A missing anterior incisor, e.g. maxillary central can be restored with a maryland bridge, an implant prosthesis, a 3-unit full crown bridge. Usually due to poor lab work we tend to restore with full crown bridge at the cost of preparing two naturally sound teeth. on the other hand, implant surgery and follow-ups are also clumsy. just for one tooth to be restored ribbond fibre and bonding of acrylic tooth is advocated in some advertisement. Is it a viable alternative ?
It varies from case to case. A long debate and careful treatment planning is required. Do you want to give the specfic case history here ?
I prefer implant first and then Maryland Bridge. But again depends on the situation and age of the patient.
It really depends on the case. In order to give you a valid answer I'd greatly appreciate more information on the case(s).
It is necessary to provide additional information such as a CT Cone Beam to verify bone quality and quantity , condition of adjacent teeth , type of occlusion , presence of parafunctional habits , thereby providing a treatment plan according to the needs and expectations of the patient
I would ask the same question but changing the patient .
what will be your treatment plan if you would treat yourself honestly?? what are your choices
I would prefer the implant, but all the alternatives are valid, the final choice depends on the clinical case: the quantity and quality of the bone, the integrity of the potential abutment teeth, the periodontal status, the occlusal conditions, and so on.
Hello Bishal,
No need to say that an implant in most cases would be the ideal single tooth replacement. However, I can understand your problem. If follow-ups are difficult, lab conditions less than ideal and funds not exactly in abundance, the possibility of a Fiber-Reinforced Direct Composite Bridge becomes very attractive. It may not be as elegant as the other solutions and is more work at the chair side but in the circumstances you described, it would be a valid alternative if excessive strain on the restoration can be avoided. The big advantage is the minimal preparation of the abutment teeth. The articles below will give you an idea about the technique and have some illustrative pictures.
https://www.dentalaegis.com/id/2015/04/an-advancement-in-fiber-reinforcement-for-restorative-dentistry
http://www.dentalcetoday.com/courses/47/html/dt_section_2.htm
https://www.dentalaegis.com/id/2015/04/an-advancement-in-fiber-reinforcement-for-restorative-dentistry
http://www.dentalcetoday.com/courses/47/html/dt_section_2.htm
Hi Bishal. Let's assume you are talking about a case that all the 3 management modalities are valid and possible. If the neighbouring teeth are intact, the option of conventional fixed-fixed bridgework is almost out of question. Resin-retained bridgework (RRB) are highly successful and highly predictable and with good survival data (King 2015 and Djemal 1999). The key to success is (1) no prep or minimal prep (2) cantilever design (3) maximum coverage of the retainer (4) use of a bi-functional cement and (5) adequate thickness of the wing to prevent flexure.
Please note that bi-functional cements (for exmaple Panavia F) have the ability to bond to metalic ions as well as the HAp if you are using a mild etching technique.
I have used the fibre-reinforced composite on only very few occasions (twice to be precise!) just as a temporary measure before the implant and they seem to work however they are a lot bulkier than the Ni-Cr alloy of a conventional RRB (and I have done well over 100 of them).
Hi Bishal. Let's assume you are talking about a case that all the 3 management modalities are valid and possible. If the neighbouring teeth are intact, the option of conventional fixed-fixed bridgework is almost out of question. Resin-retained bridgework (RRB) are highly successful and highly predictable and with good survival data (King 2015 and Djemal 1999). The key to success is (1) no prep or minimal prep (2) cantilever design (3) maximum coverage of the retainer (4) use of a bi-functional cement and (5) adequate thickness of the wing to prevent flexure.
Please note that bi-functional cements (for exmaple Panavia F) have the ability to bond to metalic ions as well as the HAp if you are using a mild etching technique.
I have used the fibre-reinforced composite on only very few occasions (twice to be precise!) just as a temporary measure before the implant and they seem to work however they are a lot bulkier than the Ni-Cr alloy of a conventional RRB (and I have done well over 100 of them).
There is a large learning curve in using Ribbond. The occlusion frequently dictates restorability. I an surprised to see the avocation of a resin retained bridge.
An awareness of the risk of treatment failures and complications is required as implant treatment outcomes compared to treatment outcomes of conventional therapies are not as predictable particularly in circumstances where esthetic considerations are the overriding concern. In order to avoid failures and complications and to establish optimal treament goals and results the planning for implant placement in the anterior maxilla should be done with caution not only in adolescents but also in adults prior to the fourth decade of life. Implants in the anterior maxilla should be generally avoided in females and cases of males with narrow teeth and therefore short distance between a planned implant and the adjacent teeth. In the new interesting field of mini-implant supported pontics as semi-permanent space maintainers we need more research on basic level and clinical follow-up studies of large samples to make evidence-based decisions.
For further information see http://dx.doi.org/10.13140/RG.2.1.1970.9524/1
https://biocoreopen.org/ijdoh/Congenitally-Missing-Lateral-Incisors-Orthodontic-Restorative-and-Implant-Approaches.php
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