Digitally Designed Snap-It
A 76-year-old male patient required replacement of a porcelain-on-metal crown on tooth No. 5.
The patient's medical history was noncontributory, and his periodontal condition was healthy. Benzo-Jel (Henry Schein) was placed on the buccal of tooth No. 5, and the patient was anesthetized with lidocaine HCL 2% and epinephrine 1:100,000 (Henry Schein). A study model was taken using Silginate (Kettenbach). The counter bite was taken using Monophase (DenMat). I removed the crown and excavated the decay using a #4 friction grip carbide bur mounted on a high-speed and right angle handpiece. I used 3.5 X magnification loupes (Designs For Vision) with an LED Day Lite.
The tooth required conventional root canal therapy. The patient and I discussed all treatment options; he elected to have the tooth replaced with an implant. During the healing process, the patient would have to wear an interim removable restoration. In our office, we keep models of conventional acrylic flippers and Snap-On-Smile (DenMat). I discussed the advantages and disadvantages of both appliances (sidebar). The patient chose Snap-It, a quadrant version of Snap-On-Smile.
We placed core build-up material (CorePaste XP, DenMat), and the tooth was prepared to receive a temporary crown. A bite registration was taken using Imprint Bite (3M), and the temporary was fabricated using Protemp Plus (3M) shade A2. The lab slip requested a hygienic pontic, CHROMASCOP universal shade 3A/310. Coverage 3=4=5=6=7 was indicated, and we informed the Cerinate Smile Design Studio (DenMat) about the extraction of No. 5 at the time of delivery of the Snap-It.
The patient returned 3 weeks later for extraction and delivery of the Snap-It. The patient was given NuCalm, a new technology that relaxes patients and allows the dentist focus on the dentistry. The patient was anesthetized. A small flap was reflected and the tooth was extracted atraumatically; the socket was debrided and irrigated. A Cerasorb M Dental (Curasan) 1.0 mL bone graft was placed along with CalMatrix (Citagenix). A bone graft barrier, CalForma (Citagenix) was placed followed by 4-0 silk black braided sutures. The Snap-It was inserted easily. Occlusion was checked and verified.
At follow-up visits, normal healing was in progress and the patient was extremely satisfied. At the patient?s 4-month follow-up, he was referred for implant CBCT scans and placement of a 3i NanoTite Certain PREVAIL implant (Biomet 3i).
Snap-On Smile vs. Conventional Flipper
- No tooth preparation required
- Can increase the esthetics of the abutment teeth
- Can be cantilevered
- Can maintain vertical dimension
- Retention is maintained by using the adjacent teeth heights of contour at the gingival third
- Does not cover the palate
- It meets the gingival tissue without impinging on it
- Can lead to more extensive cosmetic dentistry
- Can be used as a surgical guide for implant placement
- Can increase practice revenue
- Can specify type of pontic
- Cannot be used on severe periodontal cases
- If severe protrusion, cannot be used
- More expensive than conventional flipper
Conventional Dental Flipper—Advantages
- The least expensive way to replace missing teeth
- Ease of fabrication
- Fast turnaround from dental lab.
- Can be fabricated in dental office
- Can add teeth
- Can be cantilivered
Conventional Dental Flipper—Disadvantages
- Brittle acrylic
- Can break easily
- Tissue pressure
- Unsightly clasps
- If clasps are incorrectly placed mastication is impeded
- Sometimes tooth recontouring is required in the interproximal occlusal embrasure to allow space for clasping
- Taste and speech can be impeded
- Has to be relined as the bone reabsorbs
- Shade selection is critical in matching adjacent teeth
- Adhesives might be required
- Palatal coverage some patients cannot tolerate