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Short Communication

Glass fiber reinforced composite fixed partial


denture as provisional tooth replacement in
pre-adolescent age: A clinical report
Kaushal Kishor Agrawal, Pooran Chand, Neeraj Mishra, Kamleshwar Singh
Department of Prosthodontics and Dental Material Sciences, F.O.D.S, C.S.M. Medical University, Lucknow,
Uttar Pradesh, India

Address for correspondence: Dr. Kaushal Kishor Agrawal, E-mail: drkaushalp@yahoo.co.in

ABSTRACT
The loss of anterior teeth is often a serious esthetic concern. Conventional fixed partial denture and implant-supported restorations
may be the treatment of choice although non-impregnated fibers and fiber reinforced composite resins offer a conservative
alternative for improved esthetics. This article describes a clinical situation in which non-impregnated fiber glass ribbon and
fiber reinforced composite are successfully used to provisionally restore anterior edentulous area in an esthetic, functional and
timely manner.
Key words: Esthetic, fiber reinforced composite resin, pontic

INTRODUCTION

raumatic damage to anterior teeth is a


common form of injury, particularly in children
and adolescents. Patients presenting with traumatized
or lost anterior teeth require immediate attention for
restoration of esthetics and function. Since wearing of
removable appliances is inconvenient to the patient,
fixed provisional restoration is a good alternative of
choice.
Today, technology allows the opportunity to test
new materials for use as provisional replacement.
Fiber-reinforced composite resins (FRCRs) are new to
the pediatric dental market, and they can be used as
fixed alternative for provisional replacement.
FRCRs materials such as a pr e-impr egnated
unidirectional glass fiber system[1] or a multidirectional,
leno-weave reinforcement ribbon[2] used with resin
bonding techniques is available for quick and esthetic
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DOI:
10.4103/2229-5194.94195

Journal of Interdisciplinary Dentistry / Jan-Apr 2012 / Vol-2 / Issue-1

replacement. This clinical report presents a technique


for fabricating a provisional anterior fixed restoration
with composite, reinforced with non-impregnated
unidirectional glass fibers. This is a non-invasive
and reversible procedure during the time period
necessary to develop and implement the definitive
treatment plan.

CASE REPORT
A 12-year-old patient with missing maxillary right
central incisor was referred for prosthetic treatment
to Department of Prosthodontics, Chattrapati
Sahuji Maharaj Medical University. Chief complaint
was demand for esthetic replacement of missing
maxillary anterior tooth. The clinical and radiographic
examinations revealed that the patient had missing
maxillary right central incisor, stablemaximum
intercuspation position, canine protected occlusion
and adequate periodontal health and root support
without any residual ridge deficiency but mandibular
right central incisor impinging incisive papilla
[Figure1]. Conventional fixed partial denture and
implant supported restoration could not be planned
due to large pulp chamber of abutment teeth and
unwillingness of patient for surgical procedure
respectively, so provisional restoration was planned.
Interim removable partial denture and glass fiber
reinforced composite resin fixed partial denture
51

Agrawal, etal.: Provisional replacement of anterior edentulous space

(FRCFPD) were presented to patient as treatment options.


The merits and demerits of these options (prosthesis) were
also discussed. The patient desired for a FRCFPD rather
than interim-removable partial denture.
Enameloplasty of mandibular right central incisor was
done to protect the incisive papilla from impingement
and the palatal groove, at least three quarters of the
mesiodistal width of the abutment teeth, was prepared
on the palatal surfaces of the right maxillary lateral and
left maxillary central incisors using a round diamond
rotary cutting instrument (G+K Mahnhardt Dental,
Thurmansbang, Germany). The length of fiber ribbon
(Interlik,Angelus,Brasil) was determined by placing a piece
of dental floss from the distal surface of one abutment
tooth to the distal of the other, and a piece of the fiber
ribbon was cut to this length. The abutment groove
surfaces and the mesio-proximal surface of the right
maxillary lateral and disto-proximal surface of the left
maxillary central incisor were etched with 37% phosphoric
acid (Total Etch, Ivoclar,Vivadent) for 30 s. The preparations
were rinsed with water and thoroughly dried.The ribbon

was prepared for bonding by first wetting it with a bonding


agent (Single Bond, 3MESPE). A small amount of a hybrid,
small particle, universal composite resin (Z100, 3M ESPE)
was injected into the groove. The ribbon was bonded
to the lingual surfaces of the abutment teeth [Figure2].
Alayer of composite resin, approximately 0.5mm thick,
was placed on top of the ribbon to secure it in place. The
pontic was built directly in mouth and it was bonded to
acid-etched enamel and the freshly polymerized FRC
framework and its air-inhibited surface [Figure3].This
resulted in an excellent bond between the FRC and the
lingual surfaces of the abutment teeth and the pontic
to the proximal surfaces of the abutments [Figure4].
The occlusion was evaluated with articulating paper
(Hanel Articulating Paper; Coltne/Whaledent, Inc), the
premature contacts were eliminated, and the provisional
FPD was polished with an abrasive impregnated rubber
finishing system (Enhance, Dentsply Intl, York, Pa).
Patient was instructed to maintain oral hygiene. Over
the 12 month period following the FRCFPD, the patient
was examined 4 times. Evaluation of the restorations
at these visits indicated that there was no plaque
accumulation on the fiber-composite resin combination,
and no caries was observed on the abutment teeth.

Figure1: Missing right maxillary central incisor


Figure2: Ribbon bonded to the lingual surfaces of the abutment teeth

Figure3: Right maxillary central incisor pontic bonded to acid-etched


enamel and the freshly polymerized FRC framework and its air-inhibited
surface
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Figure4: Lingual view of GFRCFPD


Journal of Interdisciplinary Dentistry / Jan-Apr 2012 / Vol-2 / Issue-1

Agrawal, etal.: Provisional replacement of anterior edentulous space

DISCUSSION
This clinical report describes the successful esthetic
provisional replacement of a central incisor in pre-adolescent
patient with conservative FRCFPD over short-term follow-up.
The development of dentin adhesive systems has led to
simpler and minimally invasive preparations.[3,4] Adhesive
resin cements are composite resins that have a decreased
proportion of filler, with an organic polymer matrix of
bis-GMA and UDMA, an inorganic filler, bonding agent,
initiators and pigments.[5] Newly introduced resin luting
agents have higher proportions of filler.[5] The combination
of the resin luting agent and bonding systems is one of the
most important factors for retention of these restorations.
FRCFPDs have potential to be used as long-term provisional
restoration.[6] Continuous fiber-reinforced composites (FRCs)
have good flexure strength and other desirable physical
characteristics as a fixed prosthesis substructure material.[7-9]
In addition, the FRC substructure is translucent and requires
no opaque masking, which allows for a relatively thin layer of
particulate covering composite and excellent esthetics. The
light-polymerized FRC substructure retains a sticky oxygeninhibited layer on its external surface that allows direct
chemical bonding with the covering composite.[10] Although,
unnecessary preparation and etching of the abutment teeth
(though minimally done) is an irreversible damage.
The successful FRC restorations have following limitations:
1. Functional stresses and occlusal loading of the pontic
should be minimum.
2. Vertical and horizontal overlap should not be greater
than 3mm.[11]

3. Supporting abutment teeth should be structurally vital
and intact.[12]

CONCLUSION
This clinical report describes a conservative, esthetic
fiber-reinforced composite FPD using a direct technique

that incorporated a bondable ribbon. This provisional


restoration not only satisfied patient needs but also survival
was long term and acceptance was better.

REFERENCES
1. Freilich MA, Meiers JC, Duncan JP, Eckrote KA, Goldberg AJ. Clinical
evaluation of fiber-reinforced fixed bridges. J Am Dent Assoc
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2. Chan DC, Giannini M, De Goes MF. Provisional anterior tooth
replacement using nonimpregnated fiber and fiber-reinforced
composite resin materials: A clinical report. J Prosthet Dent
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3. Iglesia-Puig MA, Arellano-Cabornero A. Inlay fixed partial denture
as a conservative approach for restoring posterior missing teeth: A
clinical report. J Prosthet Dent 2003;89:443-5.
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fixed partial dentures. Quintessence Int 2001;32:269-81.
5. Ferracane JL. Materials in dentistry: Principles and applications.
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8. Freilich MA, Karmaker AC, Burstone CJ, Goldberg AJ. Flexure
strength of fiber-reinforced composites designed for prosthodontic
application. J Dent Res 1997;76:138.
9. Freilich MA, Karmaker AC, Burstone CJ, Goldberg AJ. Flexure
strength and handling characteristics of fiber-reinforced composites
used in prosthodontics. J Dent Res 1997;76:18.
10. Freilich MA, Karmaker AC, Burstone CJ, Goldberg AJ. Development
and clinical applications of a light-polymerized fiber-reinforced
composite. J Prosthet Dent 1998;80:311-8.
11. Ricketts RM. Provocations and perceptions in craniofacial
orthopedics: Dental science and facial art/parts 1 and 2. Vol 1.
Denver: Rocky Mountain Orthodontics; 1990. p. 702-3.
12. Rose E, Frucht S, Jonas IE. Clinical comparison of a multistranded wire
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used for lingual retention. Quintessence Int 2002;33:579-83.
How to cite this article: Agrawal KK, Chand P, Mishra N, Singh K. Glass fiber
reinforced composite fixed partial denture as provisional tooth replacement
in pre-adolescent age: A clinical report. J Interdiscip Dentistry 2012;2:51-3.
Source of Support: Nil, Conflict of Interest: None declared.

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