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Internal Root Resorbtion – using fibre technology and the patient's own tooth as a pontic. Clinical case by Dr Peet van der Vyfer.
The 13 year old patient visited the surgery after the 12 became mobile. She had had a trampoline accident some three years ago, when the mobile teeth were root canal treated and filled with gutta-percha. Peri-apical radiographs showed extensive internal root resorption, a diagnosis that was in line with the pink "blushing" observed on the palatal surface during the clinical examination.
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The palatal composite filling was removed. Note the amount of gingival tissue, causing the pink discoloration during the clinical examination.
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The extent of the internal root resorption can clearly be seen after removal of gingival tissue.
The gutta-percha and the fractured clinical crown were removed. It was decided to leave the remainder of the root in order for the active resorption to continue and not to cause severe tissue damage and resulting bone loss by attempting surgical removal.
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It was decided to use the patient's own tooth for an immediate bridge construction as her teeth had fluorosis stains that would have been difficult to incorporate into a final restoration. The removed crown was then etched, bonded and the palatal part was filled with composite.
After the rubber dam isolation was placed, the palatal surfaces of 11 and 13 were roughened by a round diamond drill and water.
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A shallow trench was prepared on the palatal surface of 12 (pontic). No preparations were done on the abutment teeth, illustrating the minimal invasiveness of these techniques. The pontic was secured to 11 and 13 with everStick®Net on the labial surface. The palatal surfaces of the pontic, 11 and 12 were then etched and an everStick® C&B fibre was bonded between these teeth. After light curing for 30 seconds the fibre was covered with composite, finished and polished.
An aesthetic end result was obtained.
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Loose crown, bleeding and inflamed gingiva. Pre-op x-ray.
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Root fracture due to metal post. Note the periodontal disease on tooth number 12.
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Implant and bone harvesting.
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Implant placed – due to periodontium health, not a candidate for immediate loading.
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everStick fibre framework, plumbers tape used for moisture and bleeding control.
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Layering technique to construct pontic.
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Pontic kept well away from implant healing cup to monitor healing process.
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End result.
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Temporization with everStick® C&B Fibre Strengthened Composite
The 34 year old patient knocked out his upper left central incisor (11) when he was 18 years old. After RCT the tooth was replaced. Over time the tooth discoloured and a direct composite veneer was placed.
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13 Years later the tooth became mobile and X-rays revealed massive internal resorbtion. The tooth was removed and an implant was placed. It was decided not to load the implant immediately but rather to manufacture a fibre strengthened direct bridge for the integration phase.
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After rubber dam isolation everStick® C&B fibres were bonded to the upper left central and on this sturdy cantilever structure a pontic was built with Z100™ composite. Eight months later the implant was fully integrated and a permanent implant-supported porcelain veneered to metal crown was placed.
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