Single-tooth replacement: bridge vs. implant-supported restoration

Options for restoring a single tooth include fixed partial denture, resin-bonded restoration and single-tooth implant. In this paper, we discuss the advantages and disadvantages of these methods and factors that must be considered when choosing between them for the replacement of a single tooth. Although in some cases a fixed partial denture is the most appropriate choice, implants have the advantage of allowing preservation of the integrity of sound teeth adjacent to the edentulous area.

Rehabilitation of a periodontal patient with rapidly progressing marginal alveolar bone loss: 1-year follow-up

BACKGROUND

The present case report describes a 1-year follow-up of functional rehabilitation of a young periodontal patient with severely advanced, rapidly progressing marginal bone loss treated by using a new splinting material, i.e., glass fiber-reinforced composite (FRC). Apart from one single tooth, the young man had retained all his natural teeth.

TREATMENT

Periodontal treatment was based on cleaning and root planing enabled by partial-thickness-flap operations. This method was selected to avoid further damage to the remaining alveolar bone. After healing for 6 months, a cavity retained internal FRC splint was constructed and 1 missing lower molar was replaced by an inlay-retained FRC resin-bonded fixed partial denture (FPD). A 12 months follow-up period revealed a healthy periodontium and good functional and esthetic results.

CONCLUSIONS

The new material allows the use of periodontal treatment methods instead of prosthetic alternatives, which until now have been a more generally used approach in the treatment of severely advanced periodontal cases. Internal fiber-reinforced composite splinting being affordable for the patient, easy for the clinician to construct and giving good esthetic and functional results, suggests that the method may be a valuable aid in periodontal treatment.

Immediate anterior tooth replacement using fibre-reinforced composite

The loss of anterior teeth can be psychologically and socially damaging to the patient the trauma of which can be minimized by immediate replacement of the teeth, preferably using a fixed prosthesis. This paper describes the immediate replacement of a lateral incisor using a fibre-reinforced composite with the natural tooth as the pontic. The abutment teeth can be conserved with minimal or no preparation, thus keeping the technique reversible, and can be completed at the chairside thereby avoiding laboratory costs. It can be used as an interim measure or as a definitive prosthesis. The advantages of this technique over other methods are also discussed.

A modified technique for direct, fibre-reinforced, resin-bonded bridges: clinical case reports

This article presents new modifications to the clinical technique of fabricating directly applied resin-bonded fibre-reinforced bridges. Torsional and flexural strength is achieved by means of a reinforced polyethylene fibre ribbon substructure surrounded by laminated layers of microhybrid and microfilled resins. The modifications provide a simple method for creating a better pontic-ridge relation and improved overall esthetics. Early clinical experience suggests that this technique has the potential to give patients a relatively conservative, esthetic and periodontally noninvasive alternative for anterior tooth replacement.

Quality of fixed restorative treatment on Brånemark implants. A 3-year follow-up study in private dental practices

The aim of the present prospective study were to describe the quality of implant supported reconstructions made by dentists previously inexperienced with implant prosthodontics and to evaluate alterations and complications from the moment of insertion to 3 years later. Before starting with the prosthodontic work, the dentists had participated in a 2-day postgraduate course focusing on planning and practical training. Forty-nine patients were clinically examined within 4 months after insertion of the fixed implant supported prosthesis. Three years later 39 of the 49 participants underwent a second examination by the same independent examiner. Thirty-one patients had a complete rehabilitation (25 with resin teeth bonded to a metal framework and 6 ceramo-metal bridges); 8 patients had partial ceramo-metal reconstructions. The parameters assessing the quality of the restoration were design, fit, occlusion/articulation and esthetics. Oral hygiene and health of the peri-implant tissues were also examined. Each parameter was scored as perfect, acceptable, to be corrected or to be redone. These scores were a modification of "The guidelines for the assessment of clinical quality and professional performance of the Californian Dental Association". The initial prosthodontic quality was rated perfect to acceptable except for one restoration which had an unacceptable fit and had to be modified. After 3 years of function the quality did not change except for esthetics which worsened for resin bonded teeth (P < 0.05). The esthetic appearance of ceramo-metal reconstructions were unaltered. The peri-implant condition was predominantly healthy and stable during 3 years. The conclusion of the present study is that dentists previously inexperienced with implant prosthodontics implemented the information from a training course satisfactorily. They were able to make a clinically acceptable restoration with a quality that was stable after 3 years except for discoloration in resin bonded teeth. This, however, had no effect on patient's opinion and satisfaction.

Case report: a non-rigid connector for a resin bonded bridge

The use of rigid connectors between pontics and retainers is common for conventional bridges. Restoration of two missing teeth and an intermediate pier abutment with a rigid bridge is not an ideal treatment. In this report a resin bonded bridge with a non-rigid connector within the pontic distal to the pier abutment was constructed and remained in place without debonding for seven years.

Photoelastic stress analysis in perforated (Rochette) resin bonded bridge design

Rochette described the perforated cast metal bonded design for splinting periodontally compromised teeth. The design was later used for replacing missing teeth. The main causes of failure of the perforated (Rochette) type design were attributed to inappropriate case selection and erosion of the composite from perforations. The aim of this study was to analyse the effect of stress magnitude and direction on failure of perforated resin bonded bridges (RBBs). The objective was to compare stress magnitudes in this design with those reported on the non-perforated RBBs. Photoelastic modelling materials were selected to represent the relative stiffnesses of a posterior mandibular and an anterior maxillary perforated (Rochette) type design. The sizes of the models were scaled to x 2.5 in order to enhance visual analysis of the stress patterns. Stress magnitudes were quantified from isochromatic fringes and stress directions were evaluated from stress trajectories. These revealed a high-stress concentration around the perforations, particularly for those at the proximo-lingual/palatal (connector) areas. This experimental study revealed that the main reason for failure of Rochette designs is deformation at the perforations.

Influence of design and mode of loading on the fracture strength of all-ceramic resin-bonded fixed partial dentures: an in vitro study in a dual-axis chewing simulator

STATEMENT OF PROBLEM

In a clinical study, all-ceramic resin-bonded fixed partial dentures showed a high rate of fractures within the first years of service but remained in function as cantilevered restorations. No data are available on the fracture strength of such cantilevered restorations.

PURPOSE

This in vitro study evaluated the influence of design and mode of loading on the fracture strength of all-ceramic resin-bonded fixed partial dentures.

MATERIAL AND METHODS

Forty-eight frameworks were copy milled using the aluminum-oxide ceramic In-Ceram, glass-infiltrated, and circularly veneered with feldspathic porcelain to replace a maxillary incisor on a test cast. The airborne particle-abraded restorations were bonded to acid-etched human abutments using composite. Twenty-four restorations used a conventional 2-retainer design and another 24 restorations used a cantilevered single-retainer design. Subgroups of 8 specimens were subjected to a quasi-static load in the direction of the long axis of the abutments (0 degrees) or in an angle of 45 degrees. Additional subgroups were subjected to dynamic loading under 45 degrees with either 50 or 25 N in a dual-axis chewing simulator until fracture.

RESULTS

Mean fracture strengths, under 45-degree quasi-static loading, were between 134 and 174 N and under 0-degree loading about 233 N. Samples subjected to dynamic loading fractured after 25 to over 200,000 loading cycles.

CONCLUSION

Direction of loading exhibited a significant influence on the fracture strength, regardless of the retainer design. The applied dynamic loading force, regardless of the retainer design, had a significant influence on the loading cycles until fracture.

A prospective study of cantilever resin-bonded bridges: an initial report

A prospective study was undertaken in a dental teaching hospital to compare the clinical performance of cantilever resin-bonded bridges with a fixed-fixed design for the replacement of a maxillary permanent incisor. A total of 25 anterior resin-bonded bridges was placed in 24 patients. The prostheses were evaluated over 14 to 45 months. During the evaluation period only one fixed-fixed type debonded, which was subsequently rebonded successfully. There was no debond in the cantilever group. The short-term, initial findings showed that cantilever resin-bonded bridges performed as successfully as their fixed-fixed counterparts and were considered to be an acceptable form of restoration.

Operative dentistry: an alternative to orthodontics

The purpose of this paper is to describe a clinical case, which highlights the role of Operative Dentistry in the treatment of Dento-alveolar Disproportion in an impoverished tropical environment. The patient had a diastema located between tooth 24 and tooth 25 due to an atypical position of his tongue while swallowing. The patient had been referred to because he could not afford Orthodontics. We suggested a conservative bridge compounded of 2 resin veneers and pontic bounded by the composite tetric ceram. The 0.5 mm teeth reduction concern lingual and proximal faces with retention form, starting at 0.3 mm from the incisal edge to 0.5 mm from the gingiva was performed with diamond burs (Shoulder and finishing). The result was satisfactory and leads us to conclude that Operative Dentistry is a good alternative to Orthodontics in a very specific social context.

Two-unit cantilevered resin-bonded fixed partial dentures--a retrospective, preliminary clinical investigation

PURPOSE

The aim of this study was to retrospectively evaluate the clinical retention and abutment movement of 2-unit cantilevered resin-bonded fixed partial dentures (FPD) that were inserted at Prince Philip Dental Hospital in Hong Kong.

MATERIALS AND METHODS

Of 45 patients who were identified from a hospital computer search after receiving a 2-unit cantilevered resin-bonded FPD, 31 were clinically examined (33 FPDs). For each patient the following data were recorded: gender, age, cementation date, endodontic treatment if performed, bone support, tooth mobility, and FPD tipping or drifting. Data about any debonds with subsequent treatment and patient satisfaction on a 10-point scale were also recorded.

RESULTS

The mean service life for the 33 prostheses was 30 +/- 18 months, with a range of 72 days to 67 months. One prosthesis debonded, resulting in a clinical retention rate of 97%. No rotation, drifting, or tipping was observed for any of the prostheses during the short period of this study.

CONCLUSION

Two-unit cantilevered resin-bonded FPDs are successful in the short term, but further research is required to determine if they offer a viable alternative to fixed-fixed resin-bonded FPD designs.

Indications and potential of bonded metal-ceramic fixed partial dentures

Recent progress in restorative dentistry has dramatically modified contemporary treatment concepts, which are typified by the preservation of healthy tissues, recognition of aesthetic expectations, and the search for simplified prosthetic solutions. While this shift in focus has justified the increasing interest in implantology, it has also resulted in the expansion of adhesive and conservative treatment options. This article reviews the various means available to replace missing anterior teeth, as well as the periodontal and surgical procedures that are associated with the optimization of biological, functional, and aesthetic results.

Short and sticky options in the treatment of the partially dentate patient

As we move into the twenty-first century, patterns of dental disease in adults are changing. Surveys of adult dental health indicate that more people are keeping their teeth for longer in life. In many cases, the ravages of dental disease and the cumulative effect of a lifetime of restorative dentistry lead to gradual tooth loss. For many of these patients, restoration of a complete dentition may not be feasible nor desirable. In recent years, functionally oriented treatment planning has become acceptable in light of recent research findings. Using this approach, treatment efforts and resources are directed principally at retaining the 'strategic' part of the dentition in the long term, ie, the anterior and premolar teeth. This paper describes, with the aid of treated cases, a means of combining a shortened dental arch strategy with resin bonded bridgework. With the aid of recent research in this area of clinical practice, some suggestions as to the use of the technique are also described.

Gold alloys for resin bonding including small amount base metals--structural changes of alloy surface by the high-temperature oxidation

To achieve durable bonding with adhesive resin, the surface roughness and the kinds of oxides, respectively to increase mechanical retention to enhance the chemical affinity of adhesive monomer with the gold alloy, were regulated by high-temperature oxidation together with the addition of small amounts of base metals. Alloys containing 2 mass% of Ni, In, or Cr with Cu were oxidized at 800 degrees C for 20 min in air, pickled in thioglycolic acid, and subsequently oxidized at 500 degrees C for 10 min in air. The morphology of the internal oxidation zone changed markedly according to the added base metals. Although the internal oxide particle composed of only Cu2O was removed by pickling, NiO, In2O3, and chromium oxides could not removed and remained on the alloy surface. The surface roughness was increased by addition of Ni, In, or Cr. Applying the present method can control the roughness and chemical states on a gold alloy surface to increase its adhesive ability with adhesive resins.

Modified bonded bridge space maintainer

The premature loss of primary teeth can create the need for space maintenance and restoration of function. This article presents a fixed bonded space maintainer, which allows space to be maintained with economy of dental tissues.

The periodontal response to cantilevered resin-bonded bridgework

This study investigated 84 cantilevered resin-bonded bridges (CRBB) in 60 patients. These CRBB (single retainer, single pontic) had been in place for an average of 43.6 months. Periodontal health was assessed on abutment teeth and contralateral control teeth. Periodontal indices utilized were Plaque Index (PI), Gingival Index (GI), Bleeding Index (BI), Pocket Depth (PD) and mobility. The marginal adaptation, the gingival extension of the retainers and the presence or absence of caries around each retainer margin were also assessed. Information about the history of debonding was collected and a success rate of 93% was reported. PI, GI and mean PD compared statistically significantly, less favourably, with scores of the control teeth. Marginal adaptation of the retainers was of a high standard and caries did not appear to be a problem.

Resin-bonded fixed partial denture: a contemporary prosthesis

This review of the evolution of the resin-bonded fixed partial denture (RBFPD) design, from the original "prepless" restoration to the present prosthesis, requiring careful treatment planning and technical skill, also discusses the materials used to enhance the longevity of this restoration. That, in turn, increases the patient's confidence in both the dentist and the prosthesis itself.

Immediate cantilevered resin-bonded bridgework: a case report

Resin-bonded bridgework (RBB) is now an accepted alternative to conventional bridgework in specific cases. This article reviews the immediate replacement of two anterior teeth with the resin-bonded technique and describes the use of immediate cantilevered RBB in the aesthetic treatment of a patient with class II division II malocclusion on a moderate skeletal II base. Both maxillary lateral incisors were extracted and immediately replaced with cantilevered RBB. This simple and conservative approach produced an instant solution to a difficult aesthetic problem of proclined lateral incisors. The reported RBB continues to function successfully after 15 months.