Download Fixed Prosthodontic Rehabilitation Using Fiber

OLGU RAPORU (Case Report)
Hacettepe Dişhekimliği Fakültesi Dergisi
Cilt: 31, Sayı: 3, Sayfa: 34-38, 2007
Fixed Prosthodontic Rehabilitation Using
Fiber-Reinforced Composite
In Conical Lateral Teeth and Tooth Loss
Konik Lateral Dişler ve Diş Kaybında Fiber ile
Güçlendirilmiş Kompozit Kullanılarak Yapılan
Sabit Protetik Rehabilitasyon
*Hüseyin KurtulmuŞ DDS, PhD, *Övül KÜmbÜloĞlu DDS, PhD, *Atilla User DDS, PhD,
**Münire E. Sabah DDS, PhD,
*Ege University Faculty of Dentistry Department of Prosthodontics
**Ege University Faculty of Dentistry Department of Orthodontics
ABSTRACT
ÖZET
Congenitally missing teeth and conical lateral
incisor teeth particularly seen on the anterior region
in adolescence is an esthetically and functionally
challenging situation for the clinician and the patient.
As far as the ages of patients are concerned, the
restoration should be applied with a minimally invasive
approach. Glass fiber-reinforced composite resin
applications, which have recently become increasingly
popular, can be considered as the treatment of choice
in these cases as they offer a minimally invasive fixed
treatment option. A 15 year-old male patient with a
congenitally missing upper right lateral incisor tooth
and a conical upper left lateral incisor tooth was
referred to our clinic following a one-year orthodontic
therapy because of crowding and malocclusion. The
space for the missing upper right lateral incisor tooth
was re-gained as well as an adequate space for the
construction of conical upper left lateral incisor tooth
without making any preparation on the teeth. The
patient has been under a six-month follow-up for
a year and the relationship of the restorations with
adjacent and opposite dentition is under control. Glass
fiber-reinforced composite resin fixed partial dentures
applied with minimally invasive approach protect the
supporting teeth and provide an esthetic, functional
and psychological rehabilitation for adolescent
patients.
Özellikle gelişim döneminde anterior bölgede görülen
konjenital diş eksikliği ve konik şekilli lateral kesici
dişler, hasta ve hekim için estetik ve fonsiyonel
açıdan zor bir durumdur. Hastaların yaşı göz önüne
alındığında, restorasyon minimal düzeyde invaziv
bir yaklaşım ile uygulanmalıdır. Son dönemde
popülaritesi giderek artan cam fiber ile güçlendirilmiş
kompozit rezin uygulamalar minimal düzeyde invaziv
bir sabit tedavi seçeneği sunduklarından dolayı, bu
tür vakalarda tercih edilebilmektedir. Konjenital sağ
üst lateral kesici diş eksikliği ve konik şekilli sol üst
lateral kesici dişe sahip 15 yaşındaki erkek hasta,
çapraşıklık ve malokluzyon nedeniyle bir yıl süre ile
uygulanan ortodontik tedavisini takiben kliniğimize
başvurdu. Eksik olan sağ üst lateral kesici diş ve konik
şekilli sol üst lateral kesici dişin restore edilmesi için
gerekli olan mesafelerin geri kazanılmış olmasından
dolayı dişler üzerinde herhangi bir preparasyon
yapılmasına gerek kalmadı. Minimal düzeyde invaziv
bir yaklaşım ile uygulanan cam fiber ile güçlendirilmiş
kompozit rezin sabit bölümlü protezler destek dişleri
korumakta ve gelişim dönemindeki hastalar için
estetik, fonksiyonel ve fizyolojik bir rehabilitasyon
uygulanabilmesine olanak vermektedir.
KEYWORDS
ANAHTAR KELİMELER
Conical laterals, Fiber reinforced composite restoration
Konik lateral, Fiberle güçlendirilmiş kompozit
restorasyon
35
INTRODUCTION
Congenitally missing teeth and conical lateral
incisor teeth particularly seen on the anterior region in adolescence is an esthetically and functionally challenging situation for the clinician and
the patient. As far as the relatively young ages
of these patients are concerned, the restoration should be applied with a minimally invasive
approach. Glass fiber-reinforced composite resin
(FRC) applications, which have recently become
increasingly popular, can be considered as the
treatment of choice in these cases as they offer a
minimally invasive fixed treatment option1.
The rehabilitation of a young patient with
fixed partial denture by using glass fiber-reinforced composite resin, who congenitally had a
missing lateral incisor tooth and a conical lateral
incisor tooth, is described in this study.
CASE REPORT
A fifteen-year-old male patient with a congenitally missing upper right lateral incisor tooth
and a conical upper left lateral incisor tooth was
referred to our clinic due to crowding and malocclusion.
The treatment objectives were (1) to re-gain
the space for the missing upper right lateral incisor tooth, to achieve an adequate space for the
construction of conical upper left lateral incisor
tooth and to correct the malocclusion by orthodontic rehabilitation; (2) to replace the missing
tooth and reconstruct the conical tooth with
fixed partial dentures by using glass fiber-reinforced composite resin and (3) to achieve the most
ideal level of esthetics and occlusion possible.
upper right central incisor and canine teeth with
a minimally invasive approach to replace the missing upper right lateral incisor tooth, and a crown
restoration to restore the conical upper left lateral
incisor tooth by using glass fiber-reinforced composite resin, which similarly did not necessitate
any preparations on the abutment tooth.
Before starting prosthodontic treatment, the
patient received an orthodontic rehabilitation for
12 months. Orthodontic treatment involved levelling of the upper arch with staightwire appliances. The spaces required for the prosthodontic
restoration of the conical laterals were prepared
with stainless steel archwires of 0.016X 0.016
inch and niti coilsprings. Orthodontic treatment
was finished using a 0.016 X 0.022 archwire.
Two months later than the conclusion of orthodontic treatment (Figure 1, 2), maxiller and
mandibular impressions were made with a silicone-based impression material and working casts
were prepared in the laboratory (Figure 3, 4). A
surface-retained bridge from upper right central
incisor to upper right canine teeth and a crown
restoration for the upper left lateral incisor tooth were fabricated with a laboratory composite
resin (Dialog, Schütz Dental, Germany). A thin
layer of flowable composite resin (Filtek Flow,
3M ESPE, USA), together with the polymer resin-impregnated uni-directional glass fiber reinforcement material (everStick C&B, Stick Tech,
Finland) was applied to the palatinal surfaces of
the adjacent teeth. The restoration was intraorally tried-in and it was continued with cementation procedures. Bonding surfaces of the retainer
parts of FRC FPD were roughened using a green stone finishing bur (Diatech, LLC, USA) with
Orthodontic treatment plan included alignment of the teeth using fixed ortodontic treatment and opening up of the necessary spaces for
the conical laterals.
Taking relatively young age of the patient into
consideration, prosthodontic treatment plan consisted of a rehabilitation with a laboratory-fabricated, surface-retained bridge, which involved
FIGURE 1
Preoperative labial view
36
FIGURE 2
Preoperative palatinal view
low-speed handpiece, followed by application of
bonding agent (Scotchbond, 3M-ESPE, USA) and
storage in a dark place for 5 min. Meanwhile, the
abutment teeth were cleaned with pumice using
a prophylaxy brush on a low-speed handpiece.
Enamel surfaces were etched with 37% orthophosphoric acid for 60 sec, the restoration was
cemented with dual-cure composite resin luting
cement (RelyX ARC, 3M-ESPE, USA) according
to manufacturer’s directions and light-cured from
every aspect for 40 sec (Elipar Freelight, 3M
ESPE, USA). After occlusal adjustments, self-assessment of oral hygiene was described and the
patient was recalled on a six-month periodical
basis (Figure 5, 6, 7).
DISCUSSION
FIGURE 3
Palatinal view of restoration on master model
FIGURE 4
Labial view of restoration on master model
FIGURE 5
Preoperative occlusal view
The patient was very pleased with the treatment outcome on the basis that the restorations
were esthetic, comfortable, functional and retentive. Their relationships with the opposing and
adjacent dentition have been under control for
1.5 years (Figure 8).
Based on scientific research studies, numerous treatment options are available to address
the esthetic and functional discomfort of spaces
on the dental arch, resulting from missing teeth.
The material and technique of choice should be
the most appropriate and pleasing option for
both the clinician and patient1-3. It has been reported that a clinical success rate of %93 was
obtained after 63 months with glass fiber-reinforced composite resin restorations4.
In restorative dentistry, a relatively new technique of etching an enamel surface with acid and
bonding composite artificial teeth directly to the
adjacent natural teeth reinforced with high-density fibres without metal frameworks has produced good outcomes.5-8 With the construction of
more and more direct resin-bonded bridges, its
advantages of minimal tooth preparation, little
or no tissue removal and low laboratory costs
have attracted extensive attention9-11.
37
tions and color changes are easily performed12.
FIGURE 6
Postoperative occlusal view
FIGURE 7
Postoperative palatinal view
Clinicians are expected to satisfy the expectations of patients who seek safe, biocompatible,
affordable, and esthetic restorations. However,
clinicians are restricted by factors such as type
of preparation, fiber frame design, span length,
and the resin composite or luting agent13. The
few reports of successful use of FRC restorations
in the peer-reviewed literature include clinical reports14 and a study with short-term follow-up15.
The long-term behavior of glass fiber restorations must be evaluated in clinical studies.
REFERENCES
1. Brunton PA. Fiber-reinforced composite fixed partial
dentures: initial experiences. The third international
symposium on fiber-reinforced plastics in dentistry. In:
Vallittu PK. (ed), Manchester, England, 2002;7-14
2. Vallittu PK. Prosthodontic treatment with a glass fiberreinforced resin-bonded fixed partial denture: a clinical
report. J Prosthet Dent. 1999;82:132-135
3. Ott KHR. Evidence based therapy for the missing tooth/
teeth. The third international symposium on fiberreinforced plastics in dentistry. In: Vallittu PK. (ed),
Manchester, England, 2002;15-23
FIGURE 8
1.5-year follow-up view
4. Vallittu PK. Survival rates of resin-bonded, glass fiber
composite fixed partial dentures with a mean follow-up of
42 months: a pilot study. J Prosthet Dent. 2004;91:241-246
5. Heymann HO. Resin-retained bridges: the natural-tooth
pontic. Gen Dent. 1983;31:479-482
6. Christensen LC. A reinforced composite fixed partial
denture. J Prosthet Dent. 1986;56:665–666
There are several advantages of this technique.
The biological cost is low, since little or no tooth
structure needs to be removed, and thus all future
treatment options remain available. The procedure can be completed in a single visit, and thus
no temporization is required. The clinican has
complete control over the shade and shape of the
pontic, and because the prosthesis is metal-free,
there is no esthetic problem with metal showing
through thin abutment teeth. Material costs are
low, and there is no laboratory fee. Repairs, addi-
7. Henry PJ, Bishop BM, Purt RM. Fibre-reinforced plastics
for interim restorations. Quintessence Dent Technol.
1990/1991;14:110–123
8. Miller TE, Barrick JA. Pediatric trauma and polyethylene
reinforced composite fixed partial denture replacements: a
new method. J Prosthet Dent. 1993;59:252–256
9. Smith BGN. Planning and making crowns and bridges. In:
Dunitz M. (2nd ed.), London, 1990;125-143
10. Knight GM. The immediate cantilever resin bridge. Aust
Dent Assoc News Bull. 1993;206:26–29
11. Altieri JV, Burstone CJ, Goldberg AJ, Patel AP.
Longitudinal clinical of fibre-reinforced composite fixed
partial dentures: a pilot study. J Prosthet Dent. 1994;71:16–
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38
12. Meiers JC, Duncan JP, Freilich MA, Goldberg AJ.
Preimpregnated, fiberreinforced polymer fixed prostheses.
Part II. Direct applications: splints and fixed partial
dentures. Quintessence Int. 1998;29:761-768
13. Culy G, Tyas MJ. Direct resin-bonded, fibre-reinforced
anterior bridges: a clinical report. Aust Dent J. 1998;43:1-4
14. Jain P, Cobb D. Evaluation of a glass-fiber-reinforced,
bonded, inlaysupported fixed partial denture–4-year
results. Compend Contin Educ Dent. 2002;23:779-783
15. Vallittu PK, Sevelius C. Resin-bonded, glass fiberreinforced composite fixed partial dentures: a clinical
study. J Prosthet Dent. 2000;84:413-418
CORRESPONDING ADDRESS
Hüseyin KURTULMUŞ DDS, PhD
Ege University Faculty of Dentistry Department of Prosthodontics 35100 Bornova – İzmir / TURKEY
Tel: 0 232 388 0327 Fax: 0 232 388 0325