Log in Register

Login to your account

Username *
Password *
Remember Me

Create an account

Fields marked with an asterisk (*) are required.
Name *
Username *
Password *
Verify password *
Email *
Verify email *
Captcha *

Captcha Image Reload image challenge



Authors: Dr. Namratha Lekshmi, Dr. Aby Mathew, Dr. Sujith. K

ABSTRACT

Fixed prosthesis is an ever green and dynamic branch of Prosthodontics that offers many advantages over removable prosthesis. Patients with single anterior missing tooth are presented with various treatment modalities like removable partial dentures, fixed partial dentures, and implants. Resin bonded fixed partial dentures are accepted treatment for single missing tooth due to their minimal preparation. This article describes a case report on the use of a resin-bonded fixed partial denture as a conservative solution for the replacement of a missing lateral incisor.

Keywords:

Fixed prosthodontics, Resin bonded bridges, Adhesive dentistry, and Minimum preparation

INTRODUCTION

The earlier concept of ‘extension for prevention’ has been evolved over the years to the newer concept of ‘minimally invasive dentistry’. This has been possible due to the development of newer adhesive technologies whose mile stone was laid back in 1955 when Dr. Buonocore introduced enamel acid etching and resin bonding.1 Patients with single anterior missing tooth are presented with various treatment modalities like removable partial dentures, fixed partial dentures, and implants.

The current trend in selecting a particular treatment depends on the patient’s choice, minimally invasive nature of the preparation with predictable esthetic and functional results.2 Resin bonded fixed partial dentures are accepted treatment for single missing tooth due to their minimal preparation. They are simple restorations with metal retainers bonded lingually and proximally to the enamel of one or more abutment teeth.3 The success with resin bonded bridges depend on the careful selection of case involving the condition of the abutment teeth and also the occlusion to assess the available space and forces that act on the pontic.4

Figure:1 Figure:2
CASE REPORT

A 27-year-old male patient with a noncontributory medical history presented to the Department of Prosthodontics, for the replacement of the upper right lateral incisor. Previous dental history revealed the extraction of the maxillary right lateral incisor due to trauma. On further examination, it was noted that the abutment teeth were intact, immobile, had a favorable crown root ratio, occlusal interferences were not present and adequate pontic space was present (figure:1). Various treatment options like conventional fixed prosthesis, implant and resin bonded fixed partial denture were suggested to the patient. Since the abutment teeth were vital and intact, conventional fixed prosthesis was discarded from the treatment option. Patient preferred resin bonded bridge over implants since no surgical procedures were required.

Considering all the factors resin bonded bridge was planned with maxillary central incisor and canine as abutments. Patient was made aware of the risks and limitations of resin bonded bridges and frequent follow ups were advised.

Figure:3 Figure:4
PREPARATION

First the preparation was done by marking the occlusal contacts, defining the limits of the preparation with a round bur leaving 1mm margins within the enamel for bonding. Better longevity is provided by proper sealing of the prosthesis to enamel hence it is advised to limit the preparation within enamel. Both central incisor and canine were prepared with minimal palatal preparation of 0.5mm.The finish line of the preparation continued to the proximal area while remaining on the side point of the distal contact. The occlusal limit of the preparation is influenced by the position of the incisal edges of opposing teeth and must be far from (2mm) the contact surface between the teeth. It should not interfere with edges of the abutment teeth with a high transparency as that can lead to metal show at the incisal edges.

A complete final impression of the arch was made with double mix single step technique using polyvinyl siloxane impression material (putty and low viscosity, Aquasil, Dentsply/Caulk, Milford, DE) in a stock tray(figure:2). Die stone was used to make the cast and this was mounted in a semi adjustable articulator along with opposing arch. Inlay wax was used to fabricate the wax pattern and this was later casted. Checking of the framework ( Maryland Bridge) was done in the mounted casts followed by try-in of the frame work in the mouth during which the marginal adaptation, pontic’s form and gingival pressure, esthetics and occlusion were evaluated. After which the bridge was send to the laboratory for final porcelain polishing and metal sandblasting.

CEMENTATION

A dual-cured resin luting agent was used for cementation. A tribochemical Rocatec System (3M ESPE, Seefeld, Germany), using silica-coated alumina particles was used for the surface conditioning of the inner surface of the retainer. Etching of the prepared teeth was done for 10 seconds followed by application of primer which was gently air dried. The resin cement was applied to metal surface of the resin bonded bridge and was cemented to the abutment teeth and light curing was done for 10 seconds. The excess cement was removed from the margins with a probe. Esthetic and occlusal evaluations were done.(figure:5)

DISCUSSION

Treatment options for missing teeth can include the absence of treatment and acceptance of the resulting space, orthodontic therapy to redistribute the space, or prosthetic tooth replacement.5

Resin bonded bridges (RBBs) offer a conservative and cost effective approach to the restoration of space compared to conventional bridgework.6 RBBs allow for the preservation of tooth structure, treatment reversibility (when RBBs are used as a provisional restoration), minimal catastrophic failure and loss of abutment, preservation of pulp vitality, minimal soft tissue interaction, ease of retrievability.7

This case report describes the replacement of the lateral incisor which is the second most common missing teeth in the arch either due to trauma or congenital defect. In case of a missing lateral incisor, the treatment planning should follow the dental and oral assessment, evaluation of the patient's complaints, needs, and socioeconomic status. This treatment offers a conservative, esthetically pleasing and rapid solution of a missing tooth when implant placement and/or fixed treatment are not feasible because of financial, social or time restrictions.8,9Even though the predictability and longevity of resin bonded fixed partial dentures are less than conventional fixed bridges, they are less expensive, offer good esthetics, easy cleaning, less biological damage and no chance of having an undetected debonded retainer with decay underneath it.10

Despite this, accumulating scientific evidence indicates that they are effective alternatives to conventional bridges, and have been used to achieve long-term success and patient satisfaction.11 The clinical performance of these restorations has been found to depend on factors that can be classified as: patient-related, design-related, and technique-related. 7 All these factors when properly combined leads to the success of the prosthesis.

CONCLUSION

Resin bonded bridges can be highly effective in replacing single missing teeth with minimum occlusal contact, restoring oral function and aesthetics and can result in high levels of patient satisfaction. They represent a minimally invasive, cost effective and long lasting treatment modality which is being followed due to the advent of adhesive technology. In this case report the benefits of using resin bonded bridge is explained. After a through case selection, it is advisable to use resin bonded bridges more frequently as the restoration of choice for short spans.

REFERENCES
  • Buonocore M G. A simple method of increasing the adhesion of acrylic filling material to enamel surfaces. J Dent Res.1955; 34:849.
  • Park JH, Kim DA, Tai K. Congenitally missing maxillary lateral incisors: treatment. Dent Today. 2011;30:81-2, 4-6; quiz 7
  • Rosenstiel. Land. Fujimoto. Contemporary Fixed Prosthodontics. (2006) Elsevier. Fourth Edition. Mosby
  • Yanti Johari, Zaihan Ariffin, Haslina Taib, Norehan Mokhtar. Minimum intervention dentistry with indirect fibrereinforced composite bridge: a case report. Arch Orofac Sci (2016), 11(2): 49-53
  • .
  • Robertsson, S., Mohlin, B., 2000. The congenitally missing upper lateral incisor: a retrospective study of orthodontic space closure versus restorative treatment. Eur. J. Orthod. 22, 697–709.
  • Fahim Ahmed Vohra, Muhammed Ayedh Al-Qahtani. Attitude and awareness of dentist towards resin bonded bridges in Saudi Arabia. The Saudi Dental Journal (2014) 26, 96–102
  • Djemal, S., Setchell, D., King, P., Wickens, J., 1999. Long-term survival characteristics of 832 resin retained bridges and splints provided in a post-graduate teaching hospital between 1978 and 1993. J. Oral Rehabil. 26, 302–320.
  • Hagiwara Y, Matsumura H, Tanaka S, Woelfel J. Single tooth replacement using a modified metal-ceramic resin bonded fixed Partial denture: A clinical report. J Prosthet Dent.2004; 91: 414–7
  • Balkaya M C, Gur H, Pamuk S. The use of a resin-bonded prosthesis while maintaining the diastemata: a clinical report. J Prosthet Dent.2005; 94:507-10.
  • Briggs P, Dunne S, Bishop K. The single unit, single retainer, cantilever Resinbonded Bridge. Br Dent J.1996; 181: 373-9.

Add comment


Security code
Refresh