Clinical case-stidies: Splinting back an extracted tooth and building up a pontic by Dr J Van Rensburg
Fibredontics is an excellent way of treating the periodontally compromised patient. This technique describes how an extracted tooth can be bonded back into the arch. At the same time the other mobile periodontally involved lower anterior teeth can be stabilised and the missing tooth can be replaced with a composite build up directly in the mouth
Patient
Male, 66 years
Case history
This is the case of a male patient aged 66 years. The patient complained about a very mobile LR2 and a missing LR1. The lower canine teeth were still stable with mobility (type2 and 3) of the remaining two lower anterior teeth. The LL1 was already missing – the patient has lost this tooth some time ago due to periodontal disease. The mobility of the LR2 was causing problems when eating. A peri-apical x-ray of the lower anterior teeth revealed very little bone support on the LR2 and slightly more bone support on the LL2. Different treatment options were discussed with the patient and the only sensible solution to this periodontal condition was splinting of the lower anterior teeth after extraction of the LR2. The only alternative treatment was an immediate lower partial denture. Both the patient and I decided not to follow the route of a removable appliance due to the unreliability of this treatment option.
Treatment
After careful consideration the following treatment was suggested and performed: Extraction of the LR2. This extracted tooth was prepared and used as a pontic. The root of this tooth was chopped off and the apical area was sealed with a flowable composite restoration to seal off the dentine tubuli and prevent blood infiltration into the tooth. A C&B fibre was used to create a splint from the LL3 to the LR3 after the prepared pontic (extracted LR2) was “spot-bonded” into position in the arch with flowable composite. A vertical piece of C&B fibre was used to reinforce the pontic to replace the missing LR1. This pontic was build up with dentine and enamel composite (Gradia Direct AO3 and A3), directly in the mouth onto the rubber dam isolation. Oral hygiene instructions ( Red TePe and Super-floss) were given and demonstrated to the patient after completion of the splint-restoration. The patient was also asked to visit the oral hygienist regularly on a three monthly basis.
Missing LR1 and very mobile and over-erupted LR2
The lingual view of the lower anterior teeth- pre-operative
The end result. Patient was very pleased with the end result
End Result Lingual view
