ISSN (Print) 2249-9725 e-ISSN 2250 - 3455
M. C. E Society's M. A. Rangoonwala College of Dental Sciences and Research Centre Pune
UNIVERSAL RESEARCH
Volume 5 Issue 2 May - August 2015
Also available online at www.urjd.org
CASE REPORT
An Innovative Approach to Maintain Ridge Contour Using Natural Tooth as Temporary Pontic Deepthi Anna Cherian, Mundoor Manjunath Dayakar, G. Prakash Pai, Tim Peter Thermadam1 Department of Periodontics and Oral Implantology, KVG Dental College, Sullia D.K, Karnataka, 1Department of Oral Medicine and Radiology, KMCT Dental College, Calicut, Kerala, India
ABSTRACT The loss of anterior teeth can be psychologically and socially damaging to the patient. Anterior teeth may be inevitably lost due to trauma, periodontal disease or endodontic failure. Irrespective of the final treatment, the first line of treatment would be to provisionally restore the patient’s esthetic appearance while functionally stabilizing the compromised arch. 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. This case report explains replacement of two lower central incisors using a stainless steel splint with the natural tooth crown as a pontic. KEY WORDS: Abutment, pontic, splints
INTRODUCTION Dentists have the potential to make a smile more beautiful, which may change the life of a patient as self‑confidence is improved. Lombardi stated dental esthetics is the most important phase of all the dental specialties, including pediatric dentistry, orthodontics, periodontics, oral surgery, and restorative dentistry.[1] That physical attractiveness plays an essential role in one’s self‑esteem is an important realization for the entire dental team. Esthetic appearance of teeth is a combination of individual tooth shape, position of teeth within each dental arch. The psychological implications of esthetic dental treatment to preserve or restore a person’s self‑image, self‑esteem, and well‑being have been well‑documented. Significant improvements in tooth colored restorative materials and adhesive techniques have resulted in numerous esthetic treatment possibilities, but the majority of patients believe that nothing could give the look as a natural tooth. Dentists occasionally are faced with the difficult esthetic situation of having to remove an anterior Access this article online Quick Response Code
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tooth because of trauma, advanced periodontal disease, root resorption or failed endodontic therapy. Following the loss of the anterior tooth, it is important that an immediate replacement is provided in order to avoid esthetic, masticatory and phonetic difficulties, and to maintain the edentulous space.[2] The natural tooth can serve as a temporary replacement after extraction. This is the concept of natural tooth pontic. Natural tooth pontic suitably modified and bonded to adjacent teeth enables proper healing in the area without compromising the anterior esthetic demands of the patient. Natural tooth pontic offers excellent color, shape, and size match and thus enhances the psychological and social acceptability of the patient with a minimal cost involved.[3]
CASE REPORT A 40‑year‑old patient reported to the Department of Periodontics and Oral Implantology. K.V.G Dental College, Sullia with a complaint of lose lower front teeth since 6 months. Clinical examination was done. Preoperative radiographs and photographs were taken. On radiographic examination, the lower central incisors presented horizontal bone loss up to the apical third of the root. After the examination, the patient was diagnosed Address for Correspondence:
DOI: 10.4103/2249-9725.157754
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Dr. Deepthi Anna Cherian, Department of Periodontics and Oral Implantology, KVG Dental College, Sullia D.K, Karnataka, India. E‑mail:
[email protected]
Universal Research Journal of Dentistry · May-August 2015 · Vol 5 · Issue 2
Cherian, et al.: Natural tooth pontic
to have chronic generalized periodontitis with grade 3 mobility wrt 31, 41.
tried in the patient’s oral cavity. It was then splinted to the adjacent teeth [Figure 3].
Keeping all the findings in mind, a thorough treatment plan was decided and executed, including a series of therapeutic procedures.
Postoperative care
• Oral hygiene instructions and motivation of the patient in performing effective oral hygiene measures • Nonsurgical periodontal therapy by means of conventional scaling and root planning, using curettes and ultrasonic instruments • Prepare patient cast for prosthetic rehabilitation • Surgical periodontal therapy was done 2 weeks after the re‑examination of the patient after completion of healing following non‑surgical periodontal therapy • Next appointment extract the lower central incisors and use it as a natural tooth pontic and splint it to the adjacent teeth using composites until the final prosthesis is ready.
The suitable antibiotics and analgesics (amoxicillin 500 mg 4 times/day for 5 days and ibuprofen 800 mg 3 times/day) were prescribed, along with chlorhexidine digluconate rinses (0.2%) twice daily for 2 weeks. Sutures were removed 1‑week postoperatively. Surgical wounds were gently cleansed with 0.2% of chlorhexidine digluconate. Patient was re‑instructed for proper oral hygiene measures.
DISCUSSION Preparing the tooth as pontic After extraction, the teeth are placed in saline for disinfection. Calculus and stains are removed from the tooth surface. The root is resected, and the pulpal tissue is removed.
Before planning for the periodontal surgical procedure, patient’s platelet count (3.5 lacs/mm3), hemoglobin (13.5 g/dl), bleeding time (2.5 min), and clotting time (5 min), were assessed and found to be within normal limits.
Surgical procedure wrt 31, 41 Intra‑oral antisepsis was performed with 0.2% chlorhexidine digluconate rinse, and iodine solution was used to carry out extra‑oral antisepsis. Following administration of local anesthesia atraumatic extraction was carried out wrt 31, 41 [Figure 1]. Defect debridement was carried out using the mucoperiosteal flaps were repositioned and secured in place using 3‑0 non‑absorbable black silk surgical suture. The simple interrupted sutures were placed.
Figure 1: Preoperative after extraction
Preparation of tooth Before extraction, the level up to which the teeth were exposed in the oral cavity was marked. At that level the extracted tooth was cut using the diamond disc and stored in saline until chair side procedure. Following root resection, the pulp tissue in the crown portion was removed and light cure composite resin was cured within the canal. A modified design was given to the natural tooth pontic. Recess grooves were placed into the pontic and intra‑coronal round 0.001” braided stainless steel wire was embedded into this preparation [Figure 2]. Before placing the wire was twisted, heated and quenched for better maneuverability. The tooth surface was etched and dried. Dentin bonding agent was cured. The wire was bonded with composite to the pontic. This was manipulated on the patient cast. Following which it was Universal Research Journal of Dentistry · May-August 2015 · Vol 5 · Issue 2
Figure 2: Preparation of natural tooth splinting of tooth with stainless steel wire
Figure 3: Postoperative picture 121
Cherian, et al.: Natural tooth pontic
The extracted prepared tooth is placed into the socket area like an ovate pontic helping the ridge to maintain the ridge contour. The interdental gingiva will form esthetic scalloped margins. Recess grooves were placed into the pontic for the purpose of intra coronal splinting. Position of this natural tooth pontic with the wire was tried on the cast for better manipulation. It was then splinted to the adjacent natural teeth.
Rationale for stabilization A splint has been defined as “any apparatus, appliance or device employed to prevent motion or displacement of fractured or movable parts.”[4] Splinting stabilizes the teeth as a unit by including healthy teeth and redirects the forces from to individual teeth to the new unit as a whole. Including the healthier teeth results in a new increase in crown root ratio and a net decrease in force to the individual tooth, especially in a horizontal direction.[5] Several method of intra‑coronal splinting have been devised, using amalgam, amalgam and wire, acrylic resin and wire, wire, threaded pins, and acrylic resin, or a combination of amalgam, wire, and acrylic resin especially adaptable to posterior quadrants.[5] In our case we have used stainless steel wire that provided increased rigidity. In most circumstances, intra‑coronal splinting is reserved for the patient in whom the severity of periodontal disease demands future permanent stabilization by extensive restorative measures. The temporary intra‑coronal splints have the following advantages:[6] • It is more retentive than other temporary splints and provides greater stabilization than do most of the other forms • It is fixed; thus, the patient wears it constantly • It lasts longer and in exceptional cases, can be considered a long‑term temporary splint • It neither irritates the gingival tissue nor impedes home care measures • It is relatively simple to construct, requires less times and less tooth reduction, and consequently is
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less expensive than the conventional full coverage provisional splint • It is relatively simple to repair • Most variations are esthetics. The temporary intra‑coronal splint has the disadvantage of pulpal damage during preparation, but in natural tooth pontic that is not of concern at all as we are splinting the extracted teeth. The shortcoming of this treatment is that if the patient bites hard on the lower anterior region the natural tooth pontic will come off and also it is not a permanent treatment. The other treatment option is to place immediate implants or immediate dentures. However, in this case bone loss is present; hence implants and dentures are not immediate options.
CONCLUSION The patient was highly pleased with the result of the treatment. Thus using natural teeth as pontic and splinting immediately after extraction enhances the post‑surgical healing, preserves arch integrity and improves the psychological morale of the patient.
REFERENCES 1.
Lombardi RE. Factors mediating against excellence in dental esthetics. J Prosthet Dent 1977;38:243‑8. 2. Ashley M, Holden V. An immediate adhesive bridge using the natural tooth. Br Dent J 1998;184:18‑20. 3. Parolia A, Shenoy KM, Thomas MS, Mohan M. Use of a natural tooth crown as a pontic following cervical root fracture: A case report. Aust Endod J 2010;36:35‑8. 4. Hallmon WW, Carranza FA, Drisko CL. Periodontal Literature Review – A Summary of Current Knowledge. Chicago: American Academy of Periodontology; 1996. 5. Hanratty JJ. Intracoronal and extracoronal stabilization. In: Periodontal Therapy. Ch. 10. Quintessence; 1998. 6. Schluger S, Yuodelis R, Roy C. Page Stabilization of teeth by splinting. Periodontal Diseases. 2nd ed. Lea and Febiger; 1990. How to cite this article: Cherian DA, Dayakar MM, Pai GP, Thermadam TP. An innovative approach to maintain ridge contour using natural tooth as temporary pontic. Univ Res J Dent 2015;5:120-2. Source of Support: Nil, Conflict of Interest: None declared
Universal Research Journal of Dentistry · May-August 2015 · Vol 5 · Issue 2
