Case Report

Single Anterior Tooth Replacement with Direct Fiber‑Reinforced

Composite Bridges: A Report of Three Cases
D Karabekmez, G Aktas1

Department of In today’s dentistry, with the development of adhesive techniques and the

Abstract
Prosthodontics, Faculty of
Dentistry, Baskent University,
improvement of resin‑based materials, invasive restorative treatments have
Ankara, 1Department of been replaced by minimally invasive or noninvasive restorative procedures.
Prosthodontics, Faculty Fiber‑reinforced adhesive bridges are minimal‑invasive or noninvasive restorations
of Dentistry, Hacettepe that can be applied for definitive restoration in single tooth loss or short spans,
University, Ankara, Turkey where teeth or implant‑supported fixed partial prosthesis cannot be applied. This
case series describes the rehabilitation of three patients with anterior single tooth
Received:
loss using the direct fiber‑reinforced adhesive bridge. In all patients, esthetic
25-May-2019; and functional deficiencies in the missing tooth regions were solved with this
Revision: minimally invasive technique, which is both cost‑effective and conservative of
07-Aug-2019; tooth structures. During the three-year follow-up of these cases, there was neither
Accepted: fracture nor decementation in the restorations. Also, no caries or sensitivity was
21-Nov-2019; noted in the support teeth.
Published:
04-Mar-2020 Keywords: Adhesive bridge, fiber‑reinforced composite, single tooth deficiency

Introduction treatment. However, it is contraindicated in long

I n conventional dentistry, invasive procedures such
as tooth preparation involving enamel or dentin
may cause irreversible damage to the tooth structure.
Depending on the development of adhesive bonding
techniques and composite materials, minimally
invasive therapy was preferred instead of invasive
options.[1] Recently, fiber‑reinforced adhesive bridges are
one of the minimally invasive treatment options posing
increased interest.[1,2] Fiber‑reinforced composite  (FRC)
bridges provide satisfactory esthetics are minimally
invasive treatment, because of their ability to bond
to abutment teeth.[3] Besides, it can be applied as a
definitive restoration in single tooth loss or short span,
due to trauma or failed endodontic treatment, where
teeth or implant‑supported fixed partial prosthesis
cannot be applied. In addition, FRC bridges may be
applied in areas of potential tooth loss and for temporary
restoration prior to implant treatment.[4] Moreover, this
prosthesis can be applied when periodontal prognosis
of the abutment teeth is uncertain, patients cannot
receive local anesthesia or long‑term therapy and thus
a fixed retainer is required to be used after orthodontic
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spans, deep bites, the presence of large restorations of
support teeth, and diastema cases.[5] The success rate of
resin‑bonded fixed partial prosthesis varies widely from
60% to 95%.[6,7] In this paper, three cases of single tooth
loss rehabilitations in the anterior area performed by
using direct FRC bridges are reported.
Case Reports
Prior to the treatment, all patients were informed of the
procedure and informed consent was obtained.
Case‑1
A 20‑year‑old male patient undergoing orthodontic
treatment admitted to Hacettepe University, Faculty of
Dentistry, Department of Prosthodontics, Turkey due
to the missing mandibular central teeth. In the clinical
evaluation, it was noticed that there were two missing
Address for correspondence: Dr. D Karabekmez,
Baskent University, Faculty of Dentistry,
Department of Prosthodontics, 82. Sokak No: 26 Bahçelievler,
Ankara 06790, Turkey.
E‑mail: dkarabekmez@gmail.com, dkarabekmez@baskent.edu.tr
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DOI: 10.4103/njcp.njcp_286_19

How to cite this article: Karabekmez D, Aktas G. Single anterior tooth

PMID: ******* replacement with direct fiber-reinforced composite bridges: A report of
three cases. Niger J Clin Pract 2020;23:434-6.

434 ©
Nigerian
2020 Nigerian
Journal of
Journal
Clinical
of Practice 
Clinical Practice | Published
¦  Volume 23  ¦  Issueby3 Wolters
¦  MarchKluwer ‑ Medknow
2020
 Karabekmez and Aktas: Direct fiber‑reinforced composite bridges: A case series
a b
c
d
Figure 1: (a): Case 1. The intraoral appearance of a missing tooth. (b):
Fiber band attached to abutment teeth.  (c): Intraoral appearance of
restoration completed by the direct method. (d): Intraoral appearance of
restoration after 3‑years follow‑up
a b
c d
Figure 2: (a): Case 2. The intraoral appearance of a missing tooth. (b):
Fiber band attached to abutment teeth.  (c): Intraoral appearance of
restoration completed by the direct method. (d): Intraoral appearance of
restoration after 3‑years follow‑up
a b
c d
Figure 3: (a): Case 3. The intraoral appearance of a missing tooth.
(b): Fiber band attached to abutment teeth. (c): Intraoral appearance of
restoration completed by the direct method. (d): Intraoral appearance of
restoration after 3-years follow-up
mandibular central teeth but the short span was narrowed
mesiodistally by the orthodontic treatment that could fit
Nigerian Journal of Clinical Practice  ¦  Volume 23  ¦  Issue 3  ¦  March 2020
the one tooth  [Figure   1a]. After radiological evaluation,
it was decided that bone augmentation should be
performed for the implant surgery. Direct FRC adhesive
bridge, which is both aesthetic and minimally invasive,
was planned for a patient who does not wish to have
an invasive treatment, such as a fixed-partial prosthesis
and implant restoration with bone augmentation. Thus,
no invasive procedure was applied to the abutment
teeth. Phosphoric acid  (37%) was applied to the palatal
surfaces of these teeth to provide adhesive bonding of
restoration. Fiber band  (Interlig Glass Fiber, Angelus)
was adapted carefully to the lingual area  [Figure  1b]
by using a flowable composite  (Filtek™ Supreme Ultra
Flowable, 3M, USA) and resin cement  (Choise, Bisco,
France). Then, it was polymerized by using curing light.
The composite resin pontic (Filtek Ultimate Universal
Restorative, 3M ESPE, Belgium) was formed by using
the incremental technique and with help of silicone
index that is prepared on the plaster model of the patient.
Further, occlusal contacts were checked. Finishing and
polishing were done by using composite finishing drills,
polishing discs, and rubbers [Figure 1c].
Case‑2
A 43‑year‑old female patient was admitted to the
Department of Prosthodontics, Hacettepe University,
Faculty of Dentistry, Turkey, to eliminate the left
maxillary lateral deficiency  [Figure  2a]. After oral and
radiological examinations, the patient was informed
about fixed prosthetic treatment options. It was explained
to the patient that the preparation was necessary on
the teeth for fixed partial dentures and the periodontal
problem on the left central incisor could negatively
affect the prognosis of fixed prosthetic treatment.
Furthermore, the patient did not accept implant treatment
due to economic reasons. Therefore, direct FRC bridge
construction was proposed to eliminate esthetic and
functional deficiencies. Both maxillary central incisors
and the left canine were selected as abutments. All the
treatment stages for the patient [Figure 2b and 2c] were
same as for case-1, except for the choice of abutments.
Case‑3
A 64-year-old male patient was admitted to the
Department of Prosthodontics with esthetic and phonetic
problems, due to a missing mandibular right central
incisor [Figure 3a]. When the prosthetic treatment
options were evaluated after clinical and radiological
examinations, the necessary bone width for the implant
was measured as insufficient. Considering the current
periodontal condition of the patient, it was explained
to him that the clinical lengths of crowns of teeth were
longer and the restoration could be far from a natural
image. The fiber band was applied to the lower right
435
 Karabekmez and Aktas: Direct fiber‑reinforced composite bridges: A case series
lateral incisor and canine, lower left center, and lateral
incisor teeth, to support the lower incisors with splinting
and also to increase the adhesion surface of these teeth
to the restoration. All the clinical stages for this patient
[Figure 3b and 3c] were same as for cases 1 and 2.
Discussion
Although FRC adhesive bridges applied by direct
technique have clinical limitations, they are known to
provide many advantages. These restorations are easy to
make and they can also be used as permanent restorations
in some cases, because they have noninvasive properties.
During the application, it can be arranged according to
the patient’s esthetic expectations. They can be applied
by chair‑side, they are economical, and easy to repair
when broken.[2,3]
Problems of FRC adhesive bridges can be minor, such
as discoloration or small chipping of composite, or they
may be major, such as framework fracture or debonding
that requires replacement of entire construction.
Consequently, discoloration has been described as a
continual problem.[8]
In a clinical study of evaluating resin‑bonded bridges in
a 5‑years follow‑up, the survival rate was reported as
87,7% to 93%.[1,9] It can be concluded that FRC bridges
are a good alternative to conventional bridges in terms
of appropriate case selection, design and material use.
In the rehabilitation of three different patients with a
single missing tooth using FRC adhesive bridge, esthetic
and functional problems in the edentulous regions were
solved in a short time, at minimal cost, and preservation
of natural tooth structures. At the end of the treatment of
all patients, they were evaluated in third and sixth months
and then regularly once every year. As a result of 3 years
follow-up of these cases, there were no mechanical
failures, such as fracture or decementation in the
restorations, and no biological failures, such as caries or
sensitivity in the support teeth [Figures 1d, 2d, and 3d].
However, the only discoloration was observed on all
436 Nigerian Journal of Clinical Practice  ¦  Volume 23  ¦  Issue 3  ¦  March 2020
restorations. Direct glass FRC adhesive bridges in the
anterior area provide sufficient stability, biological, and
functional performance at least for 3 years.
Declaration of patient consent
The authors certify that they have obtained all
appropriate patient consent forms. In the form the
patient  (s) has/have given his/her/their consent for his/
her/their images and other clinical information to be
reported in the journal. The patients understand that their
names and initials will not be published and due efforts
will be made to conceal their identity, but anonymity
cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
1. Kumbuloglu  O, Ozcan  M. Clinical survival of indirect, anterior
3‑unit surface‑retained fibre‑reinforced composite fixed dental
prosthesis: Up to 7.5‑years follow‑up. J Dent 2015;43:656‑63.
2. Shillingburg  HT. Fundamentals of Fixed Prosthodontics. 3rd ed.
Chicago: Quintessence Pub Co; 1997. p. 537‑61.
3. Garoushi  S, Vallittu  P. Fiber‑reinforced composites in fixed
partial dentures. Libyan J Med 2006;1:73‑82.
4. Eskimez  S. Adhesive Bridges and Clinical Applications. 1st ed.
Istanbul: Quintessence Pub. Co. 2008. p. 75‑118.
5. Kumbuloglu  O, Saracoglu  A, Ozcan  M. Pilot study of
unidirectional e‑glass fibre‑reinforced composite resin splints: Up
to 4.5‑year clinical follow‑up. J Dent 2011;39:871‑7.
6. Pröbster B, Henrich GM. 11‑year follow‑up study of resin‑bonded
fixed partial dentures. Int J Prosthodont 1997;10:259‑68.
7. Thoma  DS, Sailer  I, Ioannidis  A, Zwahlen  M, Makarov  N,
Pjetursson BE. A systematic review of the survival and
complication rates of resin‑bonded fixed dental prostheses after
a mean observation period of at least 5 years. Clin Oral Implants
Res 2017;28:1421‑32.
8. Van Heumen  C, Kreulen  C, Creugers  N. Clinical studies of
fiber‑reinforced resin‑bonded fixed partial dentures: A systematic
review. Eur J Oral Sci 2009;117:1‑6.
9. Hill  HK, Landwehr  D, Armstrong  S. A  moderately favorable
five‑year success rate for resin‑bonded bridges. J Am Dent Assoc
2009;140:706‑7.
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