Conservative Treatment Provides Outstanding Long-Term Results By: R. Ibsen, DDS, OD, FAGD, FACD, FICD

The patient was under the care of a periodontist and had idiopathic periodontosis with teeth that were mobile (Fig. 1, 2). I chose a conservative approach to her treatment because of the limited life expectancy of the teeth. My primary goal was to provide functionality while stabilizing the teeth to prolong their life as much as possible.

To stabilize teeth 9, 11, and 12 and to replace tooth 10, a resin bridge/splint was chosen (Fig. 3). An all porcelain bridge would be too brittle, but a TrueVitality™ resin bridge had the flexibility to withstand the forces of occlusion and resist fracturing caused by tooth mobility. The TrueVitality™ material selected is a heat-, light-, and self-curing composite used for inlays, onlays, bridges, and splints. The bridge was fabricated in the Cerinate® Lab. I did not prep teeth 9 to 12. The labial bridge/splint was cemented with TrueVitality™ cement.

Only tooth 6 required preparation in the usual manner for a PFM crown to accommodate a Thompson dowel attachment (Fig. 4). The Thompson dowel attachment provides retention with a partial denture and functions as a stress breaker attachment while delivering better esthetics by avoiding a clasp on the facial of the cuspid. Infinity® cement was used to seat the crown.

Figure 1		Figure 2
Figure 3		Figure 4

Rembrandt® Veneers made of Cerinate® Porcelain were placed on teeth 7 and 8. Preparations were not necessary and only minor contouring of the enamel for cosmetic reasons was performed. The luting cement used was Ultra-Bond®; the bonding agent, Tenure®. Teeth 7, 8, 9, 11, 12 received facial restorations to achieve esthetic harmony.

Finally, the occlusion was readjusted and the patient was dismissed. It is important to note that the porcelain laminates and the TrueVitality™ splint are virtually indistinguishable in appearance from each other on the central incisors (Fig. 5).

At the patient’s routine recall examination, her periodontist’s evaluation of the soft tissue was “excellent.” He noted no irritation caused by any of the materials used in the procedure. In fact, he commented that her periodontal condition had not looked that good in years.

Figure 1		Figure 2
Figure 3		Figure 4

Thirteen years later at recall, David Ouellet, DDS evaluated the patient’s current status and found the result appeared to be about the same as at placement: functionality has been maintained (Fig. 7, 8); the TrueVitality™ resin labial bridge/splint still stabilizes the teeth; there has been no further recession on the teeth laminated with Cerinate® Veneers; the prognosis for the life of the teeth is optimistic. The patient’s overall oral condition is more than acceptable.

Creative treatment concepts combining the right materials and techniques allow dentists to create functional and esthetic restorations. For this patient, the materials and techniques also provided a conservative, long-term solution without the requirement for tooth reduction except for the PFM on tooth 6.

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Dr. Robert Ibsen practices dentistry in Santa Maria, CA and is the founder and president of Den-Mat Corporation that provides dentists with products that preserve, restore and enhance teeth without extensive cutting, drilling and tooth removal. The firm, established in 1974, has over 400 employees and currently serves over 86,000 dentists nationwide. Den-Mat also is a leader in providing dental education programs and seminars throughout the world.

More information on Cerinate Veneers, TrueVitality or other restorative products by Den-Mat can be obtained by calling 1-800-445-0345.