A Case Report on Fiber-reinforced Composite with Natural Pontic
Corresponding Author: Vasundhara Chandra, Department of Pediatric and Preventive Dentistry, Sharavathi Dental College and Hospital, Shivamogga, Karnataka, India, Phone: +91 9304239769, e-mail: firstname.lastname@example.org
Received on: 19 October 2022; Accepted on: 27 December 2022; Published on: 02 March 2023
Aim: Prosthetic rehabilitation of missing maxillary right central incisor in a 13-year-old boy.
Background: Loss of teeth at a young age, especially in the esthetic zone, can affect a child psychologically. The rehabilitation includes advanced options, such as implants to conventional fixed partial dentures. Since the development of a child is not complete, new methods like fiber-reinforced bridges can be taken into consideration that does not affect growth.
Case description: In the following case, a 13-year-old boy with missing 11 reported to the Department of Pediatric and Preventive Dentistry with a history of trauma that occurred 2 years ago. A treatment plan for a fiber-reinforced bridge with a natural pontic from another donor was selected. The natural tooth was sterilized and reduced to the desired shape and size. It was then fixed to the fiber-reinforced bridge with the help of a flowable composite.
Conclusion: Natural tooth pontic can be used as a single-visit replacement option for missing anterior teeth in a young child. Since it is a minimally invasive procedure, patient cooperation will also be good.
Clinical significance: The use of natural pontic is a minimally invasive, biocompatible, and cost-effective method for single-tooth replacement in a growing child.
How to cite this article: Chandra V, Babaji P, Kukkalli Kamalaksharappa S, et al. A Case Report on Fiber-reinforced Composite with Natural Pontic. CODS J Dent 2022;14(1):16-19.
Source of support: Nil
Conflict of interest: None
Patient consent statement: The author(s) have obtained written informed consent from the patient’s parents/legal guardians for publication of the case report details and related images.
Keywords: Fiber-reinforced composite, Natural tooth pontic, Trauma.
The loss of anterior teeth regardless of age or gender has a huge impact on the quality of life. Missing teeth in a highly visual zone due to trauma, periodontal infection, or failed endodontic treatment leads to esthetic, phonetic, and functional disability.1 The management options for replacing the anterior missing tooth include removable temporary acrylic prosthesis, resin-bonded bridges, metal and ceramic fixed partial dentures, and implant-supported prosthesis.2 There have been a number of different techniques described in the literature related to restorative dentistry, for splinting teeth using adhesive composite resins, wire, metal mesh, nylon, and so forth bonded to adjacent teeth and adding a natural tooth pontic, denture tooth, or composite resin tooth pontic.3
Case selection criteria for a natural tooth pontic bonded with fiber-reinforced composite (FRC) resin are the following:
Patients requiring a minimally invasive procedure.
Patient needs an immediate esthetic fix.
The extracted tooth crown and abutments must be in good condition.
Natural tooth pontic not present in a heavy stress.
Periodontally compromised teeth.
Unsuccessful reimplanted tooth.
Contraindications include the following:
Presence of parafunctional habits.
Short clinical crown.
Inadequate occlusal clearance space.
To provide the best possible treatment, factors such as the patient’s cosmetic and functional needs as well as the cost factor should be considered.
A 13-year-old boy with the chief complaint of a missing tooth in the upper front tooth region for 2 years reported to our department. The patient gave a history of fall from a bicycle 2 years ago, following which he had undergone treatment in a private dental clinic. The patient gave no significant medical or dental history. On clinical and radiographic examination, soft tissues and avulsed socket was all healed, missing maxillary right central incisor and a part of FRC was found attached to 12 and 21 (Figs 1A and B). The implant was not considered an option since the patient’s growth was not complete. The patient was very apprehensive about his esthetics and wanted an immediate replacement. An option of retaining the FRC resin and bonding with a natural pontic was selected for the prosthetic rehabilitation. Informed consent was taken from the parents before proceeding with the treatment. An alginate impression of the maxillary arch was taken. A natural tooth from another donor was selected, sterilized with autoclaving at 121°C for 20 minutes, and cut down to the desired shape using diamond burs (Fig. 1C). A horizontal groove was made on the lingual surface of the crown for better adhesion with the FRC (Fig. 1D). Etchant was applied on both the prepared tooth and the FRC, followed by rinsing and drying (Fig. 2A). Subsequently, the bonding agent was applied on the tooth and the FRC and cured for the 20s (Figs 2B and C). Then the sterilized tooth fragment was attached to the FRC with the help of flowable composite resin (Figs 3A and B). Excess composite was removed using a probe and curing of the fragment was done followed by checking for occlusion and finishing was accomplished. Posttreatment the patient showed satisfactory esthetics results (Fig. 3C). The patient was recalled after 2 weeks for follow-up but they did not turn up.
The first paper depicting the use of extracted tooth fragments as restorative materials was published by Chosak and Eidelman in the year 1964. The term “biologic restoration (BR)” was coined by Santos and Bianchi in 1991 and refers to the technique of bonding sterile tooth fragments, obtained either from a tooth bank or from the same patient, onto the teeth.5 Since biological restoration is a homogeneous technique, disadvantages of composite restoration, such as discoloration of the material over time are not expected.6
Classification of Biologic Restoration
According to a new classification proposed in 2018, BR can be of four types:
Type I: Autogenic-homodontic.
Type II: Autogenic-heterodontic.
Type III: Allogenic-homodontic.
Type IV: Allogenic-heterodontic.7
Replacement of missing teeth with a conventional fixed or removable partial denture is often bulky, involves tooth preparation of abutment teeth, and can cause hypersensitivity and pulp exposure. These BR can be attached to replace a missing tooth/teeth with different methods, such as FRC bridge.
The FRC bridges are adhesive in nature, minimally invasive, cost-effective, and can be used as a single-visit replacement of a missing tooth.8 FRC bridges can be used with three types of pontic- natural extracted teeth, acrylic resin teeth, and composite resin. The prefabricated acrylic resin teeth bonds unpredictably to the FRC bridge while the composite resin pontic even though esthetically pleasing can undergo discoloration over time. If a natural tooth in good condition is available, then it can be bonded easily to the adjacent teeth producing good esthetic and functional results.8
Natural tooth as pontic provide better esthetics, especially regarding translucency, and are less subjected to extrinsic discoloration when compared to composite restorations or acrylic teeth and is also a cost-effective restorative procedure.9
The main difficulty regarding biological restoration is the acquirement of the tooth, which can either be from a tooth bank or a legally donated extracted tooth. The donated tooth should go through a sterilization process to eliminate the risk of cross-infections. Sterilization can be performed with the use of an autoclave, 10% formalin, ethylene oxide, ultraviolet radiation, and sodium hypochlorite. In our study, sterilization was performed by autoclaving at 121°C for 20 minutes.6
Once the BR gets thoroughly sterilized, it can be easily attached to the adjacent teeth with the help of FRC.
Gandhy and Baviskar conducted a similar study where a 3.5-year-old girl had the chief complaint of avulsed tooth with respect to 61, which was restored with her own avulsed tooth as a natural tooth pontic but there was no follow-up mentioned for the study.10
Kukreja and Kukreja placed the patient’s own avulsed tooth as a natural tooth pontic in a 35-year-old woman who had a history of trauma that resulted in the avulsion of the tooth (31). On 6-month follow-up, no problem was reported and the patient was satisfied with the results.11
Fiber-reinforced composite (FRC) bridge with natural pontic is a minimally invasive procedure with lesser chair side time and cost. It is well accepted by young patients and can be used as a provisional treatment option for avulsion cases until the patient is developed enough to go with a more permanent option. The prognosis of the case depends on the dental hygiene maintenance and the follow-up of the patient.
Natural tooth pontic can be used as an interim treatment option, especially in young patients until their growth is completed and a more definitive treatment such as an implant or a conventional bridge can be advised. However, the age, motivation level, and oral hygiene measures of the patient should be considered before selecting a case for natural tooth pontic. The limitations of the study are a long-term follow-up of the case, longevity, and strength as compared to fixed restorative options and the availability of intact natural teeth.
The use of natural pontic is a minimally invasive, biocompatible, and cost-effective method for single-tooth replacement in a growing child.
3. Kumar KP, Nujella SK, Gopal SS, et al. Immediate esthetic rehabilitation of periodontally compromised anterior tooth using natural tooth as pontic. Case Rep Dent 2016;2016:8130352. DOI: 10.1155/2016/8130352
4. Parolia A, Shenoy KM, Thomas MS, et al. Use of a natural tooth crown as a pontic following cervical root fracture: a case report. Aust Endodont J 2010;36(1):35–38. DOI: 10.1111/j.1747-4477.2009.00174.x
7. Srivastava N, Rana V, Pande P, et al. Total crown replacement technique: a biological treatment option for grossly destructed primary molars. Indian Soc Pedod Prev Dent 2021;39(3):325–328. DOI: 10.4103/jisppd.jisppd_419_20
8. Khetarpal A, Talwar S, Verma M. Creating a single-visit, fibre-reinforced, composite resin bridge by using a natural tooth pontic: a viable alternative to a PFM bridge. J Clin Diagn Res 2013;7(4):772–775. DOI: 10.7860/JCDR/2013/4698.2909
11. Kukreja BJ, Kukreja P. Use of natural tooth as a pontic-a case report. Clin Dent 2012;6(7).
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