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Minimally invasive procedures are the new paradigm in dental care

Clinical goals in dentistry include prevention of the disease occurrence and ending the process.  With that in mind, we want to exercise minimally invasive solutions as to prevent disturbance or create loss in the patient's oral architecture. We will use an example recently reported in General Dentistry journal that demonstrates possible solutions to a patient about to loose a tooth.

A patient came to the clinic with severe external and internal resorption(bone loss) on a mandibular(lower jaw) right central incisor (tooth 25) which would require extraction. Due to the severe resorption, simple restorative procedures are not an option. Patient was advised that the tooth needs extraction and possibly an implant; however patient immediately refused because of the high cost of implant procedure. The second option was an extraction and the placement of a direct-bonded bridge that utilized the two neighboring teeth (number 24 and 26) as abutments.

However, the cost of dental bridge was too much for him to handle at the time. The third option was an extraction and placement of a resin-bonded bridge. This option could restore aesthetics and function of the lost tooth, but patient was warned about the long-term success of the treatment.  Fourth option was to use a single-tooth Nesbit-type partial or a full interim partial denture; however, the patient did not want any removable prosthesis in this mouth. After presented with different treatment plans, patient chose the third option which was extraction and resin-bonded bridged. This option has the benefit of easy convertibility, expediency, and fast acceptance by most patients especially due to limited cutting of virgin teeth. 

Prior to extraction, a coarse, tapered diamond bur was used to remove the mesial and distal contacts from tooth 25, allowing room for air abrasion of proximal surface of teeth 24 and 26. Air abrasion would create a roughen surface for bonding of the pontic(artificial teeth). Air abrasion was done before extraction to prevent contamination of the extraction site.

An impression was taken and a model was created with polyvinyl siloxane dye material. Pontic with composite wings was made using the model. Pontic helps to stimulate and support the gingiva and also the ridge under the extracted tooth. The 1-year postoperative follow-up revealed a good tissue adaptation and normal gingival architecture.  

There are limitations with resin bonded bridges that should be noted.  There is a higher failure rate due to limited strength.  Secondly there may be occlusion interference as the wings of the resin bonded bridge may interact with the opposing teeth.  Always ask your dentist for the pros and cons of each option.


Academy of General Dentistry Jounal. 2018 September/October


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