MODIFIED FIBRE SPLINTING WITH NATURAL PONTIC

Case reference Quintessence Int 2004; 35:549-553.

The patient was diagnosed to have localized periodontitis with tooth no 42 having grade III mobility and severe bone loss. Remaining anteriors also needed splinting. The treatment plan was to do oral prophylaxis, and get the 42 extracted and placed as a natural pontic along with the splinting of other teeth.

The tooth after extraction was brought from the oral surgery clinic. Some gross calculus can be seen on the coronal portion and the apical third of root of the tooth.

The tooth was cleaned extra orally with the help of an ultrasonic scaler.

After thorough cleaning, the major half of the root was cut away. Access opening was done just as it is done in lower incisors though the opening was kept small to preserve tooth structure.

Apical view showing the opening which is later filled by composite




Facial of the same tooth.

Application of bonding agent on the whole of the surface of the tooth after acid etching.


Curing with UV curing unit after the application of bonding agent.



The finished view after the curing procedure.



The pontic was placed on the cast after taking the impression. It was fixed in the desired position with the help of wax. Care should be taken to place the pontic so that appears to emerge from the ridge but not directly over the ridge.
Also note that the tooth was placed so that no spacing is left on its mesial aspect in order to avoid the splint from being visible trough that space.


A stone key was made to secure the tooth in that position. The figure is after dewaxing.

The pontic with the stone key after dewaxing.

Acid etching of the teeth to be splinted along with the natural pontic.

Curing the same along with the fiber splint.Also note the stone key [green] holding the pontic in pre adjusted position.

Final result with patient having his smile back.
Though the pontic appears a bit lighter than the adjacent teeth but as any other tooth it will gain its darker shade when in the oral cavity for a month or two.

WIRE SPLINTING"A LOW COST ALTERNATIVE"

During the periodontal treatment, many cases are encountered which need splinting.
Though fiber splints are very popular now a days, a conventional method can sometimes prove to be very useful especially keeping in mind the economical condition of the patient. Moreover one more very strategic situation for wire only splint is if the procedure is to be done in the maxillary anterior tooth.
The major advantages are
No need for removal of tooth structure, as needed in wire and acrylic splint.
No interference in occlusion while using in maxillary arch.

The above picture shows the upper anterior teeth in traumatic occlusion which has caused considerable mobility of the teeth.

The lower teeth were reduced a bit with the help of diamond burs in order to relieve occlusion. Now a small amount of space is clearly visible between the upper and lower teeth.

The process of wire splintig starts by using a 28 or 26 gage wire. The wire is first of all prestretched by holding it with the help of needle holders at each end.

The first segment of wire about 25 cm is cut from the parent wire. Other 6 to 8 segments are made measuring about 10 to 12 cm long. Please note that the cut made with the help of the wire cutter should be at angle of about 45 degrees and not perpendicular to the wire. This ensures the easy passage of the wire through the interdental spaces.

The first longer wire is passed through the interdental space between canine and first premolar on one side to the same on the other side. The wire is then brought back to the starting point and then the two ends are twisted together. Care should be taken not to tighten the wire at this point of time. It should be left a bit slack.

Now the smaller segment is taken and it is passed from below the already tied wire, and grasped as it passes towards the lingual. The wire is the passed from lingual to buccal but now it should from above both the wires and from the next consecutive interdental space. The wire is then tied against the tooth as shown in the above picture. The main wire is now tightened a bit more, but not to the fullest.

Similar procedure is repeated for each tooth in the concerned area.
In the above figure all the required teeth have been tightened.

The wires are then cut in the twisted portion about 6 to 7 mm or long enough to be grasped and tucked in the interdental spaces or embrasures. The final result after wire splinting with wire ends in place.

SINCERE THANKS FOR TAKING TIME OFF TO VISIT THIS PAGE

Dr. Hamid Raihan

NATURAL PONTIC

THE EXTRACTED TOOTH AFTER ROOT REMOVAL AND BLEACHING
APICAL VIEW OF THE TOOTH TO BE USED AS NATURAL PONTICTREATED TOOTH FROM PALATAL VIEW
APPLICATION OF BONDING AGENT ON THE FACIAL SURFACE
LIGHT CURING AFTER FILLING THE REMAINING CANAL AND PULP CHAMBER PORTION WITH RESIN AND APPLICATION OF BONDING AGENT ON THE EXTERNAL SURFACES
FINAL GLAZE AND FINISHING DONE THE TOOTH IS NOW READY TO PLACED AS A PONTIC IN FIXED RESTORATION