Fiber Reinforced Composite Restoration
Ribbond mitigates the harmful effect of C-factor. Shrinkage of the composite against the tooth is dramatically reduced preventing gap formation, leakage, and sensitivity. Ribbond also bridges cracks and reinforces structurally compromised teeth.
Photos courtesy of: Wendell Robertson, D.D.S.
Watch the Video
This video shows a large composite restoration reinforced with Ribbond. This is an alternative to a crown.
The tooth is prepared for bonding and a bonding adhesive is applied.
The proximal wall is built-up with composite. A flowable composite is placed in the bed of the preparation and is also placed against the interior walls of the prepared tooth. Ribbond pieces are wetted with bonding resin and the Ribbond pieces are pressed through the flowable composite against the tooth surfaces covering as much of the interior tooth surfaces as possible.
The Ribbond pieces are cured and composite is incrementally placed into the preparation.
To further reduce the risk of the tooth fracturing a piece of Ribbond is placed in the composite approximately 1.5 mm below what will become the occlusal surface of the tooth.
The occlusal surfaces are built-up with composite.
Here are two presentations by Dr. Graeme Milicich presented at the Academy of Biomimetics annual meetings.
- A Ribbond-direct Composite on an Endo premolar
- A technique discussion on Ribbond cores for premolars and molars
Why and how Ribbond composite restorations work
Published research articles confirm that incorporating Ribbond into composite restorations provides the following benefits:
INCREASED MICRO-TENSILE BOND STRENGTH
The micro-tensile bond strength of the composite is significantly increased when Ribbond is closely adapted and bonded against the cavity walls.
MITIGATING THE HARMFUL EFFECT OF C-FACTOR
The increased micro-tensile bond strengths decreases the negative c-factor effects. This phenomenon is especially evident with deep and narrow Class I restorations.
MINIMIZES POLYMERIZATION AND DECREASES SHRINKAGE AND LEAKAGE
Polymerization shrinkage can result in leakage, and sensitivity. Closely lining the preparation with Ribbond significantly reduces and minimizes these harmful effects of polymerization shrinkage. Because the Ribbond is closely adapted to the cavity walls, there is less volume of composite to shrink and less polymerization shrinkage results in less leakage and less sensitivity.
BRIDGING CRACKS ON PULPAL FLOOR
Ribbond bridges the cracks that are commonly seen in the pulpal floor of old amalgam restorations. Ribbond acts like staples across the cracks and holds the parts of the tooth on both sides of the crack together.
RELIEVES CAUSES OF SYMPTOMS OF SPLIT TOOTH SYNDROME
Split tooth syndrome has been predictably successfully relieved when Ribbond has been used as a buccal-lingual cross cusp splint under the occlusal surface to bridge cracks. The cross cusp Ribbond splint prevents the parts of the split tooth from moving.
INCREASED FRACTURE TOUGHNESS
Ribbond fiber reinforcements greatly increases the fracture toughness of dental composite restorations. Ribbond’s unique combinations of fixed nodal intersections and tough ultra-high molecular weight polyethylene fibers inhibits and prevents crack propagation it composite resin.
STRESS DISTRIBUTION AND ENERGY ABSORPTION MECHANISM
Ribbond acts as a stress distribution and energy absorption mechanism. It minimizes the stress concentrations by distributing forces over a greater area, which prevents crack formation and propagation. It also absorbs the energy from repeated occlusal impacts.
Studies demonstrate that if a crack starts in a Ribbond lined composite restoration, the crack is redirected. If this crack leads to failure, the restoration/tooth complex fails safely and the tooth can be retreated. In the case of standard composite restorations techniques; when the restoration/tooth complex fails, it tends to fail catastrophically and the tooth must be extracted.
The links below reference published studies supporting these performance characteristics.
C-Factor - Effects of fiber reinforcement on adaptation and bond strength of a bulk-fill composite in deep preparations
Watch the Video
This study compares the use of a common bulk-fill composite, placed with and without Ribbond at the cavity interface. It demonstrates that the polymerization of a bulk filled composite results in gaps at the cavity interface when used in two increments or in bulk. These interface gaps are not visible to the naked eye, but they can lead to post-operative sensitivity, leakage and recurrent decay. Other Optical Coherence Tomography (OCT) studies by the lead author have demonstrated this phenomenon with a variety of bonding agents and composites, so this is not unique to a single brand or type of composite. All composites shrink and this shrinkage causes stress that can shorten the lifespan of the restoration and contribute to bond-interface gap formation, leakage and post-operative sensitivity. When Ribbond is well adapted into the cavity, interface gaps between the restoration and the tooth are nearly eliminated! The authors suggest that the Ribbond absorbs polymerization shrinkage stress, resulting in an intact bond interface. Other studies have confirmed increased fracture strength and a resistance to catastrophic fracturing of teeth restored with laminated Ribbond. With this study, we learn that by laminating Ribbond to the internal aspect of moderate to large composite restorations, we create the additional benefit of preventing bond interface gaps.
- C-Factor - The Effect of C-factor and Flowable Resin or Fiber Use at the Interface on Microtensile Bond Strength to Dentin
- Crack bridging;
- Cross cusp splinting
- Monoblock in root canals
- Micro leakage in over-flared canals
- Additional micro-leakage photos