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A transitional anterior fixed prosthesis using composite resin
A transitional anterior fixed prosthesis using composite resin Louis LaVecchia, D.D.S.,* Robert Belott, D.D.S.,** W. Patrick Naylor, D.D.S.**** Georgetown University,
Leonard DeBellis, D.D.S.,***
and
School of Dentistry, Washington, D. C.
1 he temporary replacement of an anterior tooth often presents a problem. The one-appointment technique described in this article uses ‘composite resin? to affix an acrylic resin denture tooth, supported by edgewise orthodontic wire, to natural teeth. The method requires minimal time, materials, and cost (Fig. 1).
TECHNIQUE The abutment teeth are polished with flour of pumice. A resin denture tooth of the appropriate shade and mold is selected. The denture tooth is then shaped to conform to the edentulous ridge and to esthetically restore the spacing. The lingual portion of the incisal edge is reduced slightly so that the pontic is just out of occlusion. A 0.5 mm space is provided interproximally to facilitate final finishing and to ensure proper embrasure‘ form. A rubber dam is placed to include at least two teeth on either side of the edentulous space. Once isolation has been.established, Class III cavities are prepared with lingual locks. Each lingual lock should be of sufficient depth and width to easily accommodate a piece of 0.027 X 0.016 inch edgewise orthpdontic wire and the composite resin. The site for a lingual channel is then marked in pencil on the resin pontic, and the channel is then prepared with a No. 35 inverted-cone bur. The channel should run continuous with the Class III preparations on the *Assistant Professor,Department of Operative Dentistry, Georgetown University, School of Dentistry. **Staff Dentist, V. A. Medical Center, Washington, D. C.; Clinical Instructor, Department of Operative Dentistry, &orgetown University, School of Dentistry. ***Long Island, N. Y. ****Research Fellow in Prosthetic Dentistry, Harvard School of Dental Medicine, Boston, Mass. tconcise, 3M Corp., St. Paul, Minn.
264
SEPTEMBER
1980
VOLUME
44
NUMBER
3
Fig. 1. Preoperative view of patient.
Fig. 2. Resin pontic marked for the wire placement and prepared abutments. abutment teeth (Fig. 2). Approximately 1 mm of the cavosurface margin of each tooth is roughened pith a diamond instrument. The axial wall of each preparation is protected with a layer of calcium hydroxide and then the marginal areas are etched with a 35% solution of phosphoric acid (Fig. 3).
0022-3913/80/090264
+ 03$00.30/00
1980 The C. V. Mosby Co.
TRANSITIONAL
ANTERIOR
FIXED PROSTHESIS
Fig. 3. Class III cavity preparations placed.
with CaOH base
Fig.
5.
Orthodontic
wire after filling Class III cavities.
Fig. 4. The orthodontic wire cut and stabilized with sticky wax. Note mylar strip placement to aid in restoration with composite resin.
Fig. 6. Completed restorations viewed from lingual surface.
Orthodontic wire is cut and adapted so that when placed in the prepared teeth, it is contained within the cavity preparations and does not touch the distal walls at either end. A mylar matrix* is cut to the correct contour of each abutment tooth, with a small hole in the middle to accommodate the orthodontic wire. The mylar strips are then slipped onto the wire, and the wire is stabilized within the tooth preparation with sticky wax at one end (Fig. 4). The composite resin is mixed according to manufacturer’s specifications and placed in the other cavity preparation. The matrix is pulled firmly around the tooth and held until set. Once set, the sticky wax is removed from the opposite tooth, and the second preparation is restored in the same manner. The mylar strips may be removed after 10 minutes. Both restorations may
then be finished with sandpaper disks, strips, and white stones (Fig. 5). The rubber dam is removed at this time. The acrylic resin pontic is positioned and held in place with gentie finger pressure while the lingual surface is filled with composite resin. When filling the lingual channel, resin material should be placed interproximally to cover the wire. The occlusion is checked with articulating paper to ensure that the pontic has no occlusal contact in any occlusal position. Final finishing should be completed at this time (Fig. 6).
*Matrix
strips No. 20, S. S. White,
THE JOURNAL
OF PROSTHETIC
Philadelphia,
DENTISTRY
Pa.
DISCUSSION Several alternate approaches to this method have appeared in the literature. Most of these approaches rely solely on the acid-etch technique with extracoronal bonding of the composite resin material to the abutment teeth and pontic.
265
LA VECCHIA
ET Al
The limitation of the technique is the inability of the replacement tooth to withstand normal occlusal forces. Consequently, adjusting the pontic so that it is positioned out of occlusion aids in reducing occlusal forces that may fracture the pontic or dislodge it from the orthodontic wire. This treatment is best suited for a single anterior tooth replacement; however, under ideal circumstances, several teeth may be replaced (for example, lower central incisors with minimal occlusal forces).
SUMMARY Fig. 7. Finished restoration. Note position of pontic on edentulous ridge.
A method has been described to temporarily restore an anterior edentulous space in a single appointment. The technique uses a composite resin to retain a resin denture tooth (pontic) supported by edgewise orthodontic wire. This approach is suggested as a transitional treatment for patients who are not amenable to either a definitive fixed or removable prosthesis. REFERENCES
Fig. 8. Finished restoration. The advantages of our technique include minimal materials with subsequent lower cost and greater strength in providing a temporary esthetic tooth replacement (Figs. 7 and 8). The two Class III preparations provide greater mechanical retention and allow for the addition of the edgewise orthodontic wire which not only aids in supporting the pontic but also helps to reduce rotational movement.
1. Kochavi, D., Stem, N., and Grajower, R.: A temporary space maintainer using acrylic resin teeth and a composite resin. J PROSTHET DENT 37:522, 1977. 2. Stuart, I. A.: An unusual space maintainer retained by an acid-etched polymer resin. Br Dent,J 137:437, 1974. 3. Richmond, N. L.: Acid-etch “bridge” technique. J Indiana State Dent Assoc 52:435, 1973. 4. Ibsen, R. L.: Fixed prosthetics with a natural crown pontic using an adhesive composite. J South Calif Dent Assoc 41:100, 1973. 5. Ibsen, R. L.: One-appointment technique using an adhesive composite. Dent Surv 49:30, 1973. R@int requeststo: DR. Lours J. LAVECCHIA GEORGETOWN UNIVERSITY SCHOOL OF DENTISTRY WASHINGTON, D. C. 20007
SEPTEMBER
1980
VOLUME
44
NUMBER
3
Leonard DeBellis, D.D.S.,***
and
School of Dentistry, Washington, D. C.
1 he temporary replacement of an anterior tooth often presents a problem. The one-appointment technique described in this article uses ‘composite resin? to affix an acrylic resin denture tooth, supported by edgewise orthodontic wire, to natural teeth. The method requires minimal time, materials, and cost (Fig. 1).
TECHNIQUE The abutment teeth are polished with flour of pumice. A resin denture tooth of the appropriate shade and mold is selected. The denture tooth is then shaped to conform to the edentulous ridge and to esthetically restore the spacing. The lingual portion of the incisal edge is reduced slightly so that the pontic is just out of occlusion. A 0.5 mm space is provided interproximally to facilitate final finishing and to ensure proper embrasure‘ form. A rubber dam is placed to include at least two teeth on either side of the edentulous space. Once isolation has been.established, Class III cavities are prepared with lingual locks. Each lingual lock should be of sufficient depth and width to easily accommodate a piece of 0.027 X 0.016 inch edgewise orthpdontic wire and the composite resin. The site for a lingual channel is then marked in pencil on the resin pontic, and the channel is then prepared with a No. 35 inverted-cone bur. The channel should run continuous with the Class III preparations on the *Assistant Professor,Department of Operative Dentistry, Georgetown University, School of Dentistry. **Staff Dentist, V. A. Medical Center, Washington, D. C.; Clinical Instructor, Department of Operative Dentistry, &orgetown University, School of Dentistry. ***Long Island, N. Y. ****Research Fellow in Prosthetic Dentistry, Harvard School of Dental Medicine, Boston, Mass. tconcise, 3M Corp., St. Paul, Minn.
264
SEPTEMBER
1980
VOLUME
44
NUMBER
3
Fig. 1. Preoperative view of patient.
Fig. 2. Resin pontic marked for the wire placement and prepared abutments. abutment teeth (Fig. 2). Approximately 1 mm of the cavosurface margin of each tooth is roughened pith a diamond instrument. The axial wall of each preparation is protected with a layer of calcium hydroxide and then the marginal areas are etched with a 35% solution of phosphoric acid (Fig. 3).
0022-3913/80/090264
+ 03$00.30/00
1980 The C. V. Mosby Co.
TRANSITIONAL
ANTERIOR
FIXED PROSTHESIS
Fig. 3. Class III cavity preparations placed.
with CaOH base
Fig.
5.
Orthodontic
wire after filling Class III cavities.
Fig. 4. The orthodontic wire cut and stabilized with sticky wax. Note mylar strip placement to aid in restoration with composite resin.
Fig. 6. Completed restorations viewed from lingual surface.
Orthodontic wire is cut and adapted so that when placed in the prepared teeth, it is contained within the cavity preparations and does not touch the distal walls at either end. A mylar matrix* is cut to the correct contour of each abutment tooth, with a small hole in the middle to accommodate the orthodontic wire. The mylar strips are then slipped onto the wire, and the wire is stabilized within the tooth preparation with sticky wax at one end (Fig. 4). The composite resin is mixed according to manufacturer’s specifications and placed in the other cavity preparation. The matrix is pulled firmly around the tooth and held until set. Once set, the sticky wax is removed from the opposite tooth, and the second preparation is restored in the same manner. The mylar strips may be removed after 10 minutes. Both restorations may
then be finished with sandpaper disks, strips, and white stones (Fig. 5). The rubber dam is removed at this time. The acrylic resin pontic is positioned and held in place with gentie finger pressure while the lingual surface is filled with composite resin. When filling the lingual channel, resin material should be placed interproximally to cover the wire. The occlusion is checked with articulating paper to ensure that the pontic has no occlusal contact in any occlusal position. Final finishing should be completed at this time (Fig. 6).
*Matrix
strips No. 20, S. S. White,
THE JOURNAL
OF PROSTHETIC
Philadelphia,
DENTISTRY
Pa.
DISCUSSION Several alternate approaches to this method have appeared in the literature. Most of these approaches rely solely on the acid-etch technique with extracoronal bonding of the composite resin material to the abutment teeth and pontic.
265
LA VECCHIA
ET Al
The limitation of the technique is the inability of the replacement tooth to withstand normal occlusal forces. Consequently, adjusting the pontic so that it is positioned out of occlusion aids in reducing occlusal forces that may fracture the pontic or dislodge it from the orthodontic wire. This treatment is best suited for a single anterior tooth replacement; however, under ideal circumstances, several teeth may be replaced (for example, lower central incisors with minimal occlusal forces).
SUMMARY Fig. 7. Finished restoration. Note position of pontic on edentulous ridge.
A method has been described to temporarily restore an anterior edentulous space in a single appointment. The technique uses a composite resin to retain a resin denture tooth (pontic) supported by edgewise orthodontic wire. This approach is suggested as a transitional treatment for patients who are not amenable to either a definitive fixed or removable prosthesis. REFERENCES
Fig. 8. Finished restoration. The advantages of our technique include minimal materials with subsequent lower cost and greater strength in providing a temporary esthetic tooth replacement (Figs. 7 and 8). The two Class III preparations provide greater mechanical retention and allow for the addition of the edgewise orthodontic wire which not only aids in supporting the pontic but also helps to reduce rotational movement.
1. Kochavi, D., Stem, N., and Grajower, R.: A temporary space maintainer using acrylic resin teeth and a composite resin. J PROSTHET DENT 37:522, 1977. 2. Stuart, I. A.: An unusual space maintainer retained by an acid-etched polymer resin. Br Dent,J 137:437, 1974. 3. Richmond, N. L.: Acid-etch “bridge” technique. J Indiana State Dent Assoc 52:435, 1973. 4. Ibsen, R. L.: Fixed prosthetics with a natural crown pontic using an adhesive composite. J South Calif Dent Assoc 41:100, 1973. 5. Ibsen, R. L.: One-appointment technique using an adhesive composite. Dent Surv 49:30, 1973. R@int requeststo: DR. Lours J. LAVECCHIA GEORGETOWN UNIVERSITY SCHOOL OF DENTISTRY WASHINGTON, D. C. 20007
SEPTEMBER
1980
VOLUME
44
NUMBER
3