Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2017-03-17, 11:21:45 | version 1.38.0
| case report aesthetic rehabilitation Fig. 13 Fig. 14 Fig. 15 Fig. 16 As the patient was also satisfied with the aesthetic result, the adhesive bridge could be placed immedi- ately. For this purpose, the working field was iso- lated with rubber dam and a 37 % phosphoric acid etching gel applied to the palatal enamel surfaces of both lateral incisors for 30 seconds and to the den- tine surfaces for 15 seconds before being rinsed off. The inner surfaces of the wings were conditioned to increase the surface roughness. After thorough cleaning of the surfaces, an adhesive (3M Scotch- bond Universal Adhesive) was applied, rubbed in, air-dried and light-cured according to the manu- facturer’s instructions. Then, 3M RelyX Ultimate Adhesive Resin Cement was applied and the bridge placed. The excess ce- ment was removed immediately with a sponge pel- let. To prevent a reaction of the uncured cement with oxygen and lay the foundation for a good mar- ginal integrity, the exposed margins were covered with glycerine gel (Fig. 13) and polymerised. Figure 14 shows the situation immediately after curing. Result The aesthetic appearance was already satisfactory, although the harmony was impaired by black trian- gles between the teeth. Due to the favourable char- acteristics of the ceramic, however, the soft tissue recovered quickly and closed the gaps. Figures 15 and 16 show the results eight weeks after the re- storative procedure. Discussion As an alternative to the selected treatment option, it would have been possible to place a removable partial denture or two two-unit adhesive bridges with one wing each. The former, however, is re- Fig. 13: Interfaces between tooth and restoration covered with glycerine gel. Fig. 14: Margins immediately after curing of the cement. Fig. 15: Aesthetically satisfying situation after eight weeks. Further recovery of the gingival tissues needs more time. Fig. 16: A natural look is obtained. 14 CAD/CAM 1 2017 garded as functionally less effective and not capable of supporting the preservation of soft and hard tissues. The two-unit adhesive bridges would have required stabilisation with a re- tainer. The main reason to opt against this alternative was the compromised value of the abutment tooth 22. As the root surfaces of the maxillary lateral incisors are small, it also seems questionable if this design would have offered sufficient stability to ensure the desired result. With regard to the restoration that was produced, the invasive prepara- tion is surely a matter of debate. How- ever, the existing preparation for the metal-ceramic bridge and the large composite restorations limited the amount of sound tooth structure that needed to be sacrificed at this point of the treatment to a minimum, so that the plan became acceptable. In general, the maximum preser- vation of tooth structure should always be given highest priority when a dental restoration is planned. Important criteria guiding the amount of hard tissue removal are the available intermaxillary space and the minimum wall thickness of the selected material. Due to the material selection in the present case, it is not necessary to remove the restoration as long as it serves its purpose. Thus, the planned long-term temporary might even become a definitive restora- tion over time. This, of course, is only possible with continuous monitoring and good compliance of the patient._ contact Dr Jan-Frederik Güth, PD Jan_Frederik.Gueth@med. uni-muenchen.de Hans-Jürgen Stecher, MDT info@stecher-zahntechnik.de