017- Case Report 3: Composite Bridge to replace missing central incisor

25 years old male, presented with missing upper right central incisor, he requested “to do something” to close up the gap so that he can “save more money and become rich”. Is a traditional believe among Chinese population that a gap between incisor will cause losing money in their fortune!

He lost the tooth during childhood, alleged fell from bicycle and the tooth avulsed. His parent does not have the knowledge of preserve the avulsed tooth and replanting it, so they just leave the missing tooth untreated.

Picture 1
The upper lateral incisor was drifted toward the missing tooth space, and the gap become smaller. His lower teeth is not occlude with the upper teeth in anterior, known as anterior open bite.

Picture 2 Picture 3 Picture 4
Orthodontic (braces) treatment was proposed to correct the malocclusion and open bite, to gain the proper space width to replace the missing incisors with dental implant, but patient refused to undergo orthodontic treatment due to his current financial status and personal issue.

Picture 5
He refused to temporary wearing a denture and requested a fixed prosthetic, some dentist proposed him fixed bridge by using the Upper right lateral incisor and Upper left central incisor as the abutment of the bridge.

Picture 6
I rejected his request because I do not feel comfortable to cut both the sound incisors to become abutment teeth. I counter proposed him to consider resin bonded composite restoration, because of his open bite, there will be minimal biting force on the restoration.

Picture 7

Second consideration is he might be able to do orthodontic treatment in future, then the restoration can be reversed.

Some preparation was done on the lateral incisor surface to remove plaque & stain, then the enamel surface was etched for 20 second.

Picture 8
A thin layer of Kerr Optibond Versa applied.

Picture 10
Thin layer of palatal shelf built with flowable Resin (Kerr Dyad-flow), by using a cellulose strip to support.
Picture 11
Further outline the gingival floor and gingival margin with flowable composite.
Build up the body of the restoration with opaque composite (Kerr Précis Composite)

Picture 13

and both the teeth was built according to its anatomy.

Picture 14
Final layer built with Translucent Composite

Picture 15

. The restoration was reshaped to mimic the contra-lateral incisors

Picture 16.

The restoration was then polished with Kerr Hiluster and Occlubrush to protect it from staining and plaque adhesion.

Picture 17

We managed to achieve satisfaction final result, both for patient and clinician. The last photo to compare before & after treatment, and superimpose photo to check the original position of supported lateral incisors to ensure sufficient thickness for the restoration. 

Picture 18

Patient knew that it is not a definite treatment, but a provisional treatment protocol, and he need to come back in future for braces and implant replacement of missing Central Incisor.
The products used for restoration in this case all from Kerr Corporation, USA.

Prepared by,
Dr Goon