Immediate Bridge Placement with Ribbond

A patient presented to my practice complaining about her front tooth being loose and painful. Upon clinical examination and periodontal charting, tooth #9 was found to have localized advanced periodontal disease. Radiographically, there was hardly any bone supporting this tooth.

All risks, benefits and alternatives were reviewed with the patient. Tooth #9 needed to be extracted. Because the prognosis of her other anterior teeth was somewhat guarded until further periodontal therapy, and the patient had limited funds, an alternative plan was devised to treat her symptoms and restore her smile in one visit.

Once her chief complaint was addressed, the patient would gain the confidence to continue her periodontal therapy to restore her mouth to full health and restorability. Using a dental composite system and Ribbond material an immediate bridge was fabricated after extraction of tooth #9.

Steps:

1. All risks, benefits and alternatives were reviewed with the patient who was suffering severe mobility with tooth #9 (Figure 1).
2. After local anesthetic was administered, tooth #9 was atraumatically extracted (Figure 2).
3. The extracted tooth (#9) as well as remaining dentition was inspected for any caries or debris.
4. The root of tooth #9 was shortened just apical (1.5 mm) to the free gingival margin (Figure 3). Once the proper length was achieved, the root was beveled to create a more conical root shape. This would allow the tissue to heal nicely around the tooth further enhancing the ability to clean the pontic.
5. The pulpal tissue was removed to prevent future discoloration or darkening of the tooth (Figure 4). Bleach shade composite was placed in the access opening.
6. A small channel was placed on the lingual surface of tooth #9 running mesial-distally where the Ribbond material would lie (Figure 5).
7. A piece of floss was then used to measure the proposed area (#6-11) where Ribbond would be placed. This extension would also strengthen her other teeth that were already experiencing some mobility (Figure 6).
8. After following the protocol for bonding Ribbond, super clear shade composite was used to blend in the final splint and restoration (Figure 7).

In conclusion, it is critical to address the patient’s chief concerns in a timely manner. Having the materials to be able to provide alternative or intermediate treatment not only boosts patient acceptance, but also boosts patient confidence in the provider. In the long run, it enhances the patient-provider relationship and opens the door for more comprehensive and rehabilitative care.