Pins for direct restorations

Self-threading dentine pins permit the retention of large complex direct restorations but there are problems associated with their placement. Strain and crazing of dentine following pin insertion and pulpal and lateral perforations are common. Perforations can be avoided by operator awareness of tooth morphology. Strain and crazing has been found to be minimized by unscrewing the pin slightly after insertion, by using pins with a tap thread, and by using the smallest pin possible. Twist drill form and dulling affects the pin channel shape which in turn influences pin seating. A lack of standardization of pin and twist drill diameter and length has been implicated as the cause of poor pin retention. Manufacturers, in an attempt to standardize the depth of penetration of pins, have incorporated shoulders at the midpoint of the pin, which has met with varying success. More research in the area of limiting pin penetration is necessary, as well as attempts to improve the quality control of pin and twist drill manufacture.