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Figure 6. Completed resin restorations masking darkened root surfaces and pontic build-out. |
Figure 7. Flattened proximal surfaces and slot preps ready to receive the bonded pontic. |
The pontic was primed with unfilled resin (ALL-BOND 3) and lengthened with composite resin (CLEARFIL MAJESTY Esthetic [Kuraray]) to better approximate the edentulous ridge. In this case an opaquer was not necessary. The undersurface of the resin build-out was polished with composite finishing strips (Sof-Lex finishing and polishing strips [3M ESPE]). All the composite surfaces were coated with a clear resin sealant (BisCover LV [BISCO]) to develop a glaze-like surface. In one appointment, several dark, unaesthetic spaces were eliminated (Figure 6).
At the second appointment, tooth No. 7 was removed. The porcelain surfaces of the abutment teeth were first prepared to create flat, parallel proximal surfaces for bonding the laboratory-fabricated pontic. Slot preparations were then created to enhance retention and facilitate proper positioning (Figure 7). A vinyl polysiloxane (VPS) impression (Imprint 3 VPS [3M ESPE]) was made and sent to the dental laboratory for fabrication. Several options were considered for this pontic, including composite resin, ceramic, and PFM.
A PFM was chosen for several reasons. Using the same materials as the adjacent teeth offered the best aesthetic match. This type of restoration ensures maximum strength. Finally, the dental laboratory technician could easily create a restoration with a maximum of etchable and bondable porcelain surface area. The precise fit of the restoration created by the technician was evident upon return from the laboratory (Figure 8).
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| Figure 8. PFM pontic on the laboratory model. | Figure 9. Restoration bonded in place with a dual-cured resin cement (DUOLINK [BISCO]). |
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| Figure 10. Palatal view of new pontic. | Figure 11. Intraoral view of completed aesthetic enhancement. |
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Figure 12. Extraoral view of completed aesthetic enhancement. |
The opposing surfaces were etched with HF acid (PORCELAIN ETCHANT 9.5% HF [BISCO]) and silanated. Light-cured bonding agent (ALL-BOND 3) was applied to the treated surfaces and the restoration seated into place with a dual-cured composite resin cement (DUO-LINK [BISCO]). Excess resin was removed, the restoration finished with diamond burs (858EF, 379EF [KOMET USA]), polishing points (diamond composite polishers [KOMET USA]), and a diamond polishing paste (Luster Paste [Kerr]). The rehabilitation nicely resembled a new restoration (Figures 9 to 12).
Again, the patient was informed that this should be considered a transitional rehabilitation of his anterior prosthesis. We discussed that staining due to smoking would compromise the aesthetics of the composite material over time. The potential for dislodgement of the bonded pontic was discussed if heavy occlusal forces were applied. Finally, periodontal maintenance was stressed as the most important factor in maintaining his “like new” restoration.
SUMMARY
It is not always possible to simply replace a defective restoration in every clinical situation. In certain cases, replacement of a restoration may not be an acceptable choice. As this case demonstrated, it is possible to replace a lost tooth, mask a discoloration, and add to existing porcelain restorations. Adhesive bonding chemistry has allowed dentists to become innovators in restoration and rehabilitation of a compromised restoration.