A Simplified Approach for Provisionalization Utilizing Extracted Natural Tooth as a Pontic-A Clinical Report
Citation: A Simplified Approach for Provisionalization Utilizing Extracted Natural Tooth as a Pontic-A Clinical Report. American Research Journal of Dentistry. 2017; 1(1): 1-7.
Copyright This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
The loss of anterior teeth due to trauma, caries, and periodontal diseases can result in serious functional and esthetic disabilities compromising the patients’ quality of life. The current scenario in dentistry proposes several treatment modalities for the esthetic and functional replacement of a missing anterior tooth which includes implant supported single crown, conventional FPD, Resin Bonded FPD or RPD. However when certain clinical conditions or unwillingness of the patient preclude the replacement of missing tooth with any of these prostheses, a more conservative treatment modality in the form of fiber reinforce composite resin fixed partial denture with composite resin, porcelain fused to metal, all ceramic or natural tooth pontic can be considered as a definitive treatment alternative.
Keywords: extracted tooth, fixed provisional, esthetic
Anterior teeth play an important role in overall appearance. The loss of anterior teeth may be due to trauma, caries, periodontal disease, root resorption, or failed endodontic treatment which can be considered as emergency and often requires replacement of the tooth in a single visit.1,2 Clinicians are concerned for the patient’s esthetics and function but also must realize that the process of rehabilitation can be undertaken with a series of complex procedures that could take several months to complete.3
There are many options documented for the purpose of provisionalizing anterior teeth during the surgical healing phases of treatment.3 Conventional acrylic removable partial dentures (RPDs) are most commonly preferred due to financial reasons. Acrylic RPD when placed immediately after the tooth is extracted , may be uncomfortable for the patient, and also impede healing process. They also fail to preserve the extraction socket, which results in an objectionable loss of soft and hard tissues in the extraction area.4
Fixed provisional restoration using extracted natural tooth, acrylic denture tooth, or composite resin tooth as a pontic embedded in wire, glass fibre, metal mesh, nylon, or cast metal frameworks has been described, but these can result in poor bonding at the interface between composite and metal or nylon, leading to failure of the restoration. The introduction of bondable fiber (i.e., polyethylene or quartz)permits for placement of periodontal splint as well as bonded resin-based, single-visit fixed partial dentures (FPDs).5-7
The use of patient’s extracted tooth as a pontic has been reported in the literature, with advantages of ideal shape, contour, color of the surrounding dentition and instant availability for bonding during surgery, with minimum necessity for preliminary lab work. 4,8 A fixed natural tooth pontic extends into the extraction socket in order to shape the soft tissue and support the adjacent papilla so that the final restoration emerges from the implant platform with the same contour and dimensions as the natural tooth.9-11
This clinical report presents a practical technique for immediate interim tooth replacement utilizing the clinical crown to assist the clinician in providing an esthetically acceptable treatment option.
A 32-year-old male patient presented to the Department of Prosthodontics and Maxillofacial Prosthetics with the complaint of mobile right maxillary front tooth for 2 weeks. The patient gave a history of traumatic injury to maxillary anterior region 2 weeks ago while playing football. On clinical examination, tooth #11 showed grade 3 mobility (Fig. 1). A radiographic examination revealed horizontal fracture of #11 in the middle third of the root with severe bone loss with respect to #11 (Fig. 2).
Since the prognosis of #11 was poor, it was extracted (Fig 3 and Fig 4). The extraction socket was curetted to remove the granulation tissue, followed by placement of a freeze-dried bone graft(osseograft) and a collagen membrane (Colo Gide) to permit guided bone regeneration. Surgical closure was done with 3-0 catgut suture.