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Year : 2012  |  Volume : 39  |  Issue : 2  |  Page : 102-105

Rehabilitation of an extracted anterior tooth area using bondable reinforcement ribbon and the artificial tooth

1 Department of Prosthodontics, Selcuk University, Konya, 42079, Turkey
2 Department of Endodontics, Selcuk University, Konya, 42079, Turkey

Date of Web Publication1-Oct-2012

Correspondence Address:
Pinar Cevik
Department of Prosthodontics, Selcuk University, Faculty of Dentistry, 42075, Konya
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0974-5009.101864

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Dental traumatic injuries are widespread in the population and are a frequent pathology among children and teenagers. Fiber-reinforced composite (FRC) bonded fixed dental prothesis have been used as an alternative to conventional metal-based or zirconia-based fixed restorations especially among young patients. As well as the bonding system, mechanical adaptation and the retention of the fiber frame and the grooves of the pontic are fundamental for the success of this type of adhesive restoration. The esthetic solution was the building of a biologic restoration using reinforced polyethylene fibers as an interim restoration for this case.

Keywords: Anterior esthetic, artificial tooth, dental trauma

How to cite this article:
Cevik P, Eraslan O. Rehabilitation of an extracted anterior tooth area using bondable reinforcement ribbon and the artificial tooth. J Sci Soc 2012;39:102-5

How to cite this URL:
Cevik P, Eraslan O. Rehabilitation of an extracted anterior tooth area using bondable reinforcement ribbon and the artificial tooth. J Sci Soc [serial online] 2012 [cited 2022 Dec 5];39:102-5. Available from: https://www.jscisociety.com/text.asp?2012/39/2/102/101864

  Introduction Top

Dental traumatic injuries are relatively prevalent among young patients. [1] Dental trauma is generally affecting the teeth associated with soft tissue injuries and result in fractured, avulsion or lost anterior teeth. [2] Treatment alternatives for traumatic teeth accompanied with fracture include endodontic treatment, orthodontic extrusion or intraradicular splint. [2] Alternatively, extraction of the related tooth and restoration of an interim prosthesis could be considered if age and other factors are suitable. [2],[3]

When a single tooth is extracted from the anterior region, patients expect immediate esthetic restoration to gain time for definitive interdisciplinary treatment. [1],[4],[5],[6] Fiber-reinforced composite (FRC) fixed partial dentures have been used as an alternative treatment to conventionally fixed partial metal-ceramic restorations, especially in young patients. [1]

The present clinical report describes a conservative provisional treatment of the anterior missing tooth using fiber-reinforced composite woven fiber.

  Case Report Top

A 14-year-old boy was referred to Selcuk University Faculty of Dentistry with an aesthetic, economic, and functional treatment request. Patient's history indicated that he was exposed to a trauma prior to endodontic treatment of maxillary right and left central incisors. After the treatment, patient was exposed to second trauma and had only the root of upper right central incisor [Figure 1]. After radiographic and clinical examinations, extraction of the root of upper right central incisor was planned. As soon as the extraction, left central incisor was adhesively splinted to left lateral incisor and canine with polyethylene woven fiber (Ribbond, Inc. Seattle Washington USA) at Department of Endodontics. After evaluating the clinical results in 4 th week, it was decided to restore the extracted area with an artificial tooth (Ivoclar SR-Orthosit, Ivoclar Vivadent Ag, Liechtenstein) and bondable reinforcement ribbon (Ribbond, Inc. Seattle Washington USA) at Department of Prosthodontics [Figure 2].
Figure 1: After traumatic injury

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Figure 2: Splinted teeth

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Concerning the aesthetic needs of this young boy, the treatment procedure was chosen to replace the edentulous space with an artificial tooth bonded to ribbond as a space maintainer. After early clinical results, labial-reinforced ribbond fiber extended to left central incisors to left canine was removed from traumatic teeth.

The required length of reinforced woven fiber was cut off after measuring the area between adjacent teeth with a dental floss. The fiber was embedded to bonding agent placing it under a cover to avoid light absorption. An artificial tooth of proper size was cleaned with fine pumice using a micro motor and micro brush (3M Bendable Brushes; 3M Dental Products) and rinsed with air-pressure spray [Figure 3]. Labial surface of artificial tooth was polished with alcohol, gypsum, and cotton brush. In order to acquire a mechanical strength, a groove was prepared at midpalatal surface on both the artificial tooth and adjacent teeth. Mesial and distal contours of artificial tooth were extended to fit the edentulous space area with triad material (Triad visible light curing, Dentsply, USA), then the material was polymerized, and adaptation control was done. Thereafter, all palatal grooves and proximal areas of the adjacent teeth and the artificial pontic tooth were etched with 37% phosphoric acid (Scotchbond Etchant; 3M ESPE, USA) for 20 s and then rinsed for 15 s. and air-dried [Figure 4]. The bonding agent (Clearfil SE Bond, Kuraray Co. Ltd, Tokyo) was applied and light polymerized with a light curing device at 580 mW/cm 2 power (Bluephase, Ivoclar-Vivadent, Liechtenstein) for 20 s. the flowable composite resin (Multicore Flow, Ivoclar-Vivadent, Liechtenstein) was applied on the palatal surfaces of natural teeth. The wetted fiber was adapted to groove of artificial tooth and light-cured [Figure 5]. The fiber-adapted artificial tooth was then placed in the edentulous area and adapted to the palatal grooves of natural teeth and light-cured for 40 s immediately. Another layer of composite resin was applied to all surfaces to prevent artificial tooth from any movements and light-cured from multiple directions for 20 s. Finally, occlusion was adjusted with articulating paper, premature contacts were eliminated, and esthetic contouring of the restoration was done. The restoration was finished and polished (Sof-Lex TM ; 3M ESPE).
Figure 3: Cleaning the artificial tooth

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Figure 4: Etching with phosphoric acid

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Figure 5: The groove of the artificial tooth

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The patient returned with separated artificial tooth 5 weeks later from the first treatment procedure. The fiber splint was stabile on the palatal surfaces. The palatal groove of artificial tooth was deepened and thickened prior to pumice and acid etching procedure. The artificial pontic was then reinserted to edentulous space with rebonding procedure. The flowable composite resin was applied on the pontic surface immediately and light-cured for 40 s. Finally, occlusion was controlled; finishing and polishing was done. The patient was informed about the importance of good oral hygiene and regular follow-up. The third appointment was done after 12 months. The use of fiber-reinforced artificial tooth and splint caused no problem or discomfort, except of slightly colorization of artificial tooth. The patient was satisfied with the esthetic results of this provisional restoration [Figure 6] and [Figure 7].
Figure 6: Lingual view of the related tooth

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Figure 7: The final labial view

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  Discussion Top

Provisional restorations present esthetic solutions in the anterior region until the definitive restoration. [1] Implant-supported fixed prosthesis carry many advantages for the prosthodontic treatment. In the anterior region of the mouth, implant-supported fixed prosthesis may provide excellent esthetic and patients' satisfactory. [7],[8] In addition, depending on the patient's age, different treatment strategies may be considered as a definitive interdisciplinary treatment. Conventional single tooth implant therapy is contraindicated in teenagers because of the extensive growing. The main purpose of an interim restoration in young patients is to gain time for a definitive prosthetic restoration. [6] Furthermore, as in this case, to prevent the other adjacent teeth from any lateral, vertical or mesial migration and to provide patient's oral hygiene are also important key factors. [6]

The method described in this case is based on bonding an artificial tooth to composite resin. In the literature, early reports describe the use of natural teeth as pontics in such FRC-fixed prosthesis. [1],[9],[10],[11],[12],[13] although an artificial denture tooth as a pontic have been successful with reinforced composite resins. [14],[15] Since the early 1990s, polyethylene ribbon (Ribbond TM ) has been used for the treatment of anterior missing teeth, reinforcement of provisional artificial resin-fixed partial dentures. [16]

Many treatment alternatives are present for a fixed partial prosthesis, but the esthetic superiorities of FRC frameworks to conventional fixed partial prosthesis with metal frameworks should be considered before the treatment. [14]

Bonding of the surface-retained adhesive restoration to adjacent teeth and preparing the grooves on all adjacent teeth are also important for the success of such these restorations. [1],[4],[14] Therefore, bonding procedures must be carrying out carefully to increase the retention, adhesion, and mechanical durability of the adhesive bridge restorations. [7]

  Conclusion Top

The FRC polyethylene woven fibers can be used at interim fixed restoration and maintain the esthetics with the patients' satisfaction. In the present case, using minimal invasive treatment with fiber provide minimal preparation on the adjacent teeth. Regular follow-up and long-term behavior of fiber-reinforced bridge must be evaluated in such clinical cases.

  References Top

1.Tayab T, Vizhi K, Srinivasan I. Space maintainer using fiber-reinforced composite and natural tooth-a non-invasive technique. Dent Traumatol 2011;27:159-62.  Back to cited text no. 1
2.Turkistani J, Hanno A. Recent trends in the management of dentoalveolar traumatic injuries to primary and young permanent teeth. Dent Traumatol 2011;27:46-54.  Back to cited text no. 2
3.Leung S-F. Traumatic dental injuries to the permanent dentition. Hong Kong Med Diary 2006;11:15-7.  Back to cited text no. 3
4.Bagis B, Satiroglu I, Korkmaz FM, Ates SM. Rehabilitation of an extracted anterior toothspace using fiber-reinforced composite and the natural tooth. Dent Traumatol 2010;26:191-4.  Back to cited text no. 4
5.Freilich MA, Meiers JC, Duncan JP, Goldberg AJ. Fiber-reinforced composites in clinical dentistry. Carol Stream, IL: Quintessence; 2000. p. 49-70.  Back to cited text no. 5
6.Gollner P, Jung BA, Wehrbein H, Liechti T. New method of temporary rehabilitation after traumatic tooth loss in a juvenile patient: A case report. Dent Traumatol 2009;25:238-41.  Back to cited text no. 6
7.Eminkahyagil N, Erkut S. An Innovative Approach to Chairside Provisional Replacement of an Extracted Anterior Tooth: Use of Fiber-Reinforced Ribbon-Composites and a Natural Tooth. J Prosthodont 2006;15:316-20.  Back to cited text no. 7
8.Goldstein RE: Change Your Smile, 3 rd ed. Chicago: Quintessence; 1997. p. 2-3.  Back to cited text no. 8
9.Ulusoy AT, Cehreli ZC. Provisional use of a natural tooth crown following failure of replantation: A case report. Dent Traumatol 2008;24:96-9.  Back to cited text no. 9
10.Cardoso AC, Arcari GM, Zendron MV, Magini RD. The use of natural teeth to make removable partial prostheses and complete prostheses: Case reports. Quintessence Int 1994;25:239-43.  Back to cited text no. 10
11.Ramires-Romito AC, Wanderley MT, Oliveira MD, Imparato JC, Correła MS. Biologic restoration of primary anterior teeth. Quintessence Int 2000;31:405-11.  Back to cited text no. 11
12.Ashley M, Holden V. An immediate adhesive bridge using the natural tooth. Br Dent J 1998;184:18-20.  Back to cited text no. 12
13.Ibsen RL. Fixed prosthodontics with a natural crown pontic using an adhesive composite. J South Calif Dent Assoc 1973;41:100-2.  Back to cited text no. 13
14.Kumbuloglu O, Ozdemir N, Aksoy G, User A. A different pontic design for fiber-reinforced composite bridgeworks: A clinical report. Eur J Dent 2007;1:50-3.  Back to cited text no. 14
15.Belvedere PC. Single-sitting, fiber-reinforced fixed bridges for the missing lateral or central incisors in adolescent patients. Dent Clin North Am 1998;4:665-82.  Back to cited text no. 15
16.Dickerson WG. A conservative alternate to single tooth replacement: A three-year follow-up. Pract Periodontics Aesthet Dent 1995;5:43-9.  Back to cited text no. 16


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]


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