Intracoronally implanted bridges fixed by glassionomers and

composites.The fifteen years of experiences

Martin Tvrdoň

Clinical consultant for dentistryTeaching Hospital and Policlinic

Of Academician L.Derer,Bratislava, Slovakia

Introduction

The methods of fixation of bridges by classic retainers /e.g. crowns/ used so far have been accompanied by certain disadvantages such as:

1.drastic reduction of tooth tisue by grinding off the whole surface of the abutments,

2.psychological stress and suffering of the patient,3.long appointments,4.destruction of the original natural shape of the

tooth,5.direct contact of the crowns with cervical margins

of gingiva.

Known saving methods

The conventional methods are even more serious if only one tooth is missing and it is required to drill off /sacrifice???/ sound intact neighbouring teeth. There exist traditional ways to maintain and save the tooth tissue:

1. Cantilever bridge2. Metal inlays positioned on one side of the bridge only / this may cause

aesthetic drawbacks as the inlays are usually made of gold3. Adhesive bridges – Rochette bridges, Maryland bridges 3.1. shorth longevity – the time of adhesion to the tooth surface

/average-two and half years, 1982, at present the results of the retention are better aboat 6 years, adequate with the development of composites

3.2. the contact surface under metal plates is often affected by carious erosion

3.3. indication limited by unafavorable occlusion of anterior teeth 3.4. the indication is suitable only for intact - caries and filling-free teeth 3.5 Maryland bridges / microchemical adhesion/ are more effective than Rochette desing with the perforations (macromecanical adhesion)

Our solution

Nevertheless, in our work we suggest a completely new solution...

Materials and procedure

The proposed type of the bridge is suitable for small edentulous spaces after the loss one tooth. For this type of the bridge, light curing glassionomers and composites as adherents and chrome-cobalt alloys as basic materials have been used. The procedure suggested consists of the following steps:

The fillings are removed from the abutments adjacent to the edentulous space.

In case of intact teeth, it is not necessary to drill

strict by J..V.Black I. forms, but so

called open central cavities to the gap, nevertheless, sufficient depth is required.

1. The linning glassionomer is placed on the base of cavity in thin layer. It should cover all basic surface and should not extend onto the enamel.

2. The impression of the prepared by silicone materials is taken together with occlusal registration and the impression of the opposing teeth

Metal framework of intracoronally anchored fixed-fixed bridge. It consits of the pontic and thin plates with finger-like irregular margins /occlusal view/ for intracoronal fixation by glassionomers and composites.

The framework of the bridge is constructed on a stone model incorporating the cavities of the abutments

The definitive bridge completed with C+B resin, ceramic or ADORO material on master cast.

Note opaque resin applicated on the surface

Suitable case of

42-year-old female patient with fillings and missing 15.

• ... and fixed bridge in situ after...

Schematic design of intracoronally anchored fixed-fixed bridge

Occlusal view of intracoronally anchored fixed-fixed bridge

The aim of the present study

The aim of the present study is to evaluate

the effectiveness of intracoronally anchored fixed bridges in the period of the past fifteen years.

Short statistics

- The number of the manufactured fixed bridges / 15 years - 120 In average : 8 bridges / year

- The number of the followed patients: 80 - The rest of the patients – 40, lost from our evidence /change of

residence, travel abroad, death etc./- Failure rate: from 80 cases / 6 bridges were removed = 7,6%.- The reason of the failure: 3 bridges with two pontics /fracture of the

wall of cavities of abutments, 3 bridges – pulpitis acuta

These 6 bridges were reconstructed into bridges with conventional crowns

Results

The advantages of the method are as follows:1. the method is simple, technically not complicated2. the bridges are esthetically far more satisfactory than conventional ones3. the drastic reduction of tooth tissue necessary for the construction of

most conventional retainers is avoided4. a problem of contact with the cervical margin of gingiva is none thus removing liability of gingival irritation5. natural anatomical shape of the tooth crowns is maintained6. the procedure is much more comfortable for both the patient and the

dentist as well7. bridges can utilize good fillings fillings which were placed into the teeth

prior to our treatment8. contrary to any conventional retainers of bridges, all metal or facet

crowns, it is always possible to check on the state of the abutments9. in case of any complication, it is far easier to remove the bridge.

• Utilization of the bridges in anterior area of dental arch is possible but more delicateLarger, two pontics fixed bridge is not recommended

Carious anterior teeth

with missing 12

Anterior view of

framework of intracoronally anchored fixed bridge

on working cast

Palatal view of restored anterior teeth.

The patient was a wearer of the bridge

from 1992 until 2002

Another utilization

Detailed view of the situation on the master cast:

18 – after crown preparation

17 – missing 16 – the tooth with the bifurcation and with prepared occlusal groove 15 – after preparation 14 – missing

Master cast with metal framework.

Note intracoronal plate in - 16

View of intracoronally anchored (16)

fixed-fixed bridge.