Gaining adequate interdental space with elastic separating rings against implants: a case series.

BACKGROUND: It is clinically challenging to place and restore an implant when the mesio-distal space is limited or reduced at the occlusal plane and/or the bone level. Placing implants in these cases while ignoring the clinical difficulties and compromising treatment could limit the successful outcome. Treatment options include strategic extractions, sectional orthodontics, and minor orthodontic movements. PURPOSE: To discuss the clinical problems and difficulties arising from limited edentulous mesio-distal space interdentally and to present a treatment modality and technique. MATERIALS AND METHODS: Orthodontic elastic separating rings are used to open interdental space between teeth and implants, exerting forces against implants for regaining the needed space and restoring implants with ease. RESULTS: The advantages of this technique are illustrated by clinical cases. CONCLUSIONS: Implants placed in limited interdental edentulous ridges may well assist in regaining lost spaces after loading. Neither an orthodontic background nor special instruments are required for this technique.

Teeth realignment for enhanced posterior single implant restorations.

As the use of dental implants became a widespread and acceptable treatment modality, with an overall good long-term prognosis, treatment concepts changed reciprocally. Nowadays, dental implants are considered routine and are preferred over other modalities such as removable or fixed partial dentures or etched cast restorations supported by neighboring teeth. However, we often find clinical situations that challenge the placement of an implant because of insufficient space. Congenitally missing tooth, loss of a tooth because of periodontal disease, long-lasting extracted sites, or lost tooth structures caused by caries or trauma may give rise to teeth drifting and loss of coronal space that may hamper implant placement. Minimal or minor orthodontic procedures may be used to regain adequate space for implant placement. The 3 clinical cases presented in this article discuss the various considerations and the use of teeth as mediators in small scale orthodontic treatment performed to achieve enhanced results for single implant restorations to replace missing teeth.

Orthodontic extrusion of an extensively broken down anterior tooth: a clinical report.

A predictable esthetic restoration is not limited to the restored teeth; it has to include the gingival unit and its interface with the teeth involved. Failure to deliver restorations that maintain gingival health jeopardizes the success of any restorative procedure and creates potential for periodontal problems. Perforations, fractures, root resorption, or caries in the cervical area of the tooth, especially in the anterior part of the mouth, present many challenges to the clinician. Failure to place the crown margins on sound tooth material may violate the biologic width and should be considered a restorative failure. Orthodontic root extrusion or forced eruption is a well-documented clinical method for altering the relation between a nonrestorable tooth and its attachment apparatus, elevating sound tooth material from within the alveolar socket. It has some advantages over surgical crown lengthening, which is less conservative considering the sacrifice of supporting bone and the negative change in the length of the clinical crowns of both the tooth and its neighbors. This article presents a case of a maxillary right lateral incisor, extensively broken down following trauma, treated with orthodontic extrusion combined with gingival fiberotomy, without a need for a corrective surgical procedure.

Migration following crown-lengthening procedure--a case report.

Periodontal surgery may be accompanied with some postoperative complications such as pain, swelling and sloughing, purulence or infection, transient bacteremia, nerve trauma, and hemorrhage. In general, a resective surgical intervention may implicate reduction in the attachment apparatus. Migration as a postoperative complication has never been addressed in the literature. This paper presents a case report detailing migration of a tooth, following a surgical preprosthetic clinical crown-lengthening procedure, which was repositioned using adjunctive orthodontics with a removable maxillary modified Hawley appliance. It is incumbent upon the dentist to examine meticulously the occlusal status of the teeth prior to a planned surgical intervention and to take measures preventing any possible tooth migration during the healing process. Failure to achieve occlusal and intra-arch stability may lead to undesired tooth movement in the arch postsurgery, affecting future prognosis and complicating any planned prosthetic work.

Amalgam type, adhesive system, and storage period as influencing factors on microleakage of amalgam restorations.

STATEMENT OF PROBLEM: The penetration of oral fluids and bacteria at the interface between the preparation walls and amalgam restorations, known as marginal microleakage, continues to be a problem in restorative dentistry. Microleakage may result in secondary caries and the irritation of the pulp. PURPOSE: This study evaluated the effect of amalgam type, adhesive system, and storage period on microleakage of amalgam restorations. MATERIAL AND METHODS: Eighty human premolars and molars were divided randomly into 8 equal groups of 10 teeth each. A combination of 2 different types of amalgam alloys (Spherodon and Nogama-2) and 2 bonding agents (Resinomer and High-Q-Bond) were used to restore Class V preparations. After thermocycling for 750 cycles (4 degrees C and 60 degrees C for 1-minute dwell times), the teeth were stored in a corrosive solution (modified Fusayama solution). The mean depth of fuchsin dye penetration was evaluated after an immersion period of 14 days and 180 days. The data were analyzed with a 3-way analysis of variance model and Wilcoxon paired signed rank test (alpha=.05). Main effects (aging time, amalgam, and adhesive), as well as possible interactions, were included in the model. RESULTS: Significant differences were found in all analyzed combinations. The 3-way interaction between time, restoration, and adhesive was significant (P=.04 and P=.015 for the cervical and occlusal margin, respectively). After long-term storage, dye penetration values decreased in all groups and reached a lower level compared with short-term storage (range of 0.42 mm to 0.83 mm versus 0.61 mm to 3.6 mm for the long and short term, respectively). CONCLUSION: An adhesive bonding agent may affect microleakage in the short term. However, in the long term the effect of the adhesive does not appear to be the dominant factor in reducing microleakage around amalgam restorations.

The use of an existing cast post and core as an anchor for extrusive movement.

PURPOSE: This article describes an original solution for a tooth with an existing cast post and core placed subgingivally. MATERIALS AND METHODS: The tooth was erupted rapidly using a simplified and easy technique that incorporates fiberotomy during the process of movement. RESULTS: The distal finish line of the core, which was subgingival before movement onset, was elevated, allowing the placement of crown margins on sound tooth structure. Clinical evaluation of the tooth after a period of 4 weeks, during which a provisional acrylic resin crown was used for retention, showed no need for corrective surgery, and fabrication of a metal-ceramic crown (Captek) was begun. CONCLUSION: When failing to place crown margins on sound tooth structure, the existence of a cast post and core in such a nonrestorable tooth may serve as an anchor in the process of rapid extrusion. Following the need to respect the biologic width and fulfill the obligatory ferrule effect circumferentially, this extrusive treatment modality was applied to meet high treatment standards.

Techniques for immediate core buildup of endodontically treated teeth.

Access to the pulp chamber for endodontic treatment is indicated inter alia as a result of extensive caries, trauma to the tooth causing fracture or loss of vitality, requiring restoration of the missing tooth structure. Different approaches and materials are described in the literature for foundation restorations, either with a cast post and core or immediately, with a chairside post-and-core system. This article briefly reviews the current data regarding the microbiologic, prosthetic, mechanical, and periodontal aspects while emphasizing the immediate approach using amalgam, resin composites, and glass ionomers. Factors affecting retention of the post are presented to guide the clinician in selecting a suitable post-and-core system to preserve optimal root structure and prevent root fracture. Three clinical cases are presented in which tooth structure was restored using different techniques: in the first two, provisional acrylic resin shells, one custom made and the other prefabricated, were used to house an amalgam coronal-radicular dowel core, where in the third case, a copper band was used for a composite post-and-core system. All cases emphasize the ease of production and short chairtime in the stages of crown fabrication.

Gaining adequate interdental space with modified elastic separating rings: rationale and technique.

Restoring a tooth with an inadequate contact point and root proximity is a challenge to the practitioner. Ignoring such situations or making compromises in the treatment plan may hinder a successful treatment outcome. Treatment options include strategic extractions, sectional orthodontics, and minor orthodontic movements. The purpose of this article is to discuss the clinical problems and difficulties arising from this situation and to present a modified treatment modality through two case reports. Elastic separating rings, which open an interdental space for placing orthodontic appliances, can be modified to serve as a preprosthetic means for solving mesiodistal crowding of teeth in daily practice. The classic method is modified by the use of elastic rings in sequentially increased thickness, so that the space gained with one ring is followed and increased with a thicker one. An orthodontic background and special instruments are not necessary.