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Table of Contents
Year : 2015  |  Volume : 5  |  Issue : 2  |  Page : 105-110

Ortho-prostho management of hypodontia using fibre-reinforced composite resin bridge: An interdisciplinary approach

1 Department of Orthodontics and Dentofacial Orthopaedics, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
2 Department of Orthodontics, Vyas Dental College, Jodhpur, Rajasthan, India

Date of Web Publication5-Jan-2016

Correspondence Address:
Dipti Shastri
Department of Orthodontics and Dentofacial Orthopaedics, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2229-5194.173221

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Hypodontia is the congenital absence of <6 teeth because of agenesis. The absence of teeth may be unilateral or bilateral. Several treatment options are indicated to treat hypodontia, including the maintenance of primary teeth or space redistribution for restorative treatment with partial adhesive bridges, tooth transplantation, and implants. However, an interdisciplinary approach is the most important requirement for the ideal treatment of hypodontia. This case report describes the interdisciplinary treatment of a 17-year-old female with missing teeth (mandibular central and lateral incisors), deep overbite, and spacing. The treatment plan included the first orthodontic correction and prosthetic management using fiber-reinforced composite bridge for missing teeth.
Correction of dental problems is a complex procedures and usually it requires a interdisiplinary approch for the best outcome. Interdisiplinary dentistry covers the broad area and involves management of patient records, diagnose the various problem, and establising the chain of communication.

Keywords: Fiber-reinforced composite, hypodontia, orthodontic-prosthodontic management

How to cite this article:
Shastri D, Nagar A, Tandon P, Chugh V. Ortho-prostho management of hypodontia using fibre-reinforced composite resin bridge: An interdisciplinary approach. J Interdiscip Dentistry 2015;5:105-10

How to cite this URL:
Shastri D, Nagar A, Tandon P, Chugh V. Ortho-prostho management of hypodontia using fibre-reinforced composite resin bridge: An interdisciplinary approach. J Interdiscip Dentistry [serial online] 2015 [cited 2023 Apr 1];5:105-10. Available from: https://www.jidonline.com/text.asp?2015/5/2/105/173221

   Introduction Top

Hypodontia is the congenital absence of teeth and it refers to the condition where there is an absence of one or a few teeth.[1] In addition, hypodontia of permanent teeth is fairly common in contemporary populations,[2] and is the most common human malformations. It occurs without any other signs or symptoms of developmental disorders.[3],[4],[5] Both genetic [6],[7] and environmental [8],[9] components are involved in the etiology of hypodontia,[10] and several genetic and syndromic conditions are currently known to increase the risk of hypodontia;[11] nonetheless, congenitally missing teeth are commonly found in healthy people.[4],[5]

Hypodontia usually requires extensive and complex treatments, ranges from single restoration to surgery and multiple restorations associated with lifelong maintenance. Several treatment solutions have been presented in the dental literature.[12],[13],[14],[15] In broad terms, the necessary treatment depends on the pattern of tooth absence, the amount of residual spacing, the presence of malocclusion and patient attitudes. One of the key factors for the successful treatment of patient with hypodontia is the interdisciplinary intervention which involve the close work of a team (dental practitioner, pediatric dentist, orthodontist, prosthodontist, etc.,), to achieve an optimal outcome for the patient according to the case.[1]

For the missing tooth to be replaced natural preservation, minimal invasion, esthetics, and cost are some of the important factors that are considered.[16] A conventional porcelain-fused metal bridge is the most invasive treatment in terms of the tooth reduction. The resin-bonded fixed partial denture (FPD) is a valid treatment option in selected cases.[17],[18] Traditionally, metal alloy has been used as the material for the framework, but fiber-reinforced composite (FRC) is advocated today for their favorable elastic modulus as compared to metals and better adhesion of the composite luting agent to the framework.[17],[18] The FRC bridges are adhesive, minimally invasive, and economic restorations that can be used for single visit replacement of a missing tooth. A review of the dental literature suggests that the FRC prostheses have good longevity, especially those which are made by the direct technique.[19],[20]

This report demonstrated the successful treatment of a patient with missing mandibular incisors, which was first treated orthodontically to achieve well-aligned arches and later on prosthodontically with noninvasively restored using an FRC bridgework.

Diagnosis and treatment plan

A 17-year-old female presented with the chief complaint of spacing in her front teeth. She had a normal facial form with no asymmetries but exhibited spacing in her anterior teeth with missing mandibular central incisors [Figure 1]. The molars were in Class I occlusion, with spacing in maxillary and mandibular anterior teeth with congenital absent of mandibular incisors and inadequate overbite, overjet was present. Treatment objectives were to reduce the spacing in anterior teeth and correct the axial inclinations of the both maxillary and mandibular teeth and restored the missing mandibular anterior teeth with FRC bridge and pontic to achieve a stable functional occlusion with a pleasant smile. The parents refused to consider an any invasive procedure like implant etc., so we have chosen noninvasively restored FRC bridgework for the missing teeth.
Figure 1: A 17-year-old female with Class I molar relationship on both side with anterior spacing in maxillary and mandibular arch, inadequate overjet and overbite with missing central incisors in mandibular arch before treatment. Intraoral periapical X-rays shows congenital absence of mandibular central incisor before treatment

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Construction of fiber-reinforced composite bridge

FRC is a conglomerate of fibers made out of S-glass in a Bis-GMA matrix, incorporating unfilled composite material to obtain a glass-like, highly resistant structure. Ribbond is a bondable fiber-reinforced material which is made from ultra-high molecular weight polyethylene fibers with a leno-weave orientation.[21],[22]

The required length of the Ribbond strip (Ribbond Inc., Seattle, Washington USA) was predetermined by using a dental floss, by measuring the length from the mandibular left lateral incisor to the right lateral incisor. By using the floss as a template, a piece of a 3 mm-wide Ribbond was taken from its package by using cotton pliers and it was cut to an equal length with the Ribbond scissors and placed on a clean surface to prevent contamination. The abutment teeth were roughened by using coarse flame shaped diamond abrasives. They were then isolated, cleaned, and dried. The pontic was also cleaned with pumice, washed, and dried. The abutment teeth and the pontic were then etched with 35% phosphoric acid (Mission Dental, Tinton Falls, NJ, USA) for 30 s, washed and dried. Unfilled bonding resin (Adper Single Bond 2, 3M ESPE, St. Paul, MN, USA) was applied to the etched enamel, and it was cured. A thin layer of composite resin (Flowable Composite 3M ESPE, FiltekTMZ350) was placed across the abutment teeth and the pontic. The precut fiber was thoroughly wetted by using the unfilled resin, and it was placed over the composite and cured. A further layer of composite was placed over the tape, ensuring that the whole tape was covered by the composite, and it was cured. The excess composite resin was removed, and the occlusal interferences were again checked in the protrusion and the lateral excursions. The finishing and polishing procedures were carried out by using composite finishing discs and stones (Enhance Composite Finishing and Polishing System DENTSPLY Caulk Dentsply International Inc., Milford, DE, USA). Oral hygiene instructions were given to the patient.

Treatment progress

The upper and lower first molars were then banded. Preadjusted appliance with 0.022 inch by 0.028 inch Roth brackets was bonded in both archs and initial alignment was done with 0.016 NiTi wire in maxillary and mandibular arch followed by 0.017 × 0.025 NiTi and 0.019 × 0.025 stainless steel wire for finishing purpose. Sleeves were placed in between the mandibular lateral incisor for the maintenance of space during alignment [Figure 2]. We achieved well-aligned maxillary and mandibular arches after orthodontic correction [Figure 3] and patient was planned for the prosthetic management. After orthodontic correction, patient was debonded and FRC bridge with pontics were placed in the missing mandibular central incisors [Figure 4]a,[Figure 4]b,[Figure 4]c,[Figure 4]d,[Figure 4]e,[Figure 4]f,[Figure 4]g,[Figure 4]h.
Figure 2: 016' NiTi ligated in maxillary and mandibular arch then 0.017 × 0.025 NiTi followed by 0.019 × 0.025 stainless steel wire, sleeves was placed in between mandibular lateral incisor for space maintenance purpose

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Figure 3: A patient after 8 months of orthodontic treatment showing, well-aligned maxillary and mandibular arches with adequate overjet and overbite, and well-maintained space for the fiber-reinforced composite bridge in mandibular anterior region. Orthopantomogram showing well parallel roots of both archs after orthodontic treatment

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Figure 4: (a-c) Extraoral photographs, (c) Smiling photograph of the patient showing very much improvement after the placement of fiber-reinforced composite bridge with pontic (d-h) Intraoral photographs after the placement of fibre-reinforced composite bridge with pontic

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Treatment results

After a total 8 months of orthodontic treatment, the arches were well aligned, the overbite and overjet were normal, and Class I molar and canine relationships had been maintained [Figure 3]. After orthodontic and prosthodontic correction, all upper and lower teeth appeared on smiling were pleasant [Figure 4]c. There was also a notable improvement in smile [Figure 5] of the patient that will likely enhance her quality of life. It has given her normal smiling abilities. The patient was greatly enthused by the final esthetics and function. The treatment outcome has been monitored over the 2 years and there has been no evidence of periodontal problems.
Figure 5: Improvement in smile (a) before treatment (b) after orthodontic correction (c) after prosthetic management

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   Discussion Top

The interdisciplinary approach associated the early diagnosis of individuals having hypodontia of permanent teeth is related to treatment success. However, definitive treatment of the missing teeth is often performed only after eruption of permanent teeth or completion of orthodontic treatment. Interdisciplinary treatment is usually initiated on the diagnosis of hypodontia and orthodontic treatment allows for the creation and redistribution of spaces for later rehabilitation.[13] The greatest challenge in the treatment of hypodontia is related to treatment planning, which usually depends on severity of hypodontia. The treatment options available for these cases are the maintenance of the primary teeth; orthodontic space closure, space maintenance, restoration with adhesive or fixed restoration, and orthodontic space redistribution to facilitate the prosthetic treatment.[13] In the present case, the patients with missing anterior teeth require immediate attention for the restoration of the mandibular incisors for esthetics and function. After the alignment and leveling, directly fabricated FRC bridge was opted in this case, in order to provide a single visit, cost-effective and a minimally invasive fixed solution to the patient. The recent laboratory investigations have suggested that the optimally designed FRC FPDs can provide even a higher load-bearing capacity for the FPD than that which the conventional porcelain-fused to metal FPDs can provide.[23]

The Ribbond FRC material which was used in this clinical report was made from ultra-high molecular weight polyethylene fibers which were designed with a lock-stitch feature; so that it effectively transferred forces throughout the weave without stress transfer, back into the resin, thus providing excellent bonding and manageability characteristics. Ribbond provides an increase in the flexural strength and in the flexural modulus of the composite resins, that resist cracking.[24] With the FRC bridges, the pontic and the abutment teeth require minimal or no preparation. The clinical technique which has been described here is noninvasive and reversible so that all other restorative options can be evaluated at a later date.

   Conclusion Top

In hypodontia patient interdisciplinary treatment approaches are commonly used. FRC bridges offers a simple and cost-effective treatment option for the replacement of a missing anterior teeth in single visit after orthodontic correction.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

   References Top

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  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]


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