Broken Premolar/4-Unit Bridge

Published Date 07/16/2013

A 67-year-old male presented with an unremarkable health history. The patient presented with the lingual cusp broken off of the virgin upper right second premolar. The patient wanted the tooth fixed.

To arrive at a diagnosis, I took an x-ray of the patient's tooth. After sounding to bone with a perio probe, I found that the break was at or below the level of the bone.

The 2 options in this case were whether we should save the tooth or not. To restore the tooth, the patient would need a crown lengthening procedure, a root canal procedure, post and core, and a crown. If we did not restore the tooth, the patient would have a 2-tooth edentulous space in his mouth. To treat the 2-tooth edentulous, one option was to give the patient 2 individual implant teeth. Another option was to place a single-implant cantilever bridge. A third option was to give the patient a 4-unit traditional bridge.

After a full new-patient examination, I found that the patient's upper right first molar was going to need a large restoration or a crown to repair the carious lesion in it. This information swayed the patient to the 4-unit traditional bridge option. Time was also an issue, so time to do an implant would take too long. I was able to finish the bridge in fewer than 3 weeks and the patient was happy with this time frame. The patient already had a bridge on the lower left side that he was very happy with and he was cleaning it very well.

Throughout the case, I wanted to make sure the patient was comfortable because he showed some signs of sensitivity. To help with this issue, I placed Teethmate Desensitizer (Kuraray) on his preparation site to ensure a painless experience.

The challenge doing a traditional bridge is esthetics. I chose to extract the broken tooth at the time of appointment in order to try to maintain the extraction site. I then placed the temporary ovate pontic into the space to keep a real-looking emergence profile. I also was able to sound to bone in the edentulous space of tooth No. 5 and found that there was enough tissue to create the same ovate space for this pontic.

The patient and I were very pleased with the final outcome of this 4-unit bridge case.

Case Lingual Cusp

Case Occlusal View

Case Restored and Prepped

Case Teethmate Desensitizer

Case Extraction Site Healed

Gammichia 6

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