1. The Clinical Applications of Fiber Reinforced Composites
Dr E. Habibi

2. -Fiber reinforced composites are high strength filling materials composed of conventional composites and fibres.

3. FRCs are structural materials with two distinct constituents
FRCs are structural materials with two distinct constituents. The reinforcing component provides stiffness and strength while the surrounding matrix supports the reinforcement and provides workability. The fibers most commonly employed in dental applications for reinforcement are polyethylene, glass, polypropylene, carbon or aramid. The matrix comprises of epoxy resin

4. Typically, fibers are 7 to 10 µm in diameter and span the length of the prosthesis or appliance. By comparison, the particles used in standard restorative dental composites are 1 to 5 µm in diameter, or submicron in size.

6. -Woven fiber is less technique-sensitive, has lesser flexural strength and easier to manipulate hence conforms to the desired shape and maintains its adaptation during placement and is the ideal choice while making an appliance for rotated or malpositioned teeth. 
- Unidirectional fiber has greater flexure strength and rigidity and is the better choice for high stress situations as in prosthodontic frameworks

7. The Two Approaches have Evolved Namely Non-Impregnated and Pre-Impregnated
Pre-Impregnated Fibers

8. How FRC Materials Work?
Types of fiber
Direction of fibers

9. Periodontal Splinting
Single Visit Bridges
Provisional Bridges
Composite Restoration
Trauma Stabilization
Space maintainer
Endodontic Post and Cores

10. Periodontal Splinting
Easy to Make
Esthetic
Strong
Durable
Proven

13. Fiber-reinforced Composite Resin Bridges

14. Loss of anterior tooth may be a catastrophic event for the patient
Introduction
Loss of anterior tooth may be a catastrophic event for the patient

15. The Fiber-Reinforced Resin-Bonded Bridge
Advantages
Cost effective
Less or zero reduction in healthy tooth structure
Takes short duration of time
Hygienic
Nonallergenic
Single tooth replacement premolar or incisor
ideal indication for lower incisors

16. The Fiber-Reinforced Resin-Bonded Bridge
A review of the dental literature suggests that the FRC prostheses have good longevity, especially those which are made by the direct technique

17. The Fiber-Reinforced Resin-Bonded Bridge
Three forms of pontics can be made for the FRC bridges:
natural extracted teeth,
with acrylic resin teeth
using composite resin.

18. Natural Tooth Pontic
If the natural tooth is available and if its crown is in good condition, it can be bonded easily to the adjacent teeth by using a light-cured restorative material. Using the natural tooth as a pontic offers the benefits of being the right size, shape and colour, along with producing good aesthetic and functional results

19. Considerations for Utilization of a Natural Tooth Pontic
Several factors must be taken into consideration when choosing a natural tooth pontic as an interim provisional.
First and foremost, the extracted tooth should possess an intact, clinical crown that is of ideal shape, contour, and shade, with intrinsic characterization that ideally matches the adjacent dentition.
The functional occlusal stress on the pontic site should be minimal, and the patient's preoperative centric, working, and nonworking contacts must be assessed to determine whether displacing forces can be reduced or eliminated. 

20. A 45-year-old female patient
The patient was not in pain, and her primary dental concern was to remain current with her biannual prophylactic recare visits. 
A comprehensive examination including periodontal charting, intraoral photographs, and a full- mouth series of radiographs was performed.

21. Closer inspection of the periapical radiograph
Tooth No. 21
exhibited Class I to Class II mobility with all other visual findings being within normal limits (Figure 1).
Dental history,
she indicated that, as a teenager, she had an accident that displaced teeth Nos. 11 and 21, and tooth No. 21 had required root canal therapy after becoming nonvital.
Several cracks in both teeth were observed during the visual exam with transillumination, but none were symptomatic.
Closer inspection of the periapical radiograph
indicated that tooth No. 21 was in a state of active internal resorption and the tooth was diagnosed as hopeless (Figure 2).
When the patient was informed that the diagnosis for her maxillary left central incisor was hopeless, she was heartbroken.

24. The 2-mm Ribbond THM ribbon was chosen for this case due to its minimal thickness, leno-weave construction, ease of adaptation to the teeth, and overall superior strength.
A rectangular slot was prepared on the lingual aspect of the natural tooth pontic to secure the Ribbond THM and to assure that it remained out of occlusion. The finalized pontic with a rectangular lingual slot is shown in Figure 10

25. Ribbond strands cannot be cut with conventional scissors; this most recent product includes a slimmer and more compact industrial-grade scissor, as compared to the more bulky version supplied with earlier kits.
The manufacturer recommends the use of Ribbond Wetting Resin (Ribbond), a product sold separately.

28. A thin coat of Ribbond Securing Resin (Ribbond) was applied to the lingual and interproximal surfaces of adjacent teeth.
The Ribbond THM was then seated at the desired position and adapted first with finger pressure, then with a thin IPC hand instrument. Care must be taken to ensure that the edges of the fiber are flush against the teeth, and that the material wraps slightly into the interproximal areas roughly to the previous contact area.

31. Composite pontic
A 76-year-old female patient presented with a missing mandibular left lateral incisor that had been recently extracted because of severe root caries on the distal surface that had made the tooth unrestorable (Figure 1).

32. Upon clinical and radiographic examination, it was noted that there was not enough remaining bone in the labial- lingual direction to consider an implant.
Also, the teeth adjacent to the edentulous space, aside from having some crestal bone loss, were unrestored.
The crown-to-root ratio and mesiodistal root diameter at the gingival crest of the mandibular left central incisor were not favorable due to the alveolar bone loss, making it a questionable abutment for a fixed partial denture.

33. A lingual view shows the abutment teeth that were prepared with a slot cut in the lingual surfaces to contain the imbedded fiber reinforcement to provide the "framework" to freehand the nanocomposite resin pontic in the edentulous space.

34. G-aenial Bond (GC America), a seventh-generation self-etching bonding agent, was dispensed into a disposable  mixing well.
The bonding agent was applied to all prepared surfaces using a microbrush.
The bonding agent was then light-cured for 20 seconds

35. The flowable composite resin (G-aenial Universal Flo) with an applicator tip applied to the end of the syringe; the long, narrow cannula makes precise placement very easy.
G-aenial Universal Flo was syringed into the preparations in a thin coat. The fiber reinforcement was placed into the floor of the preparations, and they were then filled with flowable composite to the cavosurface margins and light-cured.

36. Next, the flowable composite was placed on the stabilized fiberglass fiber (Connect [Kerr]) to wet the surface between the teeth with composite resin. It was then light- cured for 20 seconds
This facial view shows the composite-reinforced fiberglass reinforcement in place

37. Kalore AO3 was used to begin building a pontic on the fiber between the abutment teeth.
A plastic instrument (Goldstein Flexi­thin Mini 4 [Hu-Friedy]) was used for shaping A3.5 as the base dentin for the pontic. Kalore CV (B5) was used to simulate a root form similar to the adjacent teeth.

38. Kalore DT was used to create incisal translucency.
A sable brush (Keystone No. 4 Flat [Patterson Dental]) was used to create surface texture and refine anatomic form.
Kalore DT was used to create incisal translucency.

39. After initial contouring with an 8-fluted carbide composite finishing bur, contouring was completed using abrasive discs (Optidisc [Kerr]).
A yellow disc (Jiffy Disc [Ultradent Products]) was then used to polish the labial surface, and to refine the reflective angles and surface texture.

40. Facial view of the completed fiber-reinforced direct nanocomposite resin bridge

45. Trauma Stabilization Easy to make and remove
Thin, smooth, and non-irritating to the lip
Easy to control the degree of rigidity
Easy maintenance of oral hygiene
Does not impinge on the gingiva
Has no memory - does not move the teeth

46. Space maintainer

47. Endodontic Post and Cores

48. Fiber Post

49. Thanks for your attention