Dr Nikhil Bahuguna (Noida, India) is an endodontist & esthetic dentist. He is a Diplomate of the American Board of Aesthetic Dentistry and a Certified maillifier, Edelweiss & Light Speed instructor. In addition, he is the Secretary and Board of Director of the Indian Academy of Aesthetic & Cosmetic Dentistry (IAACD). He is also a former Professor & HOD of Kalka Dental College, UP, India and currently maintains a private practice at Noida. He is one of the coveted speakers of DRDCA 2020.
Clinical dentistry throws many challenges in day to day practice. Managing unwarranted emergencies can be a dilemma in testing times. One such situation is filling gaps left after immediate extraction especially in the anterior region.
There is a waiting time after an extraction till the socket healing happens and the final prosthesis is placed in the form of a bridge or an implant. At this time, the gap of the missing tooth can pose a considerable cosmetic challenge.
Implants have gained a considerable clinical clout in replacing missing teeth. It has its own correct indications and contraindications. It is one of the best methods of replacing missing single or multiple teeth. Once the tooth is extracted, many a times if indications permit, then immediate implant placement and temporization is a possibility. However, immediate temporization may not always be feasible to allow good primary integration and prevent loads from destabilizing the surgically placed implant. Sometimes, when immediate implant placement is not possible due to inadept bone condition post extraction and the empty gap needs to be restored immediately for esthetic reasons, the choices are a challenge.
What are your options?
There are a variety of options available to solve the esthetic dilemma of empty extraction spaces for the short and long term. Ranging from flipper dentures to natural tooth pontics to resin bonded temporary or transitional bridges, the clinical choices depend upon the operator's skill, a good understanding of bone and soft tissue healing and correct knowledge of materials used. A correct blend of these can yield beautiful and lasting results, which can solve esthetic and partial functional needs.
Fibers have long been used for the replacement of missing teeth in temporary, transitional, and long-term solutions. There are plenty of glass and polyethylene fibre available which can help in the creation of such immediate aesthetic bonded bridges. The choice of fiber lies in the following factors –
The key factors which influence the physical properties of FRC structures are listed as follows –
- Fibre loading (volumetric fraction) within the restoration.
- The efficacy of the bond at the fibre-resin interface.
- Fibre orientation relative to load.
- Fibre position in the restoration .
Though many fibre fulfill the necessary requirements, one set of glass fibre looks very promising.
Dentapreg, an acronym for Dental Preimpregnated Fiber Re-enforced Composites, is one of the most scientifically designed reinforced fibers. Its uniqueness is that it has a variety of fibres for various clinical situations and each is different from each other in its ability of bearing uni or bidirectional forces. Its ability to bear high tensile loads is highest amongst the contemporary fibers (Figure 1). This, along with the pre adhered nature of the fibre, makes it an easy yet a very effective clinical tool.
Dentapreg fiber helps create adhesive anterior bridges in a single visit. Its an excellent emergency option for tooth replacement cases in particular, the effect has an immediate gratification and the patient leaves with a happy smile.
Dentapreg is all about minimally invasive tooth retention. It's an ideal dental flipper alternative during the healing period for an implant, or for young patients with missing teeth using wing retention (the ‘Maryland Bridge’ as well as other types of resin retained bridge) or other types of retention (inlay, onlay, box and crown preparation). Dentapreg also sets you up to create pontics out of composite build-up material, or to use a pre-made denture tooth or the original tooth with the root cut out.
A young teacher reported with a fractured lower central incisor due to a staircase fall, which previously had a failed root canal treatment with a peri apical pathology.
The tooth could not be salvaged as the fracture was unfavorable and had to be extracted (Figure 2). Though she agreed for an implant post satisfactory healing period, her immediate concern was to fill that extraction gap for aesthetic and appearance purpose.
The choice had to be made keeping the healing soft tissue and extraction wound also in mind.
Immediate fabrication of a modified, bonded, directly fabricated bridge was decided upon using Dentapreg PFM fibre (Pontic Fibre Multidirectional) (Figure 3), and direct composite bonding keeping the bite in mind (Figure 4). Since the arrangement was planned for a transitional span, no cavity preparation was done on support teeth to bond the fibre and composite.
After thorough surface cleaning with non fluoridated prophylaxis paste was done for plaque removal, the healing socket was protected with a PTFE tape to prevent the irritation of healing tissue by the materials used (Figure 5).
The proximal surfaces were then etched (Figure 6), and bonded followed by attachment of pre measured Dentapreg PFM Fiber to create a pontic framework. The pre measurement of the fibre (length/size) was done using wax sheet as a scaffold over the extraction site (Figure 7).
The fibre framework was then layered with opaque composite resin as a lingual shell, dentin base followed by enamel composite as final layer. The lingual fibre attachment on the supporting teeth was covered a very thin layer of enamel flowable composite (Figure 8).
The bonded pontic was kept in passive occlusion to prevent occlusal loads form destabilizing the healing socket (Figure 9 and Figure 10).
On a 3 day recall evaluation, the patient was feeling absolutely comfortable and showed excellent soft tissue approximation and healing (Figure 11).
Such treatment options, though unconventional but can prove to be a very helpful and predictable option of managing extraction spaces for short, transitional or long term treatment modality. Not only does it help in space management, it also create a favorable soft tissue profile adapting against the provisionally creating pontic.
Author Bio – Dr.Nikhil Bahuguna is an endodontist, a Diplomate of the American Board of Aesthetic Dentistry and the Board of Director and National Secretary of the Indian Academy of Aesthetic and Cosmetic Dentistry (IAACD).
Disclaimer – The views and opinions expressed in this article are that of the author alone and does not necessarily reflect the official policy of DentalReach. DentalReach does not endorse, promote or associate with this product and this article is meant for informative purposes only.