Fiber reinforced composite resin bridges
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Fiber reinforced composite resin bridges

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Fiber reinforced composite resin bridges Presentation Transcript

  • 1. Fiber-reinforced Composite Resin Bridges DR. HAKAN ÇOLAK
  • 2. Introduction Loss of anterior tooth may be a catastrophic event for the patient
  • 3. Introduction  An immediate replacement is important, to provide a positive psychological approach and to maintain the facial aesthetics and phonetics.
  • 4. Introduction  Conservation, natural preservation, minimal invasion, aesthetics and cost are some of the important factors that are considered when a missing tooth is replaced
  • 5. Introduction  Different therapeutic options can be considered for the replacement of a congenitally or traumatically missing permanent incisor
  • 6. Introduction general and local conditions should be favorable generally not intended before the end of the growth period and around the age of 18 high cost, poor financial condition could also limit their use
  • 7. Introduction not comfortable frequently subjected to fracture
  • 8. Introduction More tooth reduction required than for a resin bonded bridge May be difficult to make it look natural in cases of excess bone or gum loss conventional fixed bridges
  • 9. Introduction compromised esthetics from the metal wings showing through translucent enamel and the inability Maryland bridge
  • 10. The Fiber-Reinforced Resin-Bonded Bridge  Advantages  Cost effective  Less or zero reduction in healthy tooth structure  Takes short duration of time  Hygienic  Nonallergenic  Single tooth replacement premolar or incisor  ideal indication for lower incisors
  • 11. The Fiber-Reinforced Resin-Bonded Bridge  A review of the dental literature suggests that the FRC prostheses have good longevity, especially those which are made by the direct technique
  • 12. The Fiber-Reinforced Resin-Bonded Bridge  Three forms of pontics can be made for the FRC bridges:  natural extracted teeth,  with acrylic resin teeth  using composite resin.
  • 13. The Fiber-Reinforced Resin-Bonded Bridge  The prefabricated acrylic resin teeth often do not have acceptable color, size and shape matching and bond unpredictably to composite resin.
  • 14.  If the natural tooth is available and if its crown is in good condition, it can be bonded easily to the adjacent teeth by using a light-cured restorative material. Using the natural tooth as a pontic offers the benefits of being the right size, shape and colour, along with producing good aesthetic and functional results
  • 15. Ribbond  Ribbond is a bondable fibre reinforced material which is made from ultra-high molecular weight polyethylene fibres with a leno-weave orientation.  Ribbond has been used for stabilizing traumatized teeth, restoring fractured teeth, for creating a fixed partial denture and for direct- bonded endodontic posts and cores
  • 16. Natural Tooth Pontic as a Provisional Restoration  The concept of using the patient's extracted tooth as a natural tooth pontic has been reported in the literature.  The benefits of using the patient's natural tooth  ideal shape, contour,  color of the surrounding dentition and mitigates the necessity of custom staining  contouring of a denture tooth or free-hand composite pontic.  the natural tooth is available immediately for bonding at the time of surgery,  no preliminary lab work is necessary.
  • 17. Considerations for Utilization of a Natural Tooth Pontic  Several factors must be taken into consideration when choosing a natural tooth pontic as an interim provisional.  First and foremost, the extracted tooth should possess an intact, clinical crown that is of ideal shape, contour, and shade, with intrinsic characterization that ideally matches the adjacent dentition.  The functional occlusal stress on the pontic site should be minimal, and the patient's preoperative centric, working, and nonworking contacts must be assessed to determine whether displacing forces can be reduced or eliminated.
  • 18. Materials for Attaching a Provisional Natural Tooth Pontic  The material utilized for the attachment must be  thin  strong  easily adapted  highly suitable for resin bonding  material used must be easy to remove from the adjacent teeth without damaging healthy tooth structure.  When the definitive restoration is an implant, the pontic may have to be removed and replaced several times throughout the course of treatment. Therefore,
  • 19. Materials for Attaching a Provisional Natural Tooth Pontic  Ultra-high strength polyethylene (UHSPE) ribbons  First made commercially available by Ribbond in 1992,  Several companies now offer versions of these materials and there use has expanded to a variety of dental applications.  Ribbond (Ribbond)  Connect (Kerr), Splint-It (Pentron Clinical)  Vectris (Ivoclar Vivadent)  These materials are useful for a large number of dental applications including  direct periodontal splints,  indirect strengthening of lab fabricated indirect crowns,  bridges,  provisional restorations.
  • 20. Case report- 1 Technique for Utilization of a Provisional Natural Tooth Pontic Natural Tooth Pontic as a Provisional Restoration
  • 21. Case Report-1  A 45-year-old female patient  The patient was not in pain, and her primary dental concern was to remain current with her biannual prophylactic recare visits.  A comprehensive examination including periodontal charting, intraoral photographs, and a full- mouth series of radiographs was performed.
  • 22. Case Report-1(con’t)  Tooth No. 21  exhibited Class I to Class II mobility with all other visual findings being within normal limits (Figure 1).  Dental history,  she indicated that, as a teenager, she had an accident that displaced teeth Nos. 11 and 21, and tooth No. 21 had required root canal therapy after becoming nonvital.  Several cracks in both teeth were observed during the visual exam with transillumination, but none were symptomatic.  Closer inspection of the periapical radiograph  indicated that tooth No. 21 was in a state of active internal resorption and the tooth was diagnosed as hopeless (Figure 2).  When the patient was informed that the diagnosis for her maxillary left central incisor was hopeless, she was heartbroken.
  • 23. Case Report-1(con’t)  Since her surrounding dentition was caries- and restoration-free, surgical extraction, possible bone and soft-tissue grafting, and implant placement were recommended. Though she had the economic means to treat the condition optimally, her primary concern was "What will I do without a front tooth until treatment is complete?"
  • 24. Case Report-1 (con’t)
  • 25. Case Report-1 (con’t)
  • 26. Case Report-1  The 2-mm Ribbond THM ribbon was chosen for this case due to its minimal thickness, leno-weave construction, ease of adaptation to the teeth, and overall superior strength.  A rectangular slot was prepared on the lingual aspect of the natural tooth pontic to secure the Ribbond THM and to assure that it remained out of occlusion. The finalized pontic with a rectangular lingual slot is shown in Figure 10
  • 27. Case Report-1 (con’t)  Ribbond strands cannot be cut with conventional scissors; this most recent product includes a slimmer and more compact industrial-grade scissor, as compared to the more bulky version supplied with earlier kits.  The manufacturer recommends the use of Ribbond Wetting Resin (Ribbond), a product sold separately.
  • 28. Case Report-1 (con’t) The span is measured with a flexible ruler, or by cutting a thin strip of foil to ideal length. The Ribbond THM is then cut to equal length. When natural teeth pontics are used as a final long-term restoration, it is recommended to prepare slots in the adjacent abutment teeth and imbed the fibers for strength and greatest wear resistance
  • 29. Case Report-1 (con’t)  Once the Ribbond THM is cut to length, Ribbond Wetting Resin is dispensed (Figure 12) and the strand is saturated (Figure 13).  Phosphoric acid etchant is applied to the lingual and interproximal aspects of the adjacent abutment teeth, and allowed to stand for 15 seconds (Figure 14), then rinsed and dried.
  • 30. Case Report-1 (con’t)  A thin coat of Ribbond Securing Resin (Ribbond) was applied to the lingual and interproximal surfaces of adjacent teeth.  The Ribbond THM was then seated at the desired position and adapted first with finger pressure, then with a thin IPC hand instrument. Care must be taken to ensure that the edges of the fiber are flush against the teeth, and that the material wraps slightly into the interproximal areas roughly to the previous contact area.
  • 31. Case Report-1 (con’t)
  • 32. Case Report-1 (con’t)
  • 33. Case-2  A 76-year-old female patient presented with a missing mandibular left lateral incisor that had been recently extracted because of severe root caries on the distal surface that had made the tooth unrestorable (Figure 1).
  • 34. Case-2 con’t  Upon clinical and radiographic examination, it was noted that there was not enough remaining bone in the labial- lingual direction to consider an implant.  Also, the teeth adjacent to the edentulous space, aside from having some crestal bone loss, were unrestored.  The crown-to-root ratio and mesiodistal root diameter at the gingival crest of the mandibular left central incisor were not favorable due to the alveolar bone loss, making it a questionable abutment for a fixed partial denture.
  • 35. Case-2 con’t A lingual view shows the abutment teeth that were prepared with a slot cut in the lingual surfaces to contain the imbedded fiber reinforcement to provide the "framework" to freehand the nanocomposite resin pontic in the edentulous space.
  • 36. Case-2 con’t  G-aenial Bond (GC America), a seventh-generation self-etching bonding agent, was dispensed into a disposable mixing well.  The bonding agent was applied to all prepared surfaces using a microbrush.  The bonding agent was then light-cured for 20 seconds
  • 37. Case-2 con’t  The flowable composite resin (G-aenial Universal Flo) with an applicator tip applied to the end of the syringe; the long, narrow cannula makes precise placement very easy.  G-aenial Universal Flo was syringed into the preparations in a thin coat. The fiber reinforcement was placed into the floor of the preparations, and they were then filled with flowable composite to the cavosurface margins and light-cured.
  • 38. Case-2 con’t  Next, the flowable composite was placed on the stabilized fiberglass fiber (Connect [Kerr]) to wet the surface between the teeth with composite resin. It was then light- cured for 20 seconds  This facial view shows the composite-reinforced fiberglass reinforcement in place
  • 39. Case-2 con’t  Kalore AO3 was used to begin building a pontic on the fiber between the abutment teeth.  A plastic instrument (Goldstein Flexithin Mini 4 [Hu-Friedy]) was used for shaping A3.5 as the base dentin for the pontic. Kalore CV (B5) was used to simulate a root form similar to the adjacent teeth.
  • 40. Case-2 con’t A sable brush (Keystone No. 4 Flat [Patterson Dental]) was used to create surface texture and refine anatomic form. Kalore DT was used to create incisal translucency.
  • 41. Case-2 con’t After initial contouring with an 8-fluted carbide composite finishing bur, contouring was completed using abrasive discs (Optidisc [Kerr]). A yellow disc (Jiffy Disc [Ultradent Products]) was then used to polish the labial surface, and to refine the reflective angles and surface texture.
  • 42. Case-2 con’t  Facial view of the completed fiber-reinforced direct nanocomposite resin bridge