PMC9722297_01
(a) Frontal view and (b) peripapical radiogarphy showing crowding, gingivitis, severe periodontitis, and severe bone loss at lateral incisors periodontal tissue. (c) Frontal and (d) occlusal views three weeks after extraction of lateral incisors.
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As the maxillary right and lateral incisors had grade II and III mobility with probing depths of 7 and 8 mm and more than 50% bone loss, respectively, with a hopeless periodontal prognosis, their extraction was recommended (Figures 1(a) and 1(b)). After three weeks, the healing of the extraction socket was re-evaluated, and the stable periodontal status was affirmed (Figures 1(c) and 1(d)).
(a) Extracted lateral incisors. (b) Initial root section. (c) Access opening for debridement of the pulp chamber. (d) The lateral incisors after cleaning and shaping the pulp chamber. (e) Tissue surface of natural tooth pontics after root canal filling. (f) Palatal surface preparation in lateral incisors.
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The extracted teeth were scaled and polished thoroughly to remove all the deposits on them and kept in distilled water at the temperature of 4 C until the restorative procedure (Figure 2(a)). The root section was initiated using a cylindrical diamond bur in a way that the remained tooth portion consisted of an anatomical crown, in addition to a part of the root due to mimicking the gingival recession (Figure 2(b)). The opening of the root canal was enlarged in the tissue side of the pontics with round diamond bur (Jota, Ruthi, Switzerland; Figure 2(c)). Louis, MO, USA) and remained in place for 10 minutes followed by irrigation with normal saline (Figure 2(d)). Taiwan) at the light intensity of 1200 mW/cm2 and wavelength of 470 nm for 40 seconds from each aspect of the pontics (Figure 2(e)). On the middle third of the palatal surfaces of pontics and abutments (from the middle of the right canine to the middle part of the left one), preparation of 2 mm incisogingival width and 1.5 mm depth to preserve the enamel substrate was performed using a round diamond bur number 1 (Figure 2(f)).
(a) Etching the prepared surface. (b) Close-up frontal view immediately after resin-bonded bridge (RBB) fabrication: reconstruction of natural smile and correction of crowding (c) occlusal contact in protrusive movement. (d) Palatal view before finishing and polishing. (e) Six-month follow-up: X-ray radiography. (f) Six-month follow-up: smile view. (g) Well adoption of pontics to the ridge six-month follow-up, there is no evidence of inflammation or recession in the soft tissue. (h) Palatal view of RBB after six months.
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The prepared palatal surfaces were etched (Scotchbond  Etchant, 3M ESPE, Washington, DC, USA) for 20 seconds, then rinsed, and dried (Figure 3(a)). USA), and then light cured for 20 seconds on each tooth. The pontics were fixed in place with Universal flow (Tokuyama) in proximal contact areas of pontics and light cured for 20 seconds. Universal composite resin (Estelite Sigma Quick, Tokuyama) was applied and cured in some areas as needed for providing smooth contour (Figure 3(b)). The occlusion was evaluated in centric position, protrusive, and lateral movements, and adjusted to remove heavy occlusion force in the pontics in the middle third portion where fiber was placed (Figures 3(c) and 3(d)). The RBB was re-evaluated after 6 months in the point of esthetic, occlusion, soft tissue contact of the pontics, and periodontal status of abutments and restored part of retainers and pontics (Figures 3(e), 3(f), 3(g) and 3(h)).
One-year follow-up. (a) X-ray radiography. (b) Retracted view. (c) Lateral movement in right side. (d) lateral movement in left side.
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Follow-up evaluation after 1 year was still satisfactory without apparent complication (Figures 4(a), 4(b), 4(c) and 4(d)).