Modern treatment planning approach facing a failure of conventional treatment. Part I: Analysis of treatment options

In this two-part case presentation, the benchmarks of our treatment planning principles are briefly explained and their application is discussed in the case of a 35-year old patient with multiple failing restorations and an esthetic complaint regarding the maxillary anterior teeth. In this first part, the four principles are proposed, the patient's main problems are presented and three treatment options are discussed. In the second part, the treatment choice will be disclosed as well as the decision making process, the respective diagnostic procedures involved, and finally the sequential treatment. The aim of these articles is to stimulate the debate and to promote therapeutic choices that take into account evolution of contemporary dental medicine.

Two-unit cantilevered resin-bonded fixed partial denture as a substitute for a prosthodontic-orthodontic treatment plan: a 5-year case report

In this case report, we describe the successful long-term treatment of a patient with dental agenesis. The initial treatment plan included an orthodontic phase to provide adequate space for replacing missing lateral incisors with implants. However, because of some complications encountered after 2 years of orthodontic treatment, a revised treatment plan was considered to achieve functional and esthetic goals. The patient was completely satisfied 5 years after being treated with two 2-unit cantilevered resin-bonded fixed partial dentures supported by the cuspids. This conservative treatment plan was cost-effective without having any significant biological cost.

Rehabilitation of an extensive anterior explantation defect--a case report

This article illustrates the surgical and prosthetic rehabilitation of an extensive defect in the area of a mandibular lateral incisor following explantation of a dental implant. Bone and soft tissue defects existed after removal of the implant. Guided bone regeneration, a subepithelial connective tissue graft, and gradual pontic contouring were used to attempt correction of the defect. The missing tooth was replaced by a single-retainer, all-ceramic, resin-bonded fixed partial denture. The gingival contours were reestablished, but without complete regeneration of the interdental papillae. This article describes the use of several regenerative techniques in the treatment of dental defects and underscores the difficulty of complete correction of papilla deficiencies.

Orthodontic and prosthetic treatment of a patient with cystic fibrosis and agenesis of maxillary lateral incisors

The young dental patient with maxillary lateral incisor agenesis, maxillary canine impaction, and cystic fibrosis presents considerable challenges to the dentist. An interdisciplinary approach is described here for the orthodontist and restorative dentist to plan and work together with the patient's and parents' cooperation and consent. Despite some compromises, a successful outcome was achieved, as demonstrated in this case report. The use of conservative yet esthetic and durable fixed replacement prostheses is highlighted. Congenitally absent maxillary lateral incisors, impacted maxillary canines, and cystic fibrosis are clinical conditions that can significantly complicate and compromise dental treatment for any young patient. All three can be present simultaneously, as described in this case report.

[Clinical observation of the 2-unit cantilever metal plate resin bonded fixed partial dentures]

OBJECTIVE

To observe a short term effect of clinical application of the 2-unit metal plate resin bonded fixed partial dentures (RBFPDs).

METHODS

Sixteen patients were restored with the 2-unit cantilever metal plate RBFPDs during the period of 2005 to 2009. Retention and margin integrity of RBFPDs, and health condition of abutments were evaluated immediately after cementation and every 6-12 months period later.

RESULTS

A total of 20 RBFPDs were made for all 16 patients. The observation period vary from 15 months to 53 months. The mean observation period was 34 months. There were 1 RBFPDs debonded. The debonding rate was 5%.

CONCLUSION

The 2-unit cantilever metal plate RBFPDs could achieve a favorable clinical outcome in the short term.

[All-ceramic resin bonded fixed partial denture made of IPS hot-pressed casting porcelain restore anterior missing teeth: a three years clinical observation]

OBJECTIVE

To clinic observation of IPS Empress2 and IPS e.max all ceramic resin bonded fixed partial dentures used in one anterior teeth lost in upper jaw or less than two anterior tooth lost in lower jaw.

METHODS

22 patients, 26 restorations had been made, which included 16 single-retainer all ceramic resin bonded fixed partial dentures and 10 two-retainers all ceramic resin bonded fixed partial dentures. Secondary caries of the abutments, shade in the margin of the retainers and the integrity of the restorations had been observed at 3 months, 6 months, 1 year, 2 years and 3 years after all ceramic resin bonded fixed partial dentures having been bonded.

RESULTS

In the 3 years of clinic observation of the anterior all ceramic resin bonded fixed partial dentures, 1 two-retainers restoration lost bond after it had been made for 3 months, a retainer of one two-retainers restoration was broken after 6 months, but they are still used after modified as one-retainer all ceramic resin bonded fixed partial dentures, 1 two-retainers restoration lost bond two year later, It was integrity and re-bonded again that was still stable. No secondary carries and no shade in margin of the retainers had been found. Their color matches with the nature teeth excellently. The success rate was 88.5%.

CONCLUSION

IPS Empress 2 and IPS e.max all ceramic resin bonded fixed partial dentures should be a good selection in one or two teeth lose in anterior jaws.

[How up-to-date are metal-based resin-bonded fixed partial dentures in the era of full-ceramics and dental implants? A case report]

Regardless of the success of preventive measures the replace¬ment of missing teeth in young patients with caries-free dentitions is a daily challenge for the clinician. The decision-making process concerning the different treatment options is difficult, based on several equivalent solutions. Thereby the significance of minimal invasive approaches is steadily increasing. In indicated cases, resin-bonded fixed partial dentures which were introduced in the last century still represent a well documented and minimally invasive procedure, even in the era of dental implants. In this article, clinical aspects of a conventional, metal-based resin-bonded fixed partial dentures are discussed according to the current literature and the clinical steps are presented in a clinical case.

Two-year study of alternative conservative treatment modalities for early anterior permanent tooth loss

Premature tooth loss in children may consist of single or multiple, primary or permanent, and anterior or posterior units of the dentition. This tooth loss may be due to either trauma or caries and, in some cases, to congenital or genetic defects. With anterior tooth loss cases, there are several problems the dental practitioner must consider. These are space maintenance, masticatory function, speech and esthetic appearance.

[Restore two posterior teeth with modified resin-bonded-bridge]

OBJECTIVE

To restore two posterior teeth with resin-bond-bridge with attachments.

METHODS

Twenty patients were selected with two adjacent posterior teeth missing and the opposite teeth were natural teeth. The mean age was 45.6 years old, 9 male and 11 female. The maxillary cases were 12 and mandibules case were 8. The female part of attachment was attached with the retainer on the bicuspid teeth; the male part was attached with the pontic. After try-in, the two parts were adhered to the abutments separately and joined by the attachment.

RESULTS

The mean survival time of the 20 cases was 28.8 months, and the max was 42 months. In only one case the posterior part debonded, and it resumed being used after rebonding.

CONCLUSION

In recent years the successful rate of resin-bond-bridge has got close to that of the traditional bridge. Most RBB were used to restore the single missing tooth. Now RBB with non-rigid connector can restore two missing teeth. When the teeth get stress, the directions of stress are different. The longer span of RBB with rigid connector, the bigger interbutment stress on the adhere layer. With the non-rigid connector the stress between the retainer and the adhesive layer can be reduced. Our clinic treatment showed that this kind of method got good results and even the service time was not very long.

Socket repair utilizing collagen membrane and mineralized allograft in the esthetic zone: a case report

As the number of patients seeking implants increases, so do the esthetic challenges. Adequate bone is necessary to place an implant with an esthetically pleasing outcome. Failing teeth that require implant replacement often have bony deficiencies, and several surgical techniques have been advocated for maintaining bone volume at the time of extraction. This case report utilized a predictable conservative technique for treating a facial bony defect prior to implant surgery. Atraumatic flapless tooth extraction and the placement of a resorbable collagen membrane and mineralized allograft allowed for adequate regeneration of the alveolar socket prior to implant placement. The dentition was later restored with a zirconia abutment and crown. Socket repair utilizing this technique was a clinically acceptable method for obtaining an esthetic implant restoration.

Providing support for the pontic of natural tooth adhesive bridges: a clinical report

Resin bonded bridges have become established as a treatment option for replacing missing teeth. Their development can be traced to the work of Rochette who used a macro mechanically bonded metal framework to stabilize mobile teeth. Adaptations of Rochette's concept, using natural teeth as pontics, have been presented. The use of a natural tooth has aesthetic and psychological advantages for the patient. The high failure rate of natural tooth pontics may be explained by a lack of support for the tooth on the metal framework. A clinical report is presented to illustrate a previously unreported technique to improve pontic support.

A preliminary report on short-term clinical outcomes of three-unit resin-bonded fixed prostheses using two adhesive cements and surface conditioning combinations

PURPOSE

The aim of this study was to evaluate the survival rate of three-unit surface-retained, resin-bonded, metal-ceramic fixed dental prostheses (RBFDP) using two adhesive cements and two surface conditioning methods.

MATERIALS AND METHODS

Between 2005 and 2009, a total of 58 patients (34 women, 24 men; mean age: 42.1 years) received 58 three-unit RBFDPs made of a nonprecious alloy (Wirocast Co-Cr). Restorations were cemented employing the following combinations: (1) alumina air abrasion-silane + Panavia F 2.0 (group A1), (2) tribochemical silica coating (CoJet)-silane + Panavia F 2.0 (group A2), (3) alumina air abrasion-silane + Super-Bond C and B (group B1), and (4) CoJet-silane + Super-Bond C and B (group B2). Teeth were conditioned using the adhesives of the cements accordingly. Adaptation, debonding, fracture, and crack and caries formation were considered for clinical evaluation. Data were collected at baseline, 6 months, and annually thereafter. Forty-eight RBFDPs were available for follow-up (mean: 20.3 months, minimum: 6 months, maximum: 42 months).

RESULTS

The effect of cement type on the survival rate of RBFDPs was not significant (P > .05). The survival rate was also not significantly affected by the location (maxilla: 93.2%, mandible: 92.9%; P = .928). All experienced failures were observed within the first year after cementation. In total, four complete debondings were encountered (two in group A1, one in group A2, and one in group B1 at months 1, 3, 7, and 3, respectively). Group B2 did not result in any failures during the observation period. The failures were adhesive debondings between the metal surface and the cement.

CONCLUSION

Early findings did not show significant differences between the cement and conditioning type combinations, with group B2 presenting no failures.

Fiber-reinforced composite fixed dental prostheses: two clinical reports

Various options are available in clinical practice for the replacement of a single missing tooth, ranging from conventional fixed and removable dental prostheses to a single implant-supported crown. There are situations in which a semipermanent fixed dental prosthesis may be desirable, particularly for patients who have completed orthodontic treatment but are too young to embark on implant therapy. Following advances in fiber-reinforcement technology, fiber-reinforced composite resin (FRC) now represents a lower-cost alternative to traditional metal-ceramic for the construction of resin-bonded prostheses. Two case reports illustrate the use of FRC prostheses as fixed semipermanent_restorations.

[Two years clinical observation of anterior all zirconia ceramic resin bonded fixed partial dentures]

OBJECTIVE

To observe the restoration effect of anterior all zirconia ceramic resin bonded fixed partial dentures, and to find a new fixed restorative method for restoring one or two missing anterior teeth.

METHODS

Twenty-nine missing anterior teeth from twenty-three patients were restored with all zirconia ceramic resin bonded fixed partial dentures, and restorations were devided in to two groups according to the number of retainers, i.e. the single-retainer group and the two-retainer group. The integrity, secondary caries, marginal shade and color match of the restorations were evaluated with the standard of American Public Health Association (APHA). The average period of observation was 22 months.

RESULTS

One restoration from the two-retainer group failed, two restorations from the single-retainer group failed. The shade of two restorations were evaluated as discernable whiter compared to adjacent teeth. There was no secondary caries and marginal shade. The two year success rate of anterior all zirconia ceramic resin bonded fixed partial dentures was 90% (26/29).

CONCLUSIONS

All zirconia ceramic resin bonded fixed partial dentures used for less than two anterior missing teeth can achieved definite aesthetic effect and physiologic function. It was a new type of fixed restoration for anterior missing teeth. However, to determine long-term result of this restoration more data are needed.

Porcelain fused to metal crown as an abutment of a metal-ceramic resin-bonded fixed partial denture: a clinical report

AIM

This clinical report describes a conventional resin-based fixed partial denture for a 42-year-old woman to close an edentulous space in the region of the second maxillary premolar. While the first maxillary molar had been crowned with porcelain fused to metal (PFM) system 10 years ago and the first premolar was intact and sound except for a small carious lesion in the distal aspect. The essential clinical and laboratory procedures are illustrated.

BACKGROUND

Multiple clinical studies document excellent long-term success of resin-bonded fixed partial dentures. In the 1970s, the Rochette resin-bonded fixed partial denture (RBFPD) was introduced. Next, to enhance retention and resistance form of posterior RBFPD preparation of parallel guide surfaces on the interproximal aspects of the adjacent teeth along with rests on the occlusal aspects to counteract dislodging forces was recommended.

REPORT

A 42-year-old woman presented with an extracted left maxillary second premolar. The first maxillary molar had been crowned 10 years ago and the first premolar had a small carious lesion in the mid distal of proximal aspect. To eliminate unnecessary cutting of the PFM of the first molar and crown preparation of the first maxillary premolar, the use of RBFPD was suggested and accepted by the patient.

SUMMARY

This clinical report described the indication, the selection of a PFM-crowned abutment, and clinical procedures involved in the fabrication of RBFPD that provided a conservative solution for replacement of one posterior tooth.

CLINICAL SIGNIFICANCE

RBFPDs can be used successfully in both the anterior and the posterior regions of the mouth to replace one or two missing teeth. However, the survival rate of RBFPDs is still considerably less than that of conventional fixed partial dentures. The principal reason for failure is debonding of the framework from the abutment tooth. The selection of nonmobile abutment teeth, the preparation design that enhances retention and resistance form, and the tooth bonding technique are critical for success.

Recovery of one retention loss of retainers of fixed partial denture using overcasting restoration. Case report

A resin-bonded overcasting restoration, which was made of silver-palladium-copper-gold alloy, was applied for one retention loss of the retainers of a maxillary anterior fixed partial denture using a metal conditioner and an adhesive resin luting agent. A resin-bonded overcasting restoration has been functioning satisfactorily for more than 10 years.

A limited and useful approach to determine proximal periodontal health

Previous researchers have shown that there exists an interaction between gingival blood flow and gingival health. The purpose of this study was to compare the papillary blood flow at sites treated by a bridge with the blood flow at untreated sites. Twenty persons with resin-bonded fixed partial dentures were included in the study. The contralateral natural teeth of the site symmetrical to that of the restorations were used as controls. Blood flow was measured from the middle point of the papillae from both test and control sites by Laser Doppler Flowmetry (LDF). The plaque index, papillary bleeding index and probing depth measurements were recorded. There was a statistically significant difference between the test and control sites in papillary blood flow measurements and clinical indices (p < 0.05). Moreover there was statistical significance between gingival blood flow measurements and papillary bleeding index in the experimental group (p < 0.05). In short, there exists an important relationship between resin-bonded fixed partial dentures and papillary blood flow. Although there were no correlations between LDF values and clinical parameters, it can be emphasized, within the limits of the study, that LDF readings have limited diagnostic value, at least when it comes to clinical performance of fixed prosthesis.

A nine-year clinical case study of a resin-bonded fixed partial denture seated on the maxillary anterior teeth

PATIENT

This report describes the longevity of a resin-bonded fixed partial denture (RBFPD). This denture was seated on the maxillary anterior teeth with minimal tooth preparation. The RBFPD was cast from a silver-palladium alloy (Castwell M.C. 12), and the pontic was veneered with an indirect composite material (Estenia). The retainers were primed with a metal conditioner (V-Primer) and seated with a tri-n-butylborane initiated adhesive resin (Super-Bond C&B). After an observation period of eight years, a fracture occurred in the incisal edge of the central incisor abutment. The fractured area was restored with light-polymerizing composite resin and the anterior guidance was re-adjusted.

DISCUSSION

RBFPD abutment teeth with deep vertical overlap should be carefully prepared to avoid abutment tooth fracture.

CONCLUSION

The clinical performance of the RBFPD made from a silver-palladium-copper-gold alloy was sufficient when seated with tri-n-butylborane initiated adhesive resin after surface modification using vinyl-thiol primer.

CLINICAL SIGNIFICANCE

The use of vinyl-thiol primer and tri-n-butylborane initiated adhesive resin is a clinically reliable bonding system for seating resin-bonded fixed partial denture (RBFPD) made from a silver-palladium-copper-gold alloy. The RBFPD, based on a reliable bonding system, can clinically function for a long time, even if the vertical overlap of the abutment teeth is excessive.

An indirect matrix technique for fabrication of fiber-reinforced direct bonded anterior bridges

This article discusses the use of a fiber-reinforced direct-bonded resin bridge, which provides lower treatment costs and requires less time than more conventional restorative materials. However, a disadvantage is the short lifespan of the prosthesis. This article describes a case report in which this technique is applied.

Composite pontics for orthodontic patients with extraction spaces

Esthetic orthodontic appliances continue to appeal to more patients, which results in objections to extraction spaces that remain for several months during orthodontic therapy. This has led orthodontists to design temporary pontics that fill extraction sites and that can be reduced as the spaces close. This report describes a simple, efficient, and expeditious technique for making such pontics.

The Healing of Free Gingival Autografts for Socket-seal Surgery: a Case Report

Tooth extraction will be followed by marked alterations to the tissue volume, in particular in the anterior zone, which may jeopardize the esthetic outcome of any dental treatment involving tooth extraction. If, however, ridge collapse can eb prevented or minimized after tooth extraction, more predictable outcomes with superior esthetics can be accomplished along with fewer surgical procedures. Therefore, it was proposed that stabilizing the soft tissue architecture with a free gingival graft could minimize the soft tissue shrinkage. The following case report describes some surgical modifications and refinements in order to enhance the predictability of the socket-seal surgery.