Abstract
Aim
Bone resorption occurs after tooth extraction or implant loss and it is followed by gingival recession. Bone resorption may continue after restorations. As a result gingival recessions or diastema problems may arise, with the need to remove and renew the restorations, which is costly and time consuming.
The aim of this technical report is to solve this clinical problem without removing the restoration or performing any surgical procedures.
Technical report
This technical report describes the construction steps of a ceramic laminate veneer on a full ceramic cantilever bridge. This technique allows the rehabilitation of the condition with the laminate veneer obtained by doing a tooth-like preparation on porcelain surface instead of removing the restoration.
Conclusion
This technique allows to clinicians to rehabilitate interdental gingival recession and diastema problems without removing the bridge or applying any surgical intervention.
Keywords
Adhesive dentistry; All ceramics; Diastema; Laminate veneer; Gingival recession.
Introduction
Treatment options for partial edentulism are fixed partial dentures (FPDs), removable partial dentures (RPDs), overdentures and implant prosthesis (1). In single missing tooth situations, implant treatment can be preferred to avoid tooth preparation, though this may have some limitations caused by anatomical structures, for example maxillary sinus and mental foramina, insufficient bone quantity in the vertical and/or horizontal direction (2,3). Cantilevered fixed dental prosthesis is an appropriate treatment option in case of risks factors related to anatomically and limited financial situation of the patients (4).
Interdental gingival recession is defined as marginal periodontal tissue removing from normal position to cemento-enamel junction (5). Interdental papilla morphology of the incisors is more important than the other gingival areas in terms of functional and esthetic results (6,7). In addition, interdental gingival recession contributes to phonetic problems and food impactions (8).
There are some surgical procedures for the treatment of gingival recession, such as laterally positioned flap, free gingival graft, coronally advanced flap (CAF), subepithelial connective tissue graft (SCTG), guided tissue regeneration with membranes, acellular dermal matrix, platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) in combination with CAF (9). These procedures are time-consuming, costly and also interventional. Alternative treatment methods are required for clinicians when there are limitations in terms of the patient's economic status, systemic diseases and expectations.
In this article, the process of construction of ceramic laminate veneer on prepared ceramic surface is described.
Technical report
Veneer preparation is performed on existing ceramic cantilever crown. Tapered round-ended diamond burs (Acurata GmbH & Co. KG) are used for preparing a chamfer finishing line on the cervical area. Then, about 0.3-0.5 mm are reduced from labial surface and a light chamfered marginal finish line is extended on the mesial proximal area (Figure 1).
After preparation, impression is taken using a polyether impression material (Impregum, 3M ESPE).
Before starting cementation procedure, the preparation surface is cleaned with polishing paste and brush.
When the porcelain laminate veneer is ready, teeth are isolated with rubber dam (Roeko Dental Dam, Coltene), upper right canine and upper right central incisor are also covered with polytetrafluoroethylene tape.
For surface preparation 4% hydrofluoric acid (Porcelain Etchant, Bisco) is applied for 1 min (Figure 2), then washed for 1 min and dried with oil free compressed air.
A silane coupling agent (Monobond S, Ivoclar Vivadent) is applied for surface preparation and allowed to react 1 min (Figure 3).
A thin layer of light curing bonding agent (Heliobond, Ivoclar Vivadent) is applied to the preparation surface and any excess is removed with compressed air (Figure 4).
After finishing the process of surface preparation, 4% hydrofluoric acid (Porcelain Etchant, Bisco) is applied to the inner surface of the porcelain laminate veneer for 1 min (Figure 5).
Then it is washed for 1 min and dried with oil free compressed air. After etching, the laminate veneer is ultrasonically cleaned in distilled water for 5 min in order to remove debris.
A silane coupling agent (Monobond S, Ivoclar Vivadent) is applied to the laminate veneer and allowed to react 1 min (Figure 6).
A thin layer of light curing bonding agent (Heliobond, Ivoclar Vivadent) is applied to the inner surface of the porcelain laminate veneer (Figure 7), any excess is removed with compressed air.
Resin cement (Variolink Veneer Esthetic N LC, Ivoclar Vivadent) is applied to the laminate veneer inner surface.
After placement of the laminate veneer, the labial surface of the laminate veneer is light-cured for 3 s (Figure 8). The light (Bluephase, Ivoclar Vivadent) has to be at least 800 mW/cm2.
Excess cement is removed with blade (Broche Blade, Broche Medical).
For oxygen inhibition layer, glycerine gel (Liquid-Strip, Ivoclar Vivadent) is applied to the border of the fracture and light-cured for 40 s on the buccal, palatal and marginal sides.
After removing the rubber dam, excess cement is cleaned with dental floss (Oral B Essential Floss).
After rinsing the glycerine gel, excess cement is removed with low speed handpiece and finishing burs under water.
Restoration margins are further polished with silicone polishers (EVE Diapol Twist, Ernst Vetter GmbH).
Occlusion is checked for each centric and eccentric movement.
Discussion
Although the results of surgical treatments in gingival recession may be closer to nature because the tissue heals spontaneously itself, surgical treatments may not be appropriate in all cases. In this situation, removing the restoration is an alternative option. Cost, loss of time, the possibility of damaging the tooth tissue or restoration are among the disadvantages of removing the restorations. This technique becomes a solution for the cases when removing the restoration and surgical procedures are not suitable.
Conclusion
This technique allows to clinicians to rehabilitate interdental gingival recession and diastema problems without removing the bridge or applying any surgical intervention.
References
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