Direct Fibre Reinforced Bridge

From inception the Styleitaliano philosophy has been one of realistic and achievable results that are reproducible. One of my main aims has been to reinforce these core values into my daily practice and hopefully to the benefit my patients.

A lovely 64 years old female patient was referred to myself from a colleague regarding a grade 1 mobile lower left central incisor and non – pulchritudinous defective crown that had been causing multiple problems over a number of years. All possible treatment modalities were discussed and the patient decided she would like the tooth removed and replaced with a provisional composite bridge while the necessary healing took place

style italiano styleitaliano dentistry

Fig.1
Pre-Operative Buccal.

style italiano styleitaliano dentistry

Fig.2
Pre-Operative Occlusal.

style italiano styleitaliano dentistry

Fig.3
Pre-Operative Occlusal Alpha.

style italiano styleitaliano dentistry

Fig.4
Reflective cross-polarized illumination removes unwanted specular reflections1

style italiano styleitaliano dentistry

Fig.5
Study Model Frontal (LL1 removed and emergence estimated) .

style italiano styleitaliano dentistry

Fig.6
Model Occlusal.

style italiano styleitaliano dentistry

Fig.7
Quick composite mock up on model to assess proportions.

style italiano styleitaliano dentistry

Fig.8
Silicone Matrix (Affinity Crystal – Clinician’s Choice).

style italiano styleitaliano dentistry

Fig.9
Measuring Ribbond beforehand to ensure good fit.

style italiano styleitaliano dentistry

Fig.10
Removal of tooth showing poorly retentive crown.

style italiano styleitaliano dentistry

Fig.11
Close up frontal view showing minimally traumatic removal.

style italiano styleitaliano dentistry

Fig.12
Occlusal view showing minimally traumatic removal.

style italiano styleitaliano dentistry

Fig.13
Frontal View.

style italiano styleitaliano dentistry

Fig.14
Lingual view of immediate isolation tied in with floss ligatures.

style italiano styleitaliano dentistry

Fig.15
Occlusal view of immediate isolation showing disproportion.

style italiano styleitaliano dentistry

Fig.16
Front right lateral view of isolation .

style italiano styleitaliano dentistry

Fig.17
Frontal view of isolation. This will ensure optimum vision and adhesion.

style italiano styleitaliano dentistry

Fig.18
Etching with 37% phosphoric acid.

style italiano styleitaliano dentistry

Fig.19
Matrix in place.

style italiano styleitaliano dentistry

Fig.20
Transparent matrix ensures comprehensive curing.

style italiano styleitaliano dentistry

Fig.21
Close up of links in fiber reinforced bridge.

style italiano styleitaliano dentistry

Fig.22
Hyper chromatic dentine core UD5 Hri Micerium, Italy.

style italiano styleitaliano dentistry

Fig.23
Dentine layers graduated.

style italiano styleitaliano dentistry

Fig.24
Mamelons and characterisations.

style italiano styleitaliano dentistry

Fig.25
Controlled thickness enamel layering UE4 and UE3.

style italiano styleitaliano dentistry

Fig.26
10 days post op showing excelling healing and integration.

style italiano styleitaliano dentistry

Fig.27
Black & White.

style italiano styleitaliano dentistry

Fig.28
Lateral View.

style italiano styleitaliano dentistry

Fig.29
Frontal Finish.

style italiano styleitaliano dentistry

Fig.30
Texture.

style italiano styleitaliano dentistry

Fig.31
Lingual aspect showing all fibers covered with composite.

style italiano styleitaliano dentistry

Fig.32
Checking occlusion.

style italiano styleitaliano dentistry

Fig.33
The importance of cleaning must be demonstrated to patient.

style italiano styleitaliano dentistry

Fig.34
Comparison, before and after.

Conclusions

The advantages of such a technique include being minimally invasive to supporting teeth, cost-effective, acceptable aesthetics and functional result during healing that allows the patient to have a non-removable prosthesis that is easy to clean. The disadvantages are that the procedure is technique sensitive, can be time consuming (total time taken is 1 hour 40 minutes), good supporting teeth are needed and a strict oral hygiene regimen.
This technique is useful to have in ones own restorative armamentarium as it can provide an acceptable solution in difficult situations. Appropriate case selection is always advised and thorough planning is a pre-requisite.

Bibliography

1. Bazos P, Magne P. Bio-Emulation: biomimetically emulating nature utilizing a histo-anatomic approach:visual synthesis. Int J Esthet Dent 2014;9:330-352.
2. Belli S, Ozer F. A simple method for single anterior tooth replacement. J Adhes Dent. 2000;2:67-70.
3. Khetarpal A, Talwar S, Verma M. Creating single-visit, fibre-reinforced, composite resin bridge by using a natural tooth pontic: a viable alternative to PFM bridge. J Clin Diagn Res 20012;7(4):772-775.
4. Heintze S, Rousson V. Clinical Effectiveness of direct class II restorations – a meta analysis. J Adhes Dent 2012;14(5):407-31.
5. Manauta J, Salat A. Layers, An atlas of composite resin stratification. Chapter 2 Free-Hand Modeling, Quintessence Books, 2012.
6. Vanini L. Light and color in anterior composite restorations. Pract Periodont Aesthet Dent 1996;8:673-682.
7. Dietschi D. Free-hand bonding in the esthetic treatment of anterior teeth: creating the illusion. J Esthet Dent 1997;9:156-164.
8. Palone G, Saracinelli M, Devoto W, Putignano A. Esthetic direct restorations in endodontically treated anterior teeth. Eur J Esthet Dent 2013;8:44-67.

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