Direct Fiber Reinforced Bridge

31 Dec 2015 - 15715

From inception the Styleitaliano philosophy has been one of realistic and achievable results that are reproducible. One of my main aims has been to reinforce these core values into my daily practice and hopefully to the benefit my patients.

A lovely 64 years old female patient was referred to myself from a colleague regarding a grade 1 mobile lower left central incisor and non – pulchritudinous defective crown that had been causing multiple problems over a number of years. All possible treatment modalities were discussed and the patient decided she would like the tooth removed and replaced with a provisional composite bridge while the necessary healing took place.

Fig. 1

Pre-Operative Buccal.

Fig. 2

Pre-Operative Occlusal.

Fig. 3

Pre-Operative Occlusal Alpha.

Fig. 4

Reflective cross-polarized illumination removes unwanted specular reflections1

Fig. 5

Study Model Frontal (LL1 removed and emergence estimated) .

Fig. 6

Model Occlusal.

Fig. 7

Quick composite mock up on model to assess proportions.

Fig. 8

Silicone Matrix (Affinity Crystal – Clinician’s Choice).

Fig. 9

Measuring Ribbond beforehand to ensure good fit.

Fig. 10

Removal of tooth showing poorly retentive crown.

Fig. 11

Close up frontal view showing minimally traumatic removal.

Fig. 12

Occlusal view showing minimally traumatic removal.

Fig. 13

Frontal View.

Fig. 14

Lingual view of immediate isolation tied in with floss ligatures.

Fig. 15

Occlusal view of immediate isolation showing disproportion.

Fig. 16

Front right lateral view of isolation .

Fig. 17

Frontal view of isolation. This will ensure optimum vision and adhesion.

Fig. 18

Etching with 37% phosphoric acid.

Fig. 19

Matrix in place.

Fig. 20

Transparent matrix ensures comprehensive curing.

Fig. 21

Close up of links in fiber reinforced bridge.

Fig. 22

Hyper chromatic dentine core UD5 Hri Micerium, Italy.

Fig. 23

Dentine layers graduated.

Fig. 24

Mamelons and characterisations.

Fig. 25

Controlled thickness enamel layering UE4 and UE3.

Fig. 26

10 days post op showing excelling healing and integration.

Fig. 27

Black & White.

Fig. 28

Lateral View.

Fig. 29

Frontal Finish.

Fig. 30

Texture.

Fig. 31
Lingual aspect showing all fibers covered with composite.
Fig. 32
Checking occlusion.
Fig. 33
The importance of cleaning must be demonstrated to patient.
Fig. 34

Comparison, before and after.

 

Conclusions

The advantages of such a technique include being minimally invasive to supporting teeth, cost-effective, acceptable aesthetics and functional result during healing that allows the patient to have a non-removable prosthesis that is easy to clean. The disadvantages are that the procedure is technique sensitive, can be time consuming (total time taken is 1 hour 40 minutes), good supporting teeth are needed and a strict oral hygiene regimen.
This technique is useful to have in ones own restorative armamentarium as it can provide an acceptable solution in difficult situations. Appropriate case selection is always advised and thorough planning is a pre-requisite.

Bibliography

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2. Belli S, Ozer F. A simple method for single anterior tooth replacement. J Adhes Dent. 2000;2:67-70.

3. Khetarpal A, Talwar S, Verma M. Creating single-visit, fibre-reinforced, composite resin bridge by using a natural tooth pontic: a viable alternative to PFM bridge. J Clin Diagn Res 20012;7(4):772-775.

4. Heintze S, Rousson V. Clinical Effectiveness of direct class II restorations – a meta analysis. J Adhes Dent 2012;14(5):407-31.

5. Manauta J, Salat A. Layers, An atlas of composite resin stratification. Chapter 2 Free-Hand Modeling, Quintessence Books, 2012.

6. Vanini L. Light and color in anterior composite restorations. Pract Periodont Aesthet Dent 1996;8:673-682.

7. Dietschi D. Free-hand bonding in the esthetic treatment of anterior teeth: creating the illusion. J Esthet Dent 1997;9:156-164.

8. Palone G, Saracinelli M, Devoto W, Putignano A. Esthetic direct restorations in endodontically treated anterior teeth. Eur J Esthet Dent 2013;8:44-67.