ABSTRACT
A smile is one of the most critical components of aesthetic rehabilitation.Various anterior rehabilitation cases present in routine clinical practice with excess space, deficient ridge anatomy and malpositioned implant placement, one of the major challenges in any form of aesthetic dentistry is the efficient use of available the space, enhancing function and conservation of components that are already available. Taking into consideration these factors we need to optimise treatment modalities, enhance clinical knowledge, balancing the available resources and time so that a scientifically driven yet uncompromised treatment is embarked upon the patient leading to a long term dental and a systemic treatment; uplifting the patients dental health having a positive impact on the patients psychologic and general health
ABSTRACT
El póntico E es una alternativa de tratamiento para la pérdida prematura dental, este tipo de póntico fue publicado por primera vez en 2014 por Robert P. Korman. El diseño del póntico permite ofrecer predictibilidad en cuanto a soporte y mantenimiento de la arquitectura gingival, también promueve que el tejido vestibular migre coronalmente sobre el póntico, creando un surco gingival. Se recibió a una paciente que presentaba fragmento radicular del diente 21 y ausencia del diente 12, reborde residual atrófico (clase I según Seibert). Como plan de tratamiento, se realizó la extracción atraumática del fragmento radicular del diente 21 para retardar el colapso del reborde alveolar y se colocó injerto de tejido conectivo en la zona del diente 12 para corregir el defecto clase I de Seibert, se realizó la conformación de los nichos gingivales con electrobisturí en conjunto con la prótesis provisional y la preparación de los dientes pilares para la recepción y rehabilitación con pónticos E. Se colocó una prótesis fija de cinco unidades (dientes 13 al 23) en material núcleo de Zr y estratificada con cerámica (AU)
Pontic E is an alternative treatment for premature dental loss, this type of pontic was published for the first time in 2014 by Robert P. Korman. The design of the pontic allows to offer predictability in terms of support and maintenance of the gingival architecture, it also promotes that the vestibular tissue migrates coronally over the pontic, creating a gingival groove. A patient was received who presented a radicular fragment of tooth 21 and absence of tooth 12, atrophic residual ridge (class I according to Seibert). As a treatment plan, atraumatic extraction of the root fragment of tooth 21 was performed to delay the collapse of the alveolar ridge and connective tissue graft was placed in the area of tooth 12 to correct Seibert's class I defect, conformation was performed of the gingival niches with electrocautery in conjunction with the provisional prosthesis and the preparation of the abutment teeth for the reception and rehabilitation with pontics E. A fixed prosthesis of five units was placed (teeth from 13 to 23) of Zr core material and stratified with ceramic (AU)
Subject(s)
Humans , Female , Adult , Denture, Partial, Fixed , Esthetics, Dental , Alveolar Ridge Augmentation , Patient Care Planning , Tooth Extraction , Ceramics , Connective Tissue/transplantation , Electrosurgery , MexicoABSTRACT
Un problema que sucede a menudo en la práctica clínica es la ausencia dental por diversos factores. Esto conduce a un gran desafío para surehabilitación, ya que debido a la pérdida dentaria se genera un colapsodel reborde alveolar, lo que ocasiona alteración en la morfología óseay gingival, o en diversos casos, se realizaron extracciones sin una planeación restaurativa, por lo que su sustitución implica mayores procedimientos. Una alternativa a esta ausencia dental es el diseño de póntico ovoide, siempre y cuando cumpla los requisitos clínicos para un mejor resultado estético, funcional e higiénico. El objetivo de este artículo es mostrar el empleo del póntico ovoide en el sector posterior con distintos aspectos clínicos: por un lado, utilizando la técnica de conformación del lecho gingival a presión y por el otro, la técnica directa postextracción, mediante prótesis fija de tres unidades en metal/porcelana.
A problem that often occurs in clinical practice is the dental absence caused by various factors. This leads to a great challenge for rehabilitation since due to tooth loss, a collapse of the alveolar ridgeis generated, causing an alteration in bone and gingival morphology; also, in many cases, extractions were made without restorative planning, so their replacement involves major procedures. An alternative to this dental absence is ovate pontic design, provided it meets the clinical requirements for better esthetic, functional and hygienic result. The aim of this article is to show the use of the ovoid pontic in the posterior region with different clinical aspects: first, using the technique of forming the gingival bed under pressure and on the other, postextraction direct technique through a three-unit fi xed prosthesis in metal/porcelain.
Subject(s)
Female , Humans , Adult , Middle Aged , Denture, Partial , Dental Prosthesis Design , Denture, Partial, Fixed , Tooth Extraction , Metal Ceramic Alloys , Immediate Dental Implant Loading , Gingiva/anatomy & histology , Denture, Partial, Temporary , Dental AbutmentsABSTRACT
To enhance the esthetic appearance, the maxillary anterior area is important. It is possible to improve the esthetic appearance through the treatment of maxillary anterior area, which includes altering the color, form, and arrangement of teeth. When planning these treatments, clinicians should individualize personal demands, by using the information obtained from facial, dento-labial, dental, and gingival analysis. It is essential to properly prepare the gingival structure, which includes the height of gingival margin, the location of zenith, reconstruction of the interdental papillae, emergence profile, and symmetry. Clinicians often face unfavorable condition of the gingiva and the edentulous ridge, and appropriate management of the gingival structure is needed. In this case report, the patients were treated to improve the gingival conditions surrounding maxillary anterior teeth. By using conservative treatment without surgical intervention, such as application of pink porcelain, subgingival contour modelling and modification of pontic base, satisfactory esthetic results were gained.
Subject(s)
Humans , Dental Porcelain , Denture, Partial, Fixed , Denture, Partial, Temporary , Esthetics, Dental , Gingiva , ToothABSTRACT
PURPOSE: The purpose of this research is to determine whether pontic metal substructures, which are currently used in clinical surgeries, are designed appropriately and identify the problems that can occur due to their shape, size, and position. Then it aimed to emphasize the importance of making and designing pontic metal substructures based on basic principles. MATERIALS AND METHODS: This research measured pontic basal surface (P1) used sample metal substructures in this study, gingiva margin (P2), and the porcelain thickness of maximum infrabulge of labial surface around 1/3 of cervix dentis (P3). One-way ANOVA analysis was carried out to test the differences among groups, Tukey Honestly Significant Difference Test was conducted for statistical analysis among groups. RESULTS: For porcelain thickness and SD value, the P1 part was 1.2 - 1.8 (±0.17) mm for experimental group 1, 1.2 - 1.7 (±0.17) mm for experimental group 2, and 0.4 - 2.8 (±0.92) mm for experimental group 3. Next, the P2 part was 1.4 - 1.6 (±0.07) mm for experimental group 1, 1.3 - 1.8 (±0.07) mm for experimental group 2, and 0.5 - 2.7 (±0.67) mm for experimental group 3. The P3 part was 1.4 - 1.7 (±0.10) mm for experimental group 1, 1.5 - 2 (±0.10) mm for experimental group 2, and 0.9 - 3.1 mm (±0.90) for experimental group 3. There was no significance when One-way ANOVA analysis/Tukey Honestly Significant Difference Test was conducted for statistical analysis among groups (P > 0.05). CONCLUSION: The suggested metal substructures can be used clinically as they meet the requirements that pontic must have.
Subject(s)
Dental Porcelain , Denture, Partial, Fixed , Gingiva , Tooth CervixABSTRACT
Extraction of tooth leads to alveolar ridge resorption, which is more pronounced in the 1st year after extraction. Ridge resorption results in loss of interdental papillae and creation of unesthetic black triangles. Root submergence technique (RST) is a procedure where the tooth is decoronated and submerged at or below the alveolar bone level. The goal of the technique is to maintain the attachment complex of the tooth, which will prevent the alveolar bone resorption at the site with maintained soft tissue profile resulting in better esthetic results. The present case describes a relatively bloodless and minimally invasive modified RST that can be implemented in routine clinical practice with the predictable esthetic outcome.
ABSTRACT
PURPOSE: This case report discusses the effect of a root submergence technique on preserving the periodontal tissue at the pontic site of fixed dental prostheses in the maxillary anterior aesthetic zone. METHODS: Teeth with less than ideal structural support for fixed retainer abutments were decoronated at the crestal bone level. After soft tissue closure, the final fixed dental prostheses were placed with the pontics over the submerged root area. Radiographic and clinical observations at the pontic sites were documented. RESULTS: The submerged roots at the pontic sites preserved the surrounding periodontium without any periapical pathology. The gingival contour at the pontic site was maintained in harmony with those of the adjacent teeth, as well as the overall form of the arch. CONCLUSIONS: The results of this clinical report indicate that a root submergence technique can be successfully applied in pontic site development with fixed dental prostheses, especially in the maxillary anterior esthetic zone.
Subject(s)
Dental Prosthesis , Denture, Partial, Fixed , Pathology , Periodontium , ToothABSTRACT
A fi xed partial denture is routinely done for the replacement of the missing natural teeth. In the case of anterior missing teeth, conventional cantilever type of fi xed partial denture is more conservative depending upon the case selection. Replacements of anterior teeth are challenging when there is a generalized spacing between the maxillary anterior teeth. Shape and size of the pontic, which replaces the missing teeth has to be in proportion with natural anterior teeth (golden proportion). In such cases, to achieve acceptable esthetics there may be a need to involve more number of teeth by regular fi xed partial denture. Spring cantilever is an ideal solution in these situations. Th e present article covers the case selection, advantages and disadvantages of spring cantilever type of fi xed partial denture.
Subject(s)
Adult , Denture, Partial, Fixed/instrumentation , Denture, Partial, Fixed/methods , Humans , Orthodontic Appliance Design , Orthodontic Brackets , Orthodontic Wires , ToothABSTRACT
Esthetics is of prime concern when replacing any anterior tooth. The prosthesis should resemble the adjacent natural tooth closely. Out of many types of pontic designs, ovate pontic may serve the purpose of providing good esthetics and phonetics. It will maintain interdental papilla and help to maintain good gingival health. In addition to it ovate pontic has an advantage of immediately replacing the missing anterior tooth.
ABSTRACT
Facial trauma resulting in tooth avulsion results in problems of physical and emotional nature for the patient, parent and a challenge for the dentist. Avulsion accounts for 0.5–16% of traumatic injuries in the permanent dentition which can occur at any age and is most common in the young permanent dentition and in the maxillary anterior region. Re-implantation of the avulsed tooth is the preferred emergency treatment depending on the extra-alveolar period and the storage medium used. The biggest advantage of immediate re-implantation is the psychological boost to the child of retaining his/her own natural teeth. A case report of 13 year old female patient with a history of trauma to the anterior region of maxilla and avulsion of 3 anterior teeth is discussed. An interim fixed partial denture was delivered using patient’s avulsed natural teeth in a single appointment.
ABSTRACT
The interrelationship of restorative dentistry and periodontics is a dynamic one. We have reviewed the various guidelines for performing periodontally compatible restorative dentistry. Using these basic guidelines, restorative care can be used to directly aid periodontal treatment by restoring an esthetically pleasing, comfortable and stable dentition. This article addresses the interactions between periodontal tissues and restorative procedures.
ABSTRACT
Soft tissue collapse around prepared teeth and pontic is inevitable after removal of the provisional restoration during the impression taking procedures. When inserting gingival retraction cord, soft tissue is displaced to an undesired contour. Viscosity of impression material also causes gingival displacement. Therefore, the consideration to transfer the prosthetically contoured soft tissue to master cast is required, especially in the esthetic area. In this report, the methods to maintain the soft tissue contour and transfer to the mastercast will be introduced. Harmonious contour of the soft tissue can be achieved with provisional restoration and be transferred to the master cast with two different techniques mentioned in this case report.
Subject(s)
Denture, Partial, Fixed , Tooth , ViscosityABSTRACT
Introduction: In patients with hopeless prognosis of the anterior teeth there is still a strong desire to save them for the sake of esthetics. If not grossly carious, broken down or discolored the extracted tooth after suitable modifications can be placed back in its original site by splinting it to the adjacent stable teeth. Materials and Methods: Fifteen patients (10 males, 5 females) in the age range of 40-65 years with pathologically migrated, unsalvageable teeth were treated by splinting the extracted teeth immediately with the stable adjacent teeth. After 12 weeks, all the patients were explained various treatment options available for replacement of the lost teeth. The patients were asked to fill out a simple closed ended questionnaire citing the various difficulties encountered during this transitional period, selection of further treatment modalities and the reasons for their choice. The feedback obtained was then analyzed statistically. Results: Hundred percent of patients were happy with the esthetics; however, 60% of them were dissatisfied with the function that it provided. The primary problem being apprehension of splint fracture and difficulty while incising and the data was found to be statistically significant (P=0.01**). All patients demanded a permanent treatment option following this with a fixed prosthesis. None of the patients were interested in the implant supported prosthesis due to cost, treatment time involved, and need for surgery. Conclusion: The concept of immediate pontic placement is surely a viable treatment option and promises an excellent transient esthetic solution for a lost tooth as well as enables good preparation of the extraction site for future prosthetic replacement.
Subject(s)
Adult , Aged , Composite Resins/chemistry , Decision Making , Dental Restoration Failure , Denture Design , Denture, Partial, Fixed , Denture, Partial, Fixed, Resin-Bonded , Denture, Partial, Immediate , Denture, Partial, Temporary , Esthetics, Dental , Female , Follow-Up Studies , Humans , Male , Mastication/physiology , Middle Aged , Oral Hygiene , Orthodontic Wires , Patient Satisfaction , Resin Cements/chemistry , Tooth , Tooth Loss/rehabilitation , Treatment OutcomeABSTRACT
OBJECTIVE: The purpose of this study was to compare the fracture resistance of implant-supported all-ceramic fixed partial dentures, which have three different pontic designs. MATERIAL AND METHODS: Two implants were placed in a metal model simulating mandibular left second premolar and mandibular left second molar. Thirty standardized 3-unit all-ceramic fixed partial dentures with biconvex, convex or concave pontic designs were fabricated using IPS e.max system (n=10). Afterwards, specimens were centrally loaded on the pontics until failure with a universal testing machine. Results were analyzed by Kruskal-Wallis and Mann-Whitney U tests at 5 percent significance level. RESULTS: The fracture resistance values of all-ceramic fixed partial dentures designed with biconvex, convex or concave pontics were 349.71, 438.20 and 300.78 N, respectively. There were no statistically significant differences between the fracture resistances of the groups (p>0.05), except for convex and concave groups (p<0.05 and p=0.009, respectively). CONCLUSIONS: Convex design showed the best mechanical properties as demonstrated by the high values of fracture resistance.
Subject(s)
Humans , Dental Abutments , Dental Porcelain , Dental Prosthesis Design , Dental Prosthesis, Implant-Supported , Dental Restoration Failure , Denture, Partial, Fixed , Bicuspid , Dental Implants , Models, Dental , Denture Design , Dental Porcelain/chemistry , Dental Stress Analysis/instrumentation , Mandible , Materials Testing , Molar , Stress, Mechanical , Surface PropertiesABSTRACT
Statement of problem: A conventional 3-unit fixed partial denture design with a pontic between two retainers is the most commonly used. However, in cases where the mental nerve is in close proximity to the second premolar, a cantilever design can be considered. As such, logical and scientific evidence is lacking for the number and position of implants to be placed for partially edentulous patients, and no clear-cut set of treatment principles currently exist. Purpose: The purpose of this study was to evaluate prognosis of implant-supported fixed partial dentures, and to compare changes in bone level which may rise due to the different factors. Material and method: The present study examined radiographical marginal bone loss in patients treated with implant-supported fixed partial dentures(87 prostheses supported by 227 implants) and evaluated the influence of the span of the pontic, type of the opposing dentition. Clinical complications were studied using a retrospective method. Within the limitation of this study, the following result were drawn. Result: 1. Seven of a total of 227 implants restored with fixed prostheses failed, resulting in a 96.9% success rate. 2. Complications encountered during recall appointments included dissolution of temporary luting agent (17 cases), porcelain fracture (8 cases), loosened screws (5 cases), gingival recession (4 cases), and gingival enlargement (1 case). 3. Marginal bone loss, 1 year after prosthesis placement, was significant(P<0.05) in the group that underwent bone grafting, however no difference in annual resorption rate was observed afterwards. 4. Marginal bone loss, 1 year post-placement, was greater in cantilever-type prostheses than in centric pontic protheses(P<0.05). 5. Marginal bone loss was more pronounced in posterior regions compared to anterior regions(P<0.05). 6. The degree of marginal bone loss was proportional to the length of the pontic(P<0.05). Conclusion: The success rate of implant-supported fixed partial dentures, including marginal bone loss, was satisfactory in the present study. Factors influencing marginal bone loss included whether bone graft was performed, location of the pontic(s), location of the surgical area in the arch, pontic span. Long-term evaluation is necessary for implant-supported fixed partial dentures, as are further studies on the relationship between functional load and the number of implants to be placed.