INTERVIEW

PAULOKANO

BALANCING THE SMILE

CAD/CAM PRETTAU® BRIDGES FOR AN EDENTULOUS PATIENT

DR. DAN LAZARDT. FLORIN STOBORAN

PHD. PROF. WAEL ATT DT. MANFRED PÖRNBACHER

IMPERFECTION MAKES PERFECTION

DENTAVANTGART

VOLUME V ISSUE 01 SPRING 2015

DT. JAMES CHOI

28 SPRING 2015

5C A S E

l a b l i n e # 1 7 ( s p r i n g 2 0 1 5 )

29SPRING 2015

MISSING LATERAL TEETH AND BONDED CANTILEVER BRIDGES IN LITHIUM DISILICATE:

A CURRENT AND ESTHETIC SOLUTION« C'est peut-être chez les artisans qu'il faut aller chercher les preuves les plus admirables de la sagacité de l'esprit, de sa patience et de ses ressources. »Jean Le Rond d’Alembert

D r . G i l T i r l e t | H é l è n e & D i d i e r C r e s c e n z o ( E s t h e t i c O r a l )

The unit anterior absence of teeth represents the difficult challenge of the esthetic integration on a prosthetic aspect. The use of bonded bridges is not new and many authors have published about this since the work of Livatidis school, Thompson, Del Castillo (Maryland school) in the mid-eighties [  1  ]. For most of them, the results in terms of clinical durability are very good and nearly all these works use a metallic infrastructure [ 2 ]. Since then, the amazing development of bonding and the improvement of the mechanical and optical properties of new ceramics have led us to consider the use of a more esthetic and biocompatible material [ 3, 4, 5 ]. Thus, the recent works (Kern, 2005, Kern, 2011, Ries, 2006 [ 4, 5, 6 ] suggest the use of bonded cantilever bridges (only leaning on a dental support) in ceramics.

This therapy seems to represent a subtle alternative, contemporary and realistic to the anterior implant, particularly in cases of agenesis of the lateral teeth or trauma on teenagers or young adults. Indeed, for these patients, we perfectly know that it is difficult, even illusory, to precisely determine at what age the growth will stop [ 7 ]. Therefore, when laid prematurely, the implant behaves like a « rigid » system in comparison with a natural tooth, which frequently raises the problem of keeping the alignment and the harmony of the lines of the cervical area compared to the natural adjacent teeth. Moreover in these specific cases, we often face a lack of the supporting tissues and the use of onlay grafts of soft tissues often applies.

The case that we are presenting is made with a lithium disilicate vitro-ceramic (e.max Press). To this day, with our team, we have realized nearly 40 bonded fabrications with cantilever of this type for the last five years. The CPC technique (pressed ceramic) makes the realization at the laboratory easier to fabricate these technically delicate pieces [ 8 ]. The results of the main clinical studies available seem to perfectly confirm our choice [ 9, 10,11 ].

30 SPRING 2015

1 Initial Situation. Young female, 14 years old, after orthodontic time. Missing 12 and 22 (agenesis).

2 Initial situation. Missing 12 and 22 (agenesis) Loss of bone and tissue in 12 and 22 areas.

3 Palatal clinical View: lack of developed surface on palatal side on 11 and 21 causes hyperplasia after orthodontic time.

4 View of occlusion. It seems to be a favorable situation in the context of occlusion.

6 Ovate pontics prepared with laser,with a transparent splint and provisional teeth above them for ten days.

5 Buccal view with contrastor to underline optical specificities on 11 and 21.

31SPRING 2015

8 Vestibular view of the initial model.

7 Design preparation with oblique axis for the insertion, proximal boxes (minimal size 12 mm2) and macro retention for stability. All the preparation is in the enamel.

9 Palatal view of the model.

32 SPRING 2015

10 Realization of the frames with the CPC technique.

11 Frames of the cantilever before pressing.

12 The two cantilevers after pressing.

13 Two cantilever bridges in lithium disilicate (e.max Press) after layering.

14 15

1614. Final result after bonding (one week later).

15. Two ceramic partial restorations (e.max Ceram) chips to modify canines axis.

16. Final situation after bonding the two chips on 13 and 23.

33SPRING 2015

17. Final restorations on the palatal side.

18. Buccal integration in black and white.

19. Three years follow-up (with two lateral softboxes).

34 SPRING 201520 Final integration.

SPRING 2015 35

DR. GIL TIRLET HÉLÈNE NIZARD-CRESCENZO DIDIER CRESCENZO

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[  1  ] Livaditis GJ, Thompson VP. Etched castings: An improved retentive mechanism for resin-bonded retainers. J Prosthet Dent 1982; 47: 52–58.

[  2  ] Degrange M, Wehbi D, Roques-Carmes C. Mechanisms of anchorage and adhesion in bonded bridges. 1: Effect of surface treatment on the strength of bonded joints. Cah Prothese. 1985 Dec; 13(52):135–48.

[  3  ] Botelho MG, Lai CN, Ha WK, Bih SK. Two-unit cantilevered resin-bonded fixed partial dentures – A retrospective, preliminary clinical investigation. Int J Prosthodont 2000; 13:25–28.

[  4  ] Kern M. Clinical long-term survival of two-retainer and single-retainer allceramic resin-bonded fixed partial dentures. Quintessence Int. 2005 Feb; 36(2): 141–7.

[  5  ] Ries S, Wolz J, Richter EJ. Effect of design of all-ceramic resin-bonded fixed partial dentures on clinical survival rate. Int J Periodontics Restorative Dent. 2006 Apr; 26(2): 143–9.

[  6  ] Kern M, Sasse M. Ten-year survival of anterior all-ceramic resin-bonded fixed dental prostheses. J Adhes Dent 2011; 13: 407–410.

[  7  ] Behrents RG. The biological basis for understanding craniofacila growth during adulthood. Prog Clin Bio Res 1985; 187: 307–319.

[  8  ] H. Crescenzo, D. Crescenzo Nouvelle technique de mise en oeuvre pour la céramique pressée (CPC). QRIPD, 2/2014; 114–124

[  9  ] Sailer I, Bonani T, Brodbeck U, Hämmerle CH. Retrospective clinical study of single-retainer cantilever anterior and posterior glass-ceramic resin-bonded fixed dental prostheses at a mean follow-up of 6 years. Int J Prosthodont. 2013 Sep-Oct; 26(5): 443–50. doi: 10.11607/ijp.3368.

[  10  ] Qiang S, Lei Chen, Lilli T, Bahuoa X. Single-tooth replacement in the anteriorarch by means of a cantileveres IPS emax press veneer-retained fixed partial denture: case series of 35 patients. Int J Prosthod 2013; Vol 26, 2, 181–187

[  11  ] Lam WYH, Botelho MG, McGrath CPJ. Longevity of implant crowns and 2-unit cantilevered resin-bonded bridges. Clin Oral Implants Res. déc 2013; 24(12): 1369–1374.

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