Use of polyethylene ribbon to create a provisional xed partial denture after immediate implant placement: A clinical report

Gurcan Eskitascoglu, DDS, PhD,a Ayse Eskitascoglu, DDS, PhD,b and Sema Belli, DDS, PhDc Faculty of Dentistry, University of Selcuk, Konya, Turkey
Provisional restorations are generally necessary to restore lost function and esthetics during the implant integration period. This article describes the fabrication of an esthetic, economic, and conservative bonded provisional xed partial denture for a patient restored with implants. A reinforcing polyethylene ribbon was used to bond the natural lateral incisors to the adjacent teeth. An acceptable esthetic outcome was obtained, and the result was satisfactory to the patient. (J Prosthet Dent 2004;91: 11-4.)

lacement of implants immediately after extractions can be an advantage.1 They signicantly prevent the collapse of hard and soft tissues, minimize augmentation procedures, and frequently lead to the desired emergence prole of the implant restoration.2 However, osseointegrated bone healing takes time. Periods of 3 to 4 months and 4 to 6 months have been recommended as healing times for osseointegrated implants placed in the mandible and maxilla, respectively.3,4 During this period, esthetic appearance may become the patients chief complaint, especially when anterior teeth are involved.1 Provisional xed partial dentures may solve this problem, but an economic, durable, and esthetic provisional xed denture, which does not require preparation of abutment teeth, was not previously possible because traditional materials lacked adhesive capability and required mechanical preparation for the retention of restorative materials.5 With recent advancements in adhesive technology, new and stronger composite materials, and the development of a bondable polyethylene ber, it is possible to create a conservative, highly esthetic prosthesis that is bonded directly to the teeth on either side of the missing tooth.6 Ribbond (Ribbond, Inc, Seattle, Wash) is an ultrahigh molecular weight polyethylene ber that is woven into a porous ribbon. It is biocompatible, inert, colorless, pliable, and compliant.7 These properties make it attractive for use in both direct and indirect restorations.6-8 This clinical report describes the fabrication of a provisional restoration using Ribbond ribbon and extracted lateral incisors as natural pontics.

Fig. 1. Labial view of anterior teeth before treatment.

CLINICAL REPORT
A 47-year-old man with missing maxillary posterior teeth was evaluated for restorative treatment with osa

Professor and Chair, Department of Prosthodontics, University of Selcuk. b Private Clinician, Periodontologist, Ankara, Turkey. c Associate Professor and Chair, Department of Endodontics, University of Selcuk. JANUARY 2004

seointegrated implants. His chief complaint was lack of masticatory function likely due to loss of posterior teeth and mobility of maxillary teeth (Figs.1 and 2). Clinical and radiographic examination revealed root resorption of lateral incisors with Class III mobility using Nymans criteria.9 The remaining maxillary incisors and premolars exhibited Class I mobility. The maxillary sinuses were expanded, possibly because of early tooth extraction. Residual alveolar bone was inadequate for a singlestage implant placement procedure. Only the maxillary tuberosity region had adequate bone thickness for implant placement. Restorative options (removable prosthesis and maxillary sinus lift procedure) were discussed and explained to the patient. The patient did not accept a removable prosthesis and additionally refused maxillary sinus lift procedures to provide adequate bone for implant placement. Extraction of the lateral incisors, an immediate implant protocol for the anterior region, and placement of 2 implants for the posterior tuberosity region was planned after periodontal treatment, consisting of oral hygiene instruction, root planning, and scaling. Splinting the teeth with a xed partial denture using wide and long implants was the treatment of choice. The patient accepted the treatment plan but was concerned
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ESKITASCIOGLU, ESKITASCIOGLU, AND BELLI

Fig. 2. Panoramic radiograph before treatment.

Fig. 3. Panoramic radiograph after placement of implants.

about his esthetic appearance after extraction of the lateral incisors. Therefore, the extracted lateral incisors were planned as natural tooth pontics for a provisional adhesive restoration.6 The lateral insicors were extracted. Two hydroxyapatite-coated, 15 3.75-mm, threaded implants (Sulzer Medica; Sulzer Calcitek Inc, Carlsbad, Calif) were placed immediately to the anterior region. Two additional 10 5-mm cylindirical posterior implants (Calcitek) were placed in the posterior tuberosity region (Fig. 3). The roots of the extracted lateral incisors were removed below the cemento-enamel junction using a high-speed diamond bur under water cooling. After the pulp tissue was removed, the coronal pulp chamber was irrigated, dried, treated with a dentin bonding agent (Clearl SE Bond; Kuraray, Osaka, Japan), and restored with composite (Clearl AP-X; Kuraray). The lingual surfaces of the crowns were trimmed
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as a pontic, covered with composite and polished using polishing discs (Nos. 281, 282, 283, and 284; Hawe Neos Dental, Bioggio, Switzerland). A groove was then prepared on the lingual surfaces of the teeth for the Ribbond ribbon (Fig. 4, A). A 2-mmwide strip of aluminium foil (Ribbond Inc) was burnished onto the lingual surface of the abutment teeth to determine the length of Ribbond (Ribbond, Inc) needed. With a hand instrument, the foil was placed interproximally so that it closely adapted to the contours of the teeth. The measured length of Ribbond was then cut and kept on a clean pad until ready for use (Fig. 4, B). The abutment teeth were cleaned using a prophylaxis cup with a pumice paste (Prophy Paste; SDI, Borlange, Sweden) and then throughly rinsed and dried; the lingual and interproximal enamel surfaces were etched for 45 seconds (K-Etchant; Kuraray). The etched surfaces
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Fig. 5. Provisional FPDs in place.

Fig. 4. A, Groove prepared on lingual surface. B, Ribbond selected according to width of groove.

of the teeth were covered with a layer of unlled bonding resin (Clearl Photo Bond; Kuraray), gently air thinned, and polymerized for 20 seconds. The following steps were performed without using the overhead operatory light to prevent premature polymerization of the composite. A thin layer of a owable composite (Star-ow; Danville Materials, San Ramon, Calif) was applied to the etched lingual and interproximal surfaces of the teeth using a syringe, but the material was not polymerized. The ribbon was wetted with a light coating of unlled bonding adhesive (Clearl Photo Bond; Kuraray), and excess material was removed with a hand instrument. Using a hand instrument, ribbon was pressed into the unpolymerized owable composite and placed interproximally and kept straight between the interproximal contacts of the abutments. After polymerizing for 20 seconds with a light polymerizing unit (Hilux 350; First Medica, Greensboro, NC) at 350 mW/ cm2, owable composite was placed on the ber between the abutment teeth, and a second piece of ribbon was applied to the surface of the composite. Excess composite around each tooth was removed, and the exposed surface of the Ribbond was light polymerized for 40 seconds with the same light-polymerizing unit. The lingual surface of the pontics were then prepared for bonding by acid etching and application of a thin
JANUARY 2004

Fig. 6. Labial view of adhesive restoration with natural tooth pontics.

Fig. 7. Labial view of denitive implant-supported xed prosthesis.

layer of unlled resin followed by light polymerization for 20 seconds. After applying a thin layer of owable composite into the grooves prepared on palatal surfaces, the pontics were placed on to the second Ribbond rib13

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bon in the desired position and light polymerized for 40 seconds. Excess material was removed, and the composite covered ribbon was then polished with a composite polishing disc (Nos. 281, 282, 283, and 284; Hawe Neos Dental) and composite polishing kit (No. 850; Kenda AG, Vaduz, Liechtenstein). Figure 5 represents the occlusal view of the provisional restoration and Figure 6 shows labial view of the provisional xed partial denture with the natural tooth pontics. After 4 months of healing, the provisional restoration was removed and the implant-supported xed partial denture was placed (Figs. 6 and 7).

SUMMARY
This article describes an esthetic and economic bonded provisional xed partial denture used in an immediate implant situation. The extracted lateral incisors of the patient were used as pontics, and the xed partial dentures were fabricated using a bondable reinforcement ber. Although long-term durability of this adhesive xed partial denture is still unknown, it was successful for this patient during the 4-month healing period.
REFERENCES
1. Schwartz-Arad D, Chaushu G. The ways and wherefores of immediate placement of implants into fresh extraction sites: a literature review. J Periodontol 1997;68:915-23.

2. Fonseca RJ. Oral and maxillofacial surgery: reconstructive and implant surgery. 1st ed. St Louis: Elsevier; 2000. p. 227. 3. Albrektsson T, Branemark PI, Hansson HA, Lindstrom J. Osseointegrated titanium implants. Requirements for ensuring a long-lasting, direct boneto-implant anchorage in man. Acta Orthop Scand 1981;52:155-70. 4. Branemark PI. Osseointegration and its experimental background. J Prosthet Dent 1983;50:399-410. 5. Black AD. G.V. Blacks operative dentistry (vol 2): technical procedures in making restorations in the teeth. Chicago: Medico-dental Publishing; 1955. 6. Belli S, Ozer F. A simple method for single anterior tooth replacement. J Adhes Dent 2000;2:67-70. 7. Rudo DN, Karbhari VM. Physical behaviors of ber reinforcements as applied to tooth stabilization. Dent Clin North Am 1999;43:18-20. 8. Strassler HE. Aesthetic management of traumatized anterior teeth. Dent Clin North Am 1995;39:181-202. 9. Nyman S, Lindhe J, Lundgren D. The role of occlusion for the stability of xed bridges in patients with reduced periodontal tissue support. J Clin Periodontol 1975;2:53-66. Reprint requests to: DR SEMA BELLI SELCUK UNIVERSITY FACULTY OF DENTISTRY DEPARTMENT OF ENDODONTICS 42079 CAMPUS, KONYA TURKEY FAX: 90-332-241-0062 E-MAIL: sbelli@selcuk.edu.tr 0022-3913/$30.00 Copyright 2004 by The Editorial Council of The Journal of Prosthetic Dentistry.

doi:10.1016/j.prosdent.2003.09.019

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