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CASE REPORT
Year : 2020  |  Volume : 23  |  Issue : 3  |  Page : 434-436

Single anterior tooth replacement with direct fiber-reinforced composite bridges: A report of three cases


1 Department of Prosthodontics, Faculty of Dentistry, Baskent University, Ankara, Turkey
2 Department of Prosthodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey

Date of Submission25-May-2019
Date of Acceptance21-Nov-2019
Date of Web Publication5-Mar-2020

Correspondence Address:
Dr. D Karabekmez
Baskent University, Faculty of Dentistry, Department of Prosthodontics, 82. Sokak No: 26 Bahçelievler, Ankara 06790
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_286_19

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   Abstract 


In today's dentistry, with the development of adhesive techniques and the improvement of resin-based materials, invasive restorative treatments have been replaced by minimally invasive or noninvasive restorative procedures. Fiber-reinforced adhesive bridges are minimal-invasive or noninvasive restorations that can be applied for definitive restoration in single tooth loss or short spans, where teeth or implant-supported fixed partial prosthesis cannot be applied. This case series describes the rehabilitation of three patients with anterior single tooth loss using the direct fiber-reinforced adhesive bridge. In all patients, esthetic and functional deficiencies in the missing tooth regions were solved with this minimally invasive technique, which is both cost-effective and conservative of tooth structures. During the three-year follow-up of these cases, there was neither fracture nor decementation in the restorations. Also, no caries or sensitivity was noted in the support teeth.

Keywords: Adhesive bridge, fiber-reinforced composite, single tooth deficiency


How to cite this article:
Karabekmez D, Aktas G. Single anterior tooth replacement with direct fiber-reinforced composite bridges: A report of three cases. Niger J Clin Pract 2020;23:434-6

How to cite this URL:
Karabekmez D, Aktas G. Single anterior tooth replacement with direct fiber-reinforced composite bridges: A report of three cases. Niger J Clin Pract [serial online] 2020 [cited 2020 Apr 6];23:434-6. Available from: http://www.njcponline.com/text.asp?2020/23/3/434/280024




   Introduction Top


In 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 treatment. However, it is contraindicated in long 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 Top


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 mandibular central teeth but the short span was narrowed mesiodistally by the orthodontic treatment that could fit the one tooth [Figure 1]a. 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 1]b 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 1]c.
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

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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 2]a. 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 2]b and 2c] were same as for case-1, except for the choice of abutments.
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

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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 3]a. 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 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 3]b and [Figure 3]c were same as for cases 1 and 2.
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

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   Discussion Top


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 [Figure 1]d, [Figure 2]d, and [Figure 3]d. However, the only discoloration was observed on all 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 Top

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.  Back to cited text no. 1
    
2.
Shillingburg HT. Fundamentals of Fixed Prosthodontics. 3rd ed. Chicago: Quintessence Pub Co; 1997. p. 537-61.  Back to cited text no. 2
    
3.
Garoushi S, Vallittu P. Fiber-reinforced composites in fixed partial dentures. Libyan J Med 2006;1:73-82.  Back to cited text no. 3
    
4.
Eskimez S. Adhesive Bridges and Clinical Applications. 1st ed. Istanbul: Quintessence Pub. Co. 2008. p. 75-118.  Back to cited text no. 4
    
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.  Back to cited text no. 5
    
6.
Pröbster B, Henrich GM. 11-year follow-up study of resin-bonded fixed partial dentures. Int J Prosthodont 1997;10:259-68.  Back to cited text no. 6
    
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.  Back to cited text no. 7
    
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.  Back to cited text no. 8
    
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.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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