Enamel-bonded immediate tooth replacement

Abstract

A significant problem which faces the orthodontist from time to time is that of the patient who suffers the sudden loss of an anterior tooth. All too often, it seems, this occurs just as highly favorable orthodontic treatment is being concluded. Most often the course of such a situation is traumatic evulsion or injury requiring extraction of the tooth. Regardless of the cause, it is an emergency situation and calls for immediate treatment. It is necessary for the lost tooth to be replaced to maintain arch form as well as to provide esthetic and psychological support to the patient. Often after active orthodontic treatment stabilizing appliances are worn for a period of time. At this stage immediate tooth replacement is necessary to support a functional retainer and prevent collapse of the case. With the loss of an anterior tooth, its temporary replacement is often accomplished by banding the adjacent teeth to support a pontic. The cosmetic result of such an appliance is highly undesirable. Should the patient be using a removable prosthesis, such as a Hawley retainer, a replacement can be added to it. This automatically limits its potential activity and requires the patient to be wedded to it, even if its use had previously been necessary only during the evening hours. In addition, the effect of a tissue-bearing prosthesis that is in constant contact with the soft interproximal tissues frequently results in a gingivitis and a loss of supporting bone structure. Also, the fastidious person has an ongoing problem maintaining good oral hygiene, especially if meals are taken in public restaurants. The discomfort experienced from entrapped particles of food and the taste and odor of the end products of putrefaction are a constant challenge. Among the many potential uses of the enamel-bonding technique, the luting or bonding’-” of single and multiple4 pontics has proved clinically successful. In vitro studies have corroborated these findings by ascertaining that the applied forces required to dislodge an anterior pontic is far greater than the forces normally experienced in mastication.” This method of immediate replacement of a missing anterior tooth thus can now be included as an alternative procedure in applicable cases. It has the advantage of being placed as soon as a dry field can be maintained following elimination of the tooth, and it is a chairside procedure, it is a reversible technique, it does