Dentistry Principles and
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