This 58 year old male patient who smokes heavily, has moderately advanced periodontal disease under marginal control had been diagnosed with a non-restorable upper left central incisor that had been temporarily repaired and was slated for extraction. The practicality of an implant replacement had been explored and declined.
The periodontal disease had been stabilized for the time being. To limit a negative periodontal reaction, the provisional bridge design was supragingival. The gingival embrasures in the provisional will be closed for a better aesthetic appearance.
The preps were as parallel and as bulky as possible for retention and strength. A model and wax-up had been previously done and a condensation silicone putty stint made prior to the appointment.
The tooth was atraumatically extracted and a stainless steel wire tacked to the preps. Flowable composite (A-3 Revolution by Kerr) was placed over the wire and a pontic form was created then cured. About 1/3 of the way into the extraction site was a piece of cotton to prevent the composite from flowing to far into the site.
The stint was filled with Zenith Luxatemp (A-1), placed over the wire framework and preps that had been coated with mineral oil and allowed to set for 2 1/2 minutes. The set material was gently removed with hemostats and shaped with a rotary tapered fine diamond bur. The final polish was done with Enhance finishing cups (Caulk Densply) and composite tints (Kerr Kolor Plus) applied to create a life-like appearance. The shades used were ochre, lavender and white. The surface was then coated with an unfilled resin (Heliobond by Ivoclar). After light curing the surface was polished with a dry 2x2 piece of cotton gauze for a lustrous finish.
The gingival tissues were recreated using pink composite (Cosmodent) medium and light shades and a little blue tint (Kerr Kolor Plus). Note how the pontic extends slightly into the extraction site for an ovate healing surface.
The provisional bridge was placed with TempBond Clear (Kerr) and the tissue will be allowed to heal for 3 months before construction of a final prosthesis.
This 58 year old male patient who smokes heavily, has moderately advanced periodontal disease under marginal control had been diagnosed with a non-restorable upper left central incisor that had been temporarily repaired and was slated for extraction. The practicality of an implant replacement had been explored and declined.
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