Single-tooth replacement with a chairside prefabricated fiber-reinforced resin composite bridge: a case study

There are many fixed options for replacing a single anterior tooth, including implants; conventional full coverage; porcelain-fused-to-metal, all-ceramic, and fiber-reinforced composite designs; and minimal preparation designs that utilize lingual wing frameworks made from metal, ceramic, or fiber-reinforced composite. All of these approaches require at least two visits; however, it is possible to replace a missing anterior tooth in a single visit by using adhesive techniques with resin composite and fiber-reinforced resin composite materials. This approach has been developed and refined with a bridge created at chairside, using a prefabricated fiber-reinforced composite framework. This framework consists of a pontic substructure that is shaped to support a resin composite pontic, with one or two wings used to attach the pontic substructure to either the lingual or facial surfaces of the abutment teeth. This article describes a chairside technique for replacing a maxillary central incisor by using a prefabricated fiber-reinforced framework.     

Technique for placement of a posterior prefabricated fiber-reinforced composite bridge

Fiber-reinforced composite (FRC) materials currently are used as alternatives for fixed restorations of edentulous areas within the posterior and anterior regions of the mouth. A chairside technique, using a prefabricated FRC framework, allows the clinician to offer the patient another fixed option for replacing a missing posterior tooth that is more time-efficient and cost-effective than other, more traditional approaches. Procedures that incorporate adhesive dentistry give dentists the ability to replace missing teeth and splint unstable teeth for periodontal or orthodontic purposes. This article demonstrates the sequence and chairside technique for placing a prefabricated FRC framework to restore a posterior edentulous area.     

Chairside prefabricated fiber-reinforced resin composite fixed partial dentures.

The introduction of pre-impregnated fiber-reinforced resin composites has provided the dental profession with the opportunity to fabricate and deliver adhesive, esthetic, and metal-free tooth replacements. Utilizing this technology, a prefabricated fiber-reinforced resin composite fixed partial denture prototype that allows rapid, cost-effective, and noninvasive fixed tooth replacement for single anterior teeth has been developed. Ideal situations for this type of service include: a fixed replacement following tooth loss from trauma; a fixed tooth replacement in medically compromised patients who cannot sit for extended periods of time or have local anesthesia; periodontally compromised abutments; a fixed space maintainer following orthodontic movement; and a fixed provisional during the post implant healing phase prior to loading. This article describes the framework construction and placement protocol for the prefabricated fiber-reinforced resin composite fixed partial denture.     

Chairside replacement of posterior teeth using a prefabricated fiber-reinforced resin composite framework technique: a case report

The fixed replacement of a single posterior missing tooth for those patients who cannot have either implants or conventional laboratory-generated fixed prostheses has always been a challenge to clinicians. The development of fiber-reinforced composites (FRCs) has opened up new possibilities of chairside treatment options to manage these types of clinical situations. Techniques using FRCs as frameworks with traditional restorative resin composites as veneering materials can provide chairside fixed prostheses that are esthetic and potentially durable, with minimal abutment tooth loss.
A clinical case is presented that will illustrate a novel concept for tooth replacement–the use of an FRC prefabricated framework–to allow for a single visit, chairside replacement of a missing molar. The assembly of the framework and the clinical steps used in the framework placement and pontic fabrication are shown in detail.     

Static and fatigue compression test for particulate filler composite resin with fiber-reinforced composite substructure.

OBJECTIVES: The aim of this study was to determine static load-bearing capacity and compressive fatigue limits (CFL) of laboratory particulate filler composite resin (PFC) with three different types of fiber-reinforced composite (FRC) substructures. METHODS: A total of 420 test specimens were prepared having 1.0mm of FRC layer as substructure (short random, continuous unidirectional and bidirectional fiber orientations), and a 2.0-mm thick surface layer of PFC. Control specimens were prepared from plain FRC or PFC. The specimens (n=15) were either dry stored or water stored (37 degrees C for 2 weeks) before they were loaded with a steel ball (? 3.0mm) under static load until fracture and cyclic load with maximum controlled regimen following a staircase approach with maximum 10(3) cycles. The decrease in CFL compared to static load was calculated and data were analyzed using ANOVA and Weibull statistics. RESULTS: The highest static loads were registered for plain FRC specimens [short random 1842 N(205), continuous bidirectional 2258 N(233) and unidirectional fiber orientation 538 N(254)]. The specimens with FRC substructure and PFC coverage gave load values of 1517 N(249), 1670 N(241) and 677 N(240), respectively. The specimens made of PFC only, failed with 1047 N(230) load. The CFL for 10(3) cycles ranged between 19 and 39% of the static load values. ANOVA revealed that all factors significantly affected the load bearing capacity (p<0.001). SIGNIFICANCE: The results suggested that the material combination of continuous bidirectional or random FRC and PFC, gave higher CFL and static load-bearing capacity than that obtained with plain particulate filler composite resin.     

Alternative fabrication method for chairside fiber-reinforced composite resin provisional fixed partial dentures

A high level of clinical skill is required for fabricating a provisional fixed partial denture with fiber-reinforced composite resin (FRC) using either the direct or chairside technique. The freehand approach to restoring missing teeth represents a challenge to the clinician, particularly when shaping and finishing a hygienic pontic. This technical report describes a simplified method for chairside fabrication of a fixed dental prosthesis with FRC. It is based on using a translucent template to guide the buildup procedure and to ensure optimal anatomy and function.     

Direct composite resin restoration of an anterior tooth: effect of fiber-reinforced composite substructure

The aim of the study was to determine the static load-bearing capacity of fractured incisal teeth restored with the conventional adhesive-composite technique or by using fiber reinforced composites (FRC). Upper incisal teeth were prepared by cutting the incisal part of the crown horizontally. Restorations were made by three techniques. Group A (control group) was restored by reattaching the original incisal edge to the tooth. Group B was restored using composite resin. Group C was restored with composite and FRC. Restored teeth were statically loaded until fracture. Results suggest that an incisally fractured tooth restored with a combination of composite resin and FRC-structure provide the highest load bearing capacity.     

Three-year clinical evaluation of fiber-reinforced composite fixed partial dentures using prefabricated pontics

PURPOSE: The purpose of this study was to evaluate the clinical performance of surface-retained adhesive composite fixed partial dentures reinforced by an ultra-high molecular weight polyethylene (UHMWP) fiber (Ribbond THM). MATERIALS AND METHODS: Twenty-three surface-retained fiber reinforced composite (FRC) fixed partial dentures (FPD) were placed by two operators in 23 patients, each with a single missing tooth. The restorations included prefabricated composite resin pontics, and no preparations were done on the lingual surfaces of the abutment teeth. The patients were recalled for examinations every year for up to 3 years. Restorations were evaluated directly using the modified Ryge criteria. The minimum observation period was 1 year and the maximum observation period was 3 years. RESULTS: At baseline, 23 restorations were graded as Alpha for all parameters. At one year and two years (n = 21), three Bravos for wear resistance and surface texture/gingival inflammation and two Bravos for color match were observed. Twenty-one of 23 restorations were retained at the end of two years (91.3%) and 78.3% were retained after a maximum of 3 years. CONCLUSION: The results of this clinical study suggestthat UHMWP FRC FPDs are quite acceptable at least forthree years. However, further clinical investigations are still needed for improved long-term clinical performance.     

Adhesion between prefabricated fiber-reinforced posts and different composite resin cores: a microtensile bond strength evaluation

PURPOSE: The aim of this study was to evaluate the bond strengths between various resin composites used as core materials (Multicore Flow, Ivoclar-Vivadent; Tetric Flow, Ivoclar-Vivadent; Filtek Flow, 3M-ESPE; Tetric Ceram, Ivoclar-Vivadent; Filtek Z250, 3M-ESPE), and an FRC post (FRC Postec Plus, Ivoclar-Vivadent) by means of the microtensile nontrimming technique. MATERIALS AND METHODS: Five experimental groups were used. For the microtensile nontrimming technique, 45 to 50 beam-shaped specimens per group were obtained from cylinders of core material, which had been built up around the post by progressively adding small increments of composite resin. Each specimen was loaded in tension until failure at either one of the two post/core interfaces present in each stick. The differences in interfacial bond strength amongthe groups were tested for statistical significance with the one-way ANOVA test, followed by the Dunnett test for post-hoc comparisons. RESULTS: The measured bond strengths in MPa were 17.29 +/- 6.02 for FRC+MultiCore Flow, 16.37 +/- 6.92 for FRC+Tetric Flow, 13.14 +/- 5.35 for FRC + Filtek Flow, 12.38 +/- 4.34 for FRC + Tetric Ceram, and 10.75 +/- 5.43 for FRC + Filtek Z250. The statistical analysis revealed that MultiCore Flow achieved significantly higher bond strengths than Filtek Flow (p = 0.03), Tetric Ceram (p < 0.001), and Filtek Z250 (p < 0.001). The bond strength of Tetric Flow was significantly higher than that of Filtek Z250 (p = 0.003). CONCLUSION: For core buildup on a fiber post, dual-cure composites appear to be preferable to light-curing composites.     

Adapting fiber-reinforced composite root canal posts for use in noncircular-shaped canals.

Post placement in oval-shaped root canals implies the sacrifice of sound dental tissue to adapt the canal shape to fit the post, which can result in one of several significant complications. A semidirect, single-visit, chairside procedure is proposed, which permits the use of an almost anatomically shaped post, starting from a preformed fiber-reinforced composite root canal post of the largest size commercially available. The utilization of this post capitalizes on the advantages of both the fiber post and the anatomical post in oval- and ribbon-shaped canals to provide restoration of endodontically treated teeth.     

Single visit replacement of maxillary canine using fiber-reinforced composite resin

Missing a canine is of serious concern in social life of a patient in most of societies. While conventional fixed partial dentures and implant-supported restorations may often be the treatment of choice, fiber-reinforced composite (FRC) resins offer a conservative, fast and cost-effective alternative for single and multiple teeth replacement. This clinical report presents two cases where FRC technology was successfully used to restore canine edentulous area in terms of esthetic-cosmetic values and functionality.     

Controlled slicing in the management of congenitally missing second premolars.

This report describes a simple method of allowing permanent first molars to drift mesially in patients with congenitally missing second premolars, thus facilitating future orthodontic treatment. Controlled slicing of the deciduous second molar between the ages of 8 and 9 years produced a bodily controlled mesial movement of the permanent first molar in less than 1 year with no or minor rotations or inclination. These results are compared with controlled slicing in 10- to 11-year-olds and with treatment involving extraction alone.     

Management of congenitally missing second premolars with orthodontics and single-tooth implants.

This article describes the treatment of an adolescent girl who was congenitally missing all 4 second premolars and had a retained mandibular second primary molar. Various treatment alternatives are discussed, and the final treatment plan of space opening for 3 implants and space closure of the maxillary left second premolar site is presented.     

Provisional anterior tooth replacement using nonimpregnated fiber and fiber-reinforced composite resin materials: a clinical report

The loss of anterior teeth is often a serious esthetic concern. While conventional fixed partial dentures and implant-supported restorations may be the treatments of choice, nonimpregnated fibers (NFs) and fiber-reinforced composite (FRC) resins offer a conservative alternative for improving esthetics. This article describes 2 clinical situations in which NF glass ribbon and FRC were successfully used to provisionally restore anterior edentulous areas in an esthetic, functional, and timely manner.     

Congenitally missing second premolars in cleft lip and cleft palate children.

Panoramic and periapical radiographs of 278 patients with cleft lip, cleft palate, or both (158 males and 120 females), age 5 to 18 years, were examined to determine the frequency of missing second premolars and the possible association between the cleft side and the side from which the premolar was absent. The prevalence (18%) of missing premolars found in this study is significantly higher than is found in the general population. A considerably higher incidence of missing second premolars was found in the maxilla compared with the mandible both for unilateral and bilateral missing teeth. The second premolar was absent more frequently on the left than on the right side, both in males and females and in both jaws. Interestingly but consistent with our previous reporting, this corresponded to the side where clefts occurred more often. The cause of the higher prevalence of left-sided clefts and missing second premolars in human beings is not known at the present time.     

Characterization of a new fiber-reinforced flowable composite

Odontology - This study aimed to evaluate certain physical properties including surface wear of a new experimental short fiber-reinforced flowable resin composite (SFRC) in comparison with...     

Use of a prefabricated fiber-reinforced composite resin framework to provide a provisional fixed partial denture over an integrating implant: a clinical report

The development of fiber-reinforced composites offers new possibilities in minimally invasive tooth replacement approaches. This article describes the use of a prefabricated fiber-reinforced composite resin framework for the chairside fabrication of a provisional fixed partial denture over an integrating implant. The framework fabrication, theory, and a clinical scenario are illustrated.     

Evaluation of a chairside gingival protease test for use in periodontal diagnosis

Collagen degradation is a major factor in the destruction of diseased periodontal tissues. Evidence from several investigations indicates that this connective tissue breakdown process may be associated with elevated levels of proteolytic activity in gingival crevicular fluid. A rapid, chairside assay for neutral proteases in biological fluids was evaluated clinically for reproducibility and an indicator of periodontal disease status. This colorimetric test is based on the use of an insoluble, covalently linked dye-collagen substrate. Enzymatic activity is monitored by estimating the production of soluble dye-labeled collagen fragments resulting from the action of sample fluid proteases on the test substrate. Gingival fluid samples were collected on three successive days from 366 interdental sites in 34 volunteers, with and without periodontal disease. Results demonstrate that the assay is reproducible with 98.6% of sampled sites remaining stable throughout the 3-day study. Furthermore, the highest percentage of elevated neutral protease activity (NPA) values and the highest NPA values were found in patients clinically diagnosed as having advanced periodontal disease.     

Bond strength of fiber-reinforced composite resin restorations.

Severe tooth wear is common in older dentate individuals, with one treatment option being composite resin restorations reinforced with a suitable matrix. This study evaluated the use of high modulus polyethylene (Celanese) fibers as a reinforcing matrix for composite resin. Human mandibular incisor teeth were sectioned to simulate severe tooth wear. Sectioned surfaces were measured, the teeth paired and assigned to control or test sample groups, and further assigned to be tested with a labial or lingual shearing force. A phosphorylated dentin bonding adhesive was applied to the abraded dentin surface. Labial and lingual intra-enamel bevel preparations were cut on each specimen. A piece of Celanese fabric was bonded onto the acid-etched labial and lingual bevels of the test specimens using an enamel bonding agent. Class IV composite resin restorations were then placed onto the test and control specimens. Following water storage, the specimens were subjected to shearing forces. Bond strengths for test specimens were significantly greater (p < 0.03) than the controls. Specimens with a labially applied force also had significantly higher bond strengths (p < 0.001). SEM analysis revealed adhesive bond failures over dentin surfaces, with cohesive bond failures within the composite resin. Celanese fibers maintained the restorations on the teeth, although adhesive failures were seen between the fibers and enamel bonding agent.