Den-Mat Guest Editorial: More Than A Lasting Impression By: David Ouellet, DDS

In 1990, I began making direct composite bridges for patients. This patient presented with a congenital missing tooth no. 7 and anterior spacing (Fig. 1). She was 20 years old, working nights, and was a full-time student with no parental aid. Another dentist had presented a treatment plan of porcelain laminates with an implant to replace the missing lateral. She was not in a financial situation to afford this treatment option. Therefore, an alternate plan was offered—using composite, during a single-visit, to close all spaces including the edentulous space. She accepted the treatment option. The teeth (nos. 8 and 9) were etched, bonded, and homogenous microfill (Virtuoso Sculptable) was used, without any preparation. The diastema was filled and tooth no. 10 lengthened.

The mesial facial aspect of the bicuspid, and the distal aspect of the canine, was etched and Ultra-Bond was used to build up a composite substructure bridge which was then veneered with a pre-formed laminate made of Cerinate porcelain (Ceri-Forms) (Fig. 5). All composites were then thoroughly cured and finished (Fig. 2). The case has been followed through routine recalls. A 14-year recall can be seen in Figures 3 and 4.

Conclusion
Materials can be used for multiple clinical situations such as single anterior tooth replacement. This bridge can be used after injury as a temporary over an implant, a long-term temporary to hold a space, and as a periodontal splint. It has been the author’s experience that one should maximize the surface bonding area by wrapping the buccal or lingual surface. The use of Virtuoso Flowable, in conjunction with GlasSpan® or Ribbond® to reinforce the bridge or splint seems to work well.

David Ouellet, DDS, is a native of Boston and graduate of Georgetown University Dental School. He has conducted clinical research for placement and evaluation of composite resin and is a consultant for Den-Mat Corp. David has published numerous clinical and research oriented papers and is an accredited member of the American Academy of Cosmetic Dentistry. David is in private practice, where he specializes in adhesive cosmetic dentistry. He has conducted lectures and hands-on workshops on aesthetic materials and techniques throughout the United States and overseas. You can contact Dr. Ouellet at drO123@aol.com or (805) 925-8767.