USE OF DENTAL PIN

1. USE OF DENTAL PIN 가천의대 길병원 치과

2. HISTORY • 1958년 Dr. Miles Markery가 threaded S.S wire를 이용 cement를 사용하여 pin을 고정 시키는 방법을 소개

3. OBJECTIVE • To increase retention and resistance

4. Indications • Grossly mutilated teeth • Extended preparation • Questionable teeth • Cores for full coverage restoration • Economic factors

5. Contra-indications • Sensitive, active caries • Large pulp chamber • Abnormal crown or root contour • Difficulty in access for twist drill and pin placement

6. Types of pin • Cemented type

7. Types of pin • Friction-locked pin

8. Types of pin • Self-threading pin

9. CEMENTED PINS (MARKERY PINS) • INSTRUMENTATION • Threaded wire • Lentulo spiral • Twist drill

10. CEMENTED PINS (MARKERY PINS) • PIN PREPARATION • End-round cutting; with carborundum disk • Bending “[“ form

11. CEMENTED PINS (MARKERY PINS) • SIZES Twist drill pins Star .021” .018 -.020” .024” .021” Beck .025” .022” .027” .025”

12. CEMENTED PINS (MARKERY PINS) • Types of cement • ZnPO4 : strong, NEED varnish liner which decreases strength 47% • ZOE-EBA : fair strength, no liner • Carboxylate : fair strength, no liner • Cyanoacrylate (PANAVIA)

14. CEMENTED PINS (MARKERY PINS) • ADVANTAGES • No stress on tooth structure • Versatile : can try-in, pre-bend • Inexpensive • Minimum equipment needed

15. CEMENTED PINS (MARKERY PINS) • DISADVANTAGES • Time-consuming • Preparation of pin, mixing, placing and setting of cement • Least retentive of 3 types

16. FRICTION-LOCK PINS • INSTRUMENT • Twist drill • Insertion tool • Mallet

17. FRICTION-LOCK PINS • SIZES Brands Twist drill Pins Unitek .021” .022” Beck .021” .0225”

18. FRICTION-LOCK PINS • CONSIDERING FACTORS • Must tap or push into place with a special insertion tool • Less retentive than self-threading, but more retentive than cemented • Danger of crazing or fracturing tooth structure due to high lateral stress

19. FRICTION-LOCK PINS • CONSIDERING FACTORS • Must tap or push into place with a special insertion tool • Less retentive than self-threading, but more retentive than cemented • Danger of crazing or fracturing tooth structure due to high lateral stress

20. FRICTION-LOCK PINS • CONSIDERING FACTORS • Must tap or push into place with a special insertion tool • Less retentive than self-threading, but more retentive than cemented • Danger of crazing or fracturing tooth structure due to high lateral stress

21. FRICTION-LOCK PINS • CONSIDERING FACTORS • Fast, inexpensive • Pins come pre-cut to various length • Difficult in posterior teeth or at unusual angles

22. FRICTION-LOCK PINS • CONSIDERING FACTORS • Fast, inexpensive • Pins come pre-cut to various length • Difficult in posterior teeth or at unusual angles

23. FRICTION-LOCK PINS • CONSIDERING FACTORS • Fast, inexpensive • Pins come pre-cut to various length • Difficult in posterior teeth or at unusual angles

24. SELF-THREADING PINS (TMS) • INSTRUMENT • 10:1 speed-reduction contra-angle • Hand wrench • Bending tool • Pins

26. SELF-THREADING PINS (TMS) • INSTRUMENTATION Name color code pin diameter drill diameter Regular gold 0.031” 0.027” Regular gold 0.031” 0.027” (twin-one) Minim silver 0.024” 0.021 Minikin red 0.019” 0.017” Minuta pink 0.15” 0.0135”

27. PINS IN RESTORATIVE DENTISTRY • THE COMPLETED PINS • Will be stable • Will not perforate to the pulp or to the periodontal membrane • Will allow 2~3mm of restorative material to cover occlusally • Will clear matrix band lateraly • Will not predispose to crazing or fracture of tooth structure

28. PINS IN RESTORATIVE DENTISTRY • THE COMPLETED PINS • Will allow 2~3mm of restorative material to cover occlusally • Will clear matrix band lateraly • Will not predispose to crazing or fracture of tooth structure

29. PINS IN RESTORATIVE DENTISTRY • THE COMPLETED PINS • Will be stable • Will not perforate to the pulp or to the periodontal membrane • Will allow 2~3mm of restorative material to cover occlusally • Will clear matrix band lateraly • Will not predispose to crazing or fracture of tooth structure

30. PINS IN RESTORATIVE DENTISTRY • PIN LOCATION • Pin hole의 위치 DEJ로 부터 0.5mm 이상 간격을 두어야 한다. • Pin hole위치는 치아 표면과 pulp 사이 중간에 위치 • 각 교두상 한 개의 pin 혹은 훼손된 각 면당 한 개의 pin을 두어야 한다. • Furcation area는 피한다 • 치근의 함몰된 근원심 부위는 피한다

31. PINS IN RESTORATIVE DENTISTRY • PIN LOCATION • Pin hole의 위치 DEJ로 부터 0.5mm 이상 간격을 두어야 한다. • Pin hole위치는 치아 표면과 pulp 사이 중간에 위치 • 각 교두상 한 개의 pin 혹은 훼손된 각 면당 한 개의 pin을 두어야 한다. • Furcation area는 피한다 • 치근의 함몰된 근원심 부위는 피한다

32. PINS IN RESTORATIVE DENTISTRY • PIN LOCATION • Pin hole의 위치 DEJ로 부터 0.5mm 이상 간격을 두어야 한다. • Pin hole위치는 치아 표면과 pulp 사이 중간에 위치 • 각 교두상 한 개의 pin 혹은 훼손된 각 면당 한 개의 pin을 두어야 한다. • Furcation area는 피한다 • 치근의 함몰된 근원심 부위는 피한다

33. PINS IN RESTORATIVE DENTISTRY • PIN LOCATION • Pin hole의 위치 DEJ로 부터 0.5mm 이상 간격을 두어야 한다. • Pin hole위치는 치아 표면과 pulp 사이 중간에 위치 • 각 교두상 한 개의 pin 혹은 훼손된 각 면당 한 개의 pin을 두어야 한다. • Furcation area는 피한다 • 치근의 함몰된 근원심 부위는 피한다

34. PINS IN RESTORATIVE DENTISTRY • PIN LOCATION • Pin hole의 위치 DEJ로 부터 0.5mm 이상 간격을 두어야 한다. • Pin hole위치는 치아 표면과 pulp 사이 중간에 위치 • 각 교두상 한 개의 pin 혹은 훼손된 각 면당 한 개의 pin을 두어야 한다. • Furcation area는 피한다 • 치근의 함몰된 근원심 부위는 피한다

35. Location of pin

36. PINS IN RESTORATIVE DENTISTRY • PIN LOCATION • Pin hole의 위치 DEJ로 부터 0.5mm 이상 간격을 두어야 한다. • Pin hole위치는 치아 표면과 pulp 사이 중간에 위치 • 각 교두상 한 개의 pin 혹은 훼손된 각 면당 한 개의 pin을 두어야 한다. • Furcation area는 피한다 • 치근의 함몰된 근원심 부위는 피한다

37. Bonding strength to amalgam

38. Bond strength to dentin

39. PIN PREPARATION • Parallel to external surface of tooth

40. PINS IN RESTORATIVE DENTISTRY • 치아의 형태와 pin의 위치

41. PREPARATION OF PIN CHANNELS • GENERAL PRINCIPLES • DETERMINATION OF PIN CHANNEL SIZE • HOW TO AVOID BREAKAGE OF TWIST DRILL • IF THE SELF-THREADING PIN WON’T HOLD

42. PREPARATION OF PIN CHANNELS • GENRAL PRINCIPLES • Choose pin location and direction carefully • Prepare in a clean, dry, caries-free field • Use rubber dam to prevent swallowing or aspiration of instrument • Use slow speed ( 10:1 speed reduction )

43. PREPARATION OF PIN CHANNELS • GENRAL PRINCIPLES • Keep drill rotating at all times • Complete procedure quickly (10 seconds) • Watch for dentin filings, and have assistant blow away intermittently.

44. PREPARATION OF PIN CHANNELS • If no filings appear, or if not completed in 10 seconds. • Check direction of rotation • Use more pressure • Assume drill is dull and replace • You may be in enamel.

45. PREPARATION OF PIN CHANNELS • GENERAL PRINCIPLES • DETERMINATION OF PIN CHANNEL SIZE • HOW TO AVOID BREAKAGE OF TWIST DRILL • IF THE SELF-THREADING PIN WON’T HOLD

46. PREPARATION OF PIN CHANNELS • Determination of pin channel size • Size of twist drill use • Number of times in and out (once is best) • Length of time spent drilling • Steady orientation of drill direction • Sharpness of twist drill

47. PREPARATION OF PIN CHANNELS • GENERAL PRINCIPLES • DETERMINATION OF PIN CHANNEL SIZE • HOW TO AVOID BREAKAGE OF TWIST DRILL • IF THE SELF-THREADING PIN WON’T HOLD

48. PREPARATION OF PIN CHANNELS • How to avoid breakage of twist drill • Use only 2mm depth-limiting drills

49. PREPARATION OF PIN CHANNELS • When using longer twist drills • Maintain same orientation • Never stop rotating with drill in hole • Never place a drill in a hole to test depth, direction, etc. • Don’t press hard when using small diameter twist drills

50. PREPARATION OF PIN CHANNELS • If the self-threading pin won’t hold, • Go to a large size pin • Drill channel deeper – up to 3mm • Change to a cemented pin