Professional Documents
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Natural Tooth Pontic
Natural Tooth Pontic
17]
Case Report
Abstract
Replacement of missing anterior teeth due to periodontal reasons is challenging due to the poor support of abutment teeth. This prevents the
use of fixed partial dentures (FPDs). Fiber-reinforced splinting provides a viable alternative to the dentist while choosing a treatment plan in
replacing missing anterior teeth in periodontally compromised patients as opposed to conventional modalities like FPDs or removable partial
dentures. Replacing missing teeth using either patients own tooth or a denture tooth as pontic can be done by splinting adjacent teeth with
fiber reinforced composite. The splinting has an additional advantage of stabilizing adjacent mobile teeth. This case report details the case
selection, procedure with follow-up of a case where the natural extracted tooth of the patient was used as pontic to replace a missing anterior
tooth. The splinting was done with fiber reinforced composite resin. Fiber-reinforced composite resin splinting of patients extracted natural
tooth is economical, fast, and easy to use chairside technique with the added benefit of periodontal stabilization.
Key words: Fiber reinforced composite resin, natural tooth pontic, splinting, tooth mobility
Srinidhi and Raghavendra: Natural tooth pontic splinted with fiber reinforced composite splint
had to undergo extraction for pain relief and infection control. pontic was attached to the fiber splint, taking care to see that
However, replacement was patients main concern. Adjacent the fiber splint was placed in the prepared groove [Figure4].
teeth showed severe recession, severe bone loss, and variable The fiber splint was covered with composite resin and cured,
degrees of mobility but patient was unwilling to consider taking care to see that the ends of the fiber are covered.
extraction at the present stage. This was followed by a thorough finishing and polishing of
the restoration [Figure 5]. Care was taken to eliminate any
Treatment plan
The patient was advised to undergo supra and subgingival
scaling and was reviewed 2 weeks later. Response of the tissues
to periodontal therapy after scaling was good. There was good
compliance with the oral hygiene instructions. The mandibular
right central incisor was having hopeless periodontal prognosis
and needed extraction.
Various treatment options available were removable partial
denture (RPD), FPD or splinting with natural teeth pontic.
The abutment teeth available were periodontally weak. RPD
with supporting clasps on the abutment teeth would have made
them weaker. An FPD using two abutments on either side was
a viable treatment option. It was not acceptable to the patient
due to high expense involved.
Splinting of the mandibular anterior using fiber splint and the
inclusion of the extracted natural tooth as pontic in the splint Figure 1: Marking for groove placement
was considered. This option had the advantage of stabilizing
periodontally weak abutments. It also was flexible to allow any
other treatment needed in future (like endodontic/periodontic/
extraction) for questionable abutments. The patient found the
treatment plan appealing because of the comparative low cost
and possibility of having a fixed prosthesis.
Treatment
The mandibular right central incisor was extracted under local
anesthesia. The extraction was uneventful. The extracted tooth
was scaled and polished thoroughly to remove all the deposits
on them. After healing of extraction socket, impressions were
made and study models prepared. The extracted tooth was
trimmed so as to rest passively on the edentulous ridge in
mandibular central incisor area. The tooth was endodontically
instrumented from the apical area and sealed with composite.
The tooth was prepared by making a groove of 0.75 mm depth Figure 2: Acid etching of abutment teeth
in the lingual mid 1/3rd area with a round abrasive point (BR
40, Mani, Japan) and arranged on the edentulous ridge of the
study model. The pontic was passively touching the edentulous
ridge and had no incisal contact point with opposing teeth. The
adjacent teeth were marked and grooved to a depth of 0.75 mm
in the middle third of lingual aspect with round abrasive point
(BR 40, Mani, Japan) [Figure 1].
Lingual surfaces of mandibular laterals and canines were acid
etched (Dentsply, USA) for 15 s [Figure 2]. After application
of bonding agent (Prime and Bond NT, Dentsply, USA) and
curing with LED curing unit (Apoza, Taiwan), flowable
composite (Charisma, Kulzer) was placed in the lingual
groove area. The fiber splint (Interlig, Angelus, Brazil) was
immersed in the flowable composite and cured one tooth at
a time [Figure3]. The other teeth were covered with foil to
prevent premature polymerization. The trimmed natural tooth Figure 3: Placement of fiber reinforced splint on abutment teeth
Srinidhi and Raghavendra: Natural tooth pontic splinted with fiber reinforced composite splint
Figure 4: Natural tooth pontic placed and splinted Figure 5: Postoperative view
occlusal contact on the splint. The patient was trained to use added boost on seeing his own tooth being used instead of an
an interdental brush to keep the splinted teeth clean. She was artificial one. These natural tooth pontics can be splinted to
put on supportive periodontal therapy, that is, maintenance the adjacent teeth by composite resins, with or without wire
recall schedule. reinforcement.[7] One of the alternatives of splinting is with the
use of fiber reinforced composites. The most popular fiber types
Discussion are ultra-high molecular weight polyethylene (UHMWPE)
and glass fibers.
Tooth splinting may be indicated for individual mobile teeth
as well as for an entire dentition in cases where extraction The use of a UHMWPE leads to very low friction coefficient,
and implant therapy is not a viable alternative. These can be high wear resistance, and high impact strength. It is woven
successfully managed by retaining the tooth through more into a ribbon for dental application. The polyethylene
conservative methods like splinting. The overall objective of reinforcement fiber has a flexible white mesh appearance
splinting is to create an environment where the tooth movement and is treated with cold plasma gas in order to increase its
can be contained within physiological limits, thereby reactivity and wetting ability. This enables chemical and
improving patient comfort and the restoration of function. physical interactions with composite resins.[8] Interlig by
Angelus, Brazil used here is a braided, intertwined glass fiber
Provisional splints are indicated for a limited time period. impregnated with dental resin.
They will provide information as to whether teeth stabilization
will have benefits before planning comprehensive treatment. The reinforcing capacity of fibers is dependent on their
Examples include ligature wires, nightguards, and interim adhesion to the resin, orientation of the fibers and their
fixed prosthesis, composite resin splints (with or without wire impregnation with the resin. The advantages of fiber reinforced
and fiber support). Definitive splints are placed only after composite material for periodontal splinting include:
completion of periodontal therapy and achievement of occlusal a. Ease of application with minimal tooth preparation.
stability. They are intended to increase functional stability and b. Low to moderate cost as compared to fixed prostheses.
improve esthetics on a long term basis.[5] c. Can easily be removed when splinting is no longer
considered necessary.
When a periodontally compromised tooth in the visible or d. Easily repaired in case of failure through re-bonding and
esthetic zone is planned for extraction, the primary concern re-application of material.
of the patient is of esthetics. There are various options which e. Ease of accommodation of oral hygiene practices by the
can be given to the patient like acrylic RPDs or the extracted patient.[9,10]
natural teeth can be used as a pontic. The acrylic RPDs are
The most common type of failure seen is the exposure of the
bulky and uncomfortable to the patient. Prefabricated denture
ends of the fiber and debonding of the fiber from the tooth.
teeth can be used as a pontic when bonded to the adjacent teeth.
This is especially seen when we are replacing many teeth
They present challenges with regard to color matching, size and
and stabilizing with fiber. The lingual grooving to a depth
shape matching. They may require substantial modifications
of 0.75 mm on the abutment teeth and the pontics enable the
to achieve an acceptable appearance. Implant supported
fiber to be placed perfectly within the tooth surface without
prostheses may not be the best option due to severe localized
any protruding area. Placing a flowable composite and then
soft and hard tissue loss.[6]
embedding the fiber in that helps the integration of the resin
Using the natural tooth as a pontic offers the benefits of being with the fiber. This is due to the gas plasma treatment done
the right shape, size, and color. Moreover, the patient gets an to the fiber. Trimming the pontic teeth is important so that
Srinidhi and Raghavendra: Natural tooth pontic splinted with fiber reinforced composite splint
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