Clinical case-stidies: A typical periodontal splint and pontic with everStick Perio Fibres by Dr J Van Rensburg.
The treatment option was chosen because it was the most cost effective option for this elderly lady. The existing bone support of the remaining teeth and the age of the patient didn’t justify expensive crown and bridge work. The whole procedure was completed within a one hour session and the patient was extremely satisfied with the outcome of the treatment.
Patient
Female, 85 years
Case history
The patient is still active despite her age, with no significant medical history. The patient had treatment for periodontal disease and her lower anterior teeth were splinted and the extracted LR1 was bonded back in position in the arch. The periodontal disease was under control but the lower anterior teeth were extremely loose and the LR1 much discolored. The patient had lost several teeth with no molars left in the lower right quadrant. The LL6 was the only molar tooth left in the lower left quadrant. Several teeth in the maxilla are also missing. The oral hygiene of the patient was acceptable considering the age of the patient. The patient was well motivated and visited the oral hygienist on a regular base as part of her periodontal maintenance program. The patient’s main complaint was the unsatisfactory, aesthetic appearance of the discolored LR1. The remaining lower anterior teeth were also mobile and the patient did find them uncomfortable at times. The patient wished to have the teeth splinted for more stability and the replacement of the discolored LR1. Description of the treatment plan: After a thorough examination it was decided to remove the existing splint and discolored LR1 and to splint the lower anterior teeth again. The stable lower premolars were to be included in the splint for more support and anchorage. The missing LR1 was to be replaced with a pontic built up with composite using the splint as reinforcement. An extra vertical piece of everStick Perio fibre was to be used to reinforce the composite pontic vertically.
Treatment
The previous splint and replacement of the LR1 were removed and the teeth were prepared for the new splint. A groove was prepared on the lingual surface of the teeth – just big enough to accommodate the everStick perio fibres. Rubber dam isolation was placed to ensure a dry field and also to make the procedure easier for the patient and the dentist. The teeth to be splinted were roughened with a fine thin tapered diamond bur to enhance the bonding to the enamel. These areas were treated with 37% phosphoric acid for 40 seconds. The acid was washed off and the areas were treated with bonding agent according to the manufacturer’s instructions. The teeth were then bonded together on the labial, inter-proximal areas with a flowable composite. The teeth were now stable and ready to be reinforced with the everStick Perio fibre on the lingual side in the prepared groove. The lingual surfaces with the groove preparation were etched and bonded in the same way as described above. Flowable composite was placed in the groove and the already measured and cut periodontal fibre was placed into the uncured flowable composite. A piece of thin ligature wire was used to measure the length of the fibre. The Stepper instrument from StickTech Ltd was used to sectionally cure the fibre in position. The fibre was cured properly (30 seconds per tooth) to ensure the fibre was well bonded in position. The vertical piece of perio fibre was bonded to the already in place lingual perio fibre. The pontic was then built up layer by layer with composite material. The lingual aspects of the teeth were also filled in and covered with composite material. After sufficient curing of the composite the splint and pontic were finished and polished.
PRE-OPERATIVE
PERI-APICAL X-RAY
DISCOLOURED SPLINT REMOVED
LIGHT SHIELD TO PROTECT EYES
EVERSTICK PERIO FIBRE BONDED IN POSITION
NOTE VERTICAL REINFORCEMENT FOR [PONTIC
COMPOSITE BUILD-UP
BUILD-UP COMPLETED. PONTIC FREE FROM GINGIVA-EASY TO MAINTAIN
