Rachel derby and Enikő sztuparity Discuss the restoration of congenital absence of side cutters to adolescents from the perspective of the dentist and technician.
Restoration of relatives absence of lateral cutters to adolescents can be clinically provocative.
As a clinician, you should try to look at the future and plan further restorations and implants when your restorative work finally fails.
You must also be able to notify this ongoing recovery cycle to the patient and, most importantly, their parents.
Case study
Patient ZG, a 15 -year -old man, attended the clinic with his mother looking for restorative solutions for his ur2 after having his steady straps.
The examination showed that the patient had a relative is missing ur2 and a light UL2. His oral hygiene was good and there were mild to moderate levels of fluoridation in his teeth.
Orthodontic treatment had left the patient in a 1 -class class, molecular and dog relationship. Had provided 6mm space to place a restoration.
The patient was currently wearing a mouse Essex resistor in the UR2, but hated it to school for food.
A complete range of clinical photography was used to help plan this case (pictures 1 to 5).
Treatment process
The ideal treatment for UR2 replacement would be an implant.
On average, an implant has a survival rate of 94.6% over 13.4 years (Moraschini et al, 2015). However, in this case, the patient was very young. If we had to place an implant now, the implant would function as an hook tooth, stabilize in place.
The growth of jaws would still appear until adulthood, which for a male would be about 24 years, perhaps more. This would result in the teeth moving, but the corona of the implant would stabilize in its original position, resulting in a disgusting appearance.
We needed a solution for the medium -term until one year for up to one year an implant would be suitable.
If we leave the space and do nothing, the teeth will move and lose the space.
A single denture was a possibility, however, the patient and the mother denied this option. Socially, the patient did not want dentures or be known among his peers as a denture.
A bridge would be the only viable choice for this patient. A conventional bridge would be extremely disastrous, but a resin bridge that maintained the forearm (RRB) would work well.
A study completed at the University of Bristol in 2015 by the king and his colleagues showed that the RRB with little tooth preparation had superior longevity than those with other preparation plans.
The study also showed that the survival of a five -year -long resin bridge was 80.8% and 80.4% in 10 years (King et al, 2015).
A resin preservation bridge would be the best stable choice for the ZG patient and, if we are right, will last until ready for an implant.
It would be best to place the RRB wing on a dog tooth, this is due to the larger surface it provides. In addition, aesthetics is not as affected as the metal of the wing tends not to shine and darken the tooth.
However, in the case of the ZG, the dog was small and would not provide such a large surface compared to its central flock. If we place the metal wing in the central herd, the metal can shine.
Research now shows that reserved zirconia -based bridges can provide excellent results as:
- Are extremely durable
- Are aesthetically
- You have a high rate of survival and success. One study showed a survival rate of 10 years 98.2% and 92% success rate (KERN et al, 2017).
What about UL2? By placing an RRB on UR2, we would restore it to ideal height and width. If we left only the UL2, the symmetry would be disabled. A veneer could be placed to match the height and width, however, no matter how little we are trying to be, this would require irreversible teeth preparation.
A complex veneer would not require preparation and will provide a cosmetic effect. If the patient decided to have a veneer when he was older then he could be able to.
The treatment plan was a resin preservation bridge based on zirconia using UR1 as a bracket to replace UR2 and a complex veneer to restore UL2.
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