Immediate Provisionalization Before Implant Placement
An 18-year-old female presented with tooth No. 7 missing after a history of trauma. At age 7, she fell and the tooth avulsed. It wasn't stored in any "liquid" or ideal environment, and when it was reimplanted, the results were compromised. No endodontic treatment was performed and at age 16, the patient lost the tooth; a temporary was fabricated. Subsequently, she had a bone graft using DynaBlast DBM Paste (Keystone Dental) plus a membrane barrier placed after decortification of the site; another temporary was placed. The patient again lost her temporary, and it was rebonded with resin composite at another clinic.
Looking for a longer-lasting treatment option, the patient came to the Advanced Program for International Dentists in Aesthetic Dentistry at NYU. Her oral hygiene was good; radiographic, oral cancer examinations, and medical history were within normal limits.
We decided to create a composite bridge with fiber reinforcement. The selected material was Ribbond bondable reinforcement ribbon, Ribbond-thm Thinner Higher Modulus 3 mm (Ribbond, Inc).
The use of fiber reinforcement provides distinct advantages in composite restorative techniques. The use of ultra-high molecular weight polyethylene (UHMWP) fibers is based on the improvement of the composite resin mechanical properties and behavior. To reinforce the restoration in multiple directions, woven fiber and meshes have been proposed, where isotropic properties are achieved.
Incorporated into composite materials, the fibers provide enhanced fracture resistance, indicating their application even when high stress is present in the oral environment. The 2 key reasons for using the fiber-reinforced composite for this case: minimal removal of sound dental structure and esthetics.
The treatment is described in the figure captions. After a painless, fast, in-office procedure, the patient left very happy and able to smile with new self-confidence.
This was not your typical patient who wanted to improve her smile. Even though she had upper anterior teeth that were out of position, she wanted only her front tooth restored to its original position.