Chairside fabricated fiber-reinforced composite fixed partial denture

Abstract

The advances in the materials and techniques for adhesive dentistry have allowed the development of non-invasive or minimally invasive approaches for replacing a missing tooth in those clinical situations when conservation of adjacent teeth is needed. Good mechanical and cosmetic/aesthetic properties of fiber-reinforced composite (FRC), with good bonding properties with composite resin cement and veneering composite are needed in FRC devices. Some recent studies have shown that adhesives of composite resins and luting cements allow diffusion of the adhesives to the FRC framework of the bridges. By this so-called interdiffusion bonding is formed [1]. FRC bridges can be made in dental laboratories or chairside. This article describes a clinical case of chairside (directly) made FRC Bridge, which was used according to the principles of minimal invasive approach. Treatment was performed by Professor Vallittu from the University of Turku, Finland.

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Libyan J Med, AOP: 061206
Chairside fabricated fiber-reinforced
composite fixed partial denture

Sufyan Garoushi and Pekka K.Vallittu
Department of Prosthetic Dentistry & Biomaterials Science
Institute of Dentistry, University of Turku, Turku, Finland

Key Words: : Fiber-reinforced composite, fixed partial denture.

Introduction
The advances in the materials and techniques
for adhesive dentistry
development of non-invasive or minimally invasive
approaches for replacing a missing tooth in those
clinical situations when conservation of adjacent
teeth is needed. Good
cosmetic/aesthetic properties of fiber-reinforced
composite (FRC), with good bonding properties
with composite resin cement and veneering
composite are needed in FRC devices. Some
recent studies have shown that adhesives of
composite resins and luting cements allow
diffusion of the adhesives to the FRC framework of
the bridges. By this so-called interdiffusion
bonding is formed [1]. FRC bridges can be made
in dental laboratories or chairside. This article
describes a clinical case of chairside (directly)
made FRC Bridge, which was used according to
the principles of minimal invasive approach.
Treatment was performed by Professor Vallittu
from the University of Turku, Finland.

Clinical Case
The patient is a 33 year old female who lost the
first premolar because of root fracture caused by
occlusal trauma (Figure 1).

© Vallittu
have allowed the
mechanical and

Figure 1: Lateral view of the missing tooth.

The fabrication of a traditional fixed partial
denture was contraindicated due to patient's young
age and intact neighbouring teeth. As replacing
the missing tooth quickly is important to patient's
appearance. Directly made FRC bridge was
selected in order to provide quick and minimally
invasive fixed solution to the patient. The
treatment was completed during one visit to the
dentist.
Clinical Protocol
Materials used are shown in Table 1. There
were free spaces on the occlusal surface for fibers
of the framework. Consequently, no cavity
preparation for receiving vertical support for the
bridge was needed (Figure 1).

Table 1. Materials used in the study
Brand Manufacturer
Z100 3M ESPE,
Seefeld,
Germany
Composition
Aliphatic and
aromatic acrylic
monomer
Tetric
Color
Ivoclar,
Schaan,
Liechtenstein
Paste of
dimethacrylates,
silicon dioxide
and pigments
PMMA, Bis-
GMA,
E-glass fibers
60% BisGMA-
40% TEGDMA
everStick StickTeck Ltd,
Turku, Finland
Stick
Resin
StickTeck Ltd,
Turku, Finland
Scotchbon
d (multi-
purpose)
Adhesive.
PMMA: poly methyl methacrylate, Mw 220.000
BisGMA: bisphenol A-glycidyl dimethacrylate
EGDMA: triethylenglycol dimethacrylate
HEMA: hydroxyethyl methacrylate.

The rubber dam for good isolation was used. A
piece of resin impregnated glass fibers was cut
and spread from the ends for increasing the
bonding surface area (Figure 2).

3M ESPE,St
Paul, MN, USA
HEMA, Bis-
GMA, water


Figure 2: Placement of the fibers.

The fiber bundle was placed so that the buccal
cusp of premolar was encapsulated with the
© Vallittu
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Libyan J Med, AOP: 061206
fibers. Application of acid etching (37% phosphoric
acid gel). Subsequently, the gel was rinsed
thoroughly and gently air dried. Adhesive resins
were applied according to the manufacturer's
instructions (Figure 3).

© Vallittu

Figure 3: Bonding the tooth surfaces.

Flow composite was applied on the bonding
surfaces prior placing the fiber bundle. The flow
composite was not light cured before fibers were
pressed tightly against the tooth surface using
transparent silicone mould (Figure 4).

© Vallittu

Figure 4: Pressing the fiber bundle against the tooth
surface.

The resin impregnated fibers were light cured
initially through the silicone mould. The purpose of
the flow composite was to seal the space between
the fiber frame and the enamel surface. Placement
of an additional fiber bundle on the buccal surface
of the canine and pressed tightly against the fiber
that was applied (Figure 5).

Figure 5: Placement of an additional fiber bundle.

The fiber framework was polymerized two times
for 40 seconds. Fiber-frame
characterized by light curing paints (Tetric color)
(Figure 6).

work was

Figure 6: Applying of light curing paints.

Fiber-frame work was fully covered with a thin
layer of filling composite resin and pontic was
veneered with composite resin. (Figure 7).


Figure 7: Veneering the pontic area.

Care must be taken not to cut the reinforcing
fibers when interproximal spaces are opened
(Figure 8).
© Vallittu
© Vallittu
© Vallittu
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Libyan J Med, AOP: 061206

© Vallittu

Figure 8: Opening of the interproximal spaces.

Occlusion was carefully adjusted. Figures 9 and
10 show occlusal and labial views of the finished
restoration.

© Vallittu

Figure 9: Occlusal view of the finished bridge.


© Vallittu

Figure 10: Lateral view of the finished bridge.

Conclusion Remarks
The reported case has been followed for over
five years without any major or minor problems.
Based on current clinical results, it is reasonable to
expect FRC-fixed partial dentures may attain
longevity of 5-10 years [2-5]. However, it needs to
be emphasized the importance of using high
quality and proven materials with correct use of
the materials.


References
1. Vallittu PK. Experiences of using glass fibers
with multiphase acrylic resin systems. Theoretical
background and clinical examples. In: Vallittu PK,
Editor, The first International Symposium on Fiber-
reinforced Plastics in Dentistry, Institute of
Dentistry and Biomaterials Project, University of
Turku, Finland.
2. Vallittu PK. Survival rates of resin-bonded,
glass fiber-reinforced composite fixed partial
dentures with a mean follow-up of 42-months: a
pilot study. J Prosthet Dent 2004; 91:241-7.
3. Göhring TN, Roos M. Inlay-fixed partial
dentures adhesively and reinforced by glass fiber:
clinical and scanning electron microscopy analysis
after five years. Eur J Oral Sci 2005; 113:60-9.
4. Freilich MA, Meiers JC, Duncan JP, Eckrote
KA, Goldberg AJ. Clinical evaluation of fiber-
reinforced fixed bridges. J Am Dent Assoc 2002;
133:1524-34.
5. Farah JW. A 4-years clinical performance of
Sculpture/Fibrekor. Dental Advisor 2001; 18:6-7.
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