An Alternative Method

Using Crownless Bridgeworks to Replace a Single Missing Tooth

1/2 point CDT documented scientic credit. See Page 38.

By Sergey Chikunov, DMD (Russia) Translated by Ekaterina Golombisky

Article courtesy of Dental Market - Russia.

n recent years, there has been a marked increase in demand from both clinicians and patients for minimally invasive treatments to replace a single tooth. While the notion of a single tooth implant is widely disseminated, not all patients are ideal candidates and not all ideal candidates are amenable to the possible ancillary treatments, namely bone augmentation or sinus lift or even the establishment of integration of the implant simply to replace one tooth. This article reviews the outcome of Crownless Bridgeworks (CBW) treatment.
Figures 1 and 2

Dentists regularly encounter patients who need to replace a single missing tooth and generally proceed either to an implant or to a conventional three-unit xed bridge, procedures which carry the disadvantages of high price and a signicant surgical aspect (possibly very signicant), both of which are offputting to many patients. Moreover, not all dentists are prepared to provide these services on a day-to-day basis. Further, the amount of damage to adjacent intact teeth required by conventional preparation is not well received by many patients. CBW has been developed to provide an alternative to these traditional methods.

The patient in Figures 1 and 2 is missing tooth a single tooth but the surrounding teeth are sound, intact and healthy. Reducing these teeth for bridge abutments may not be the best solution. On average 60 percent of coronal tooth structure is lost in a crown preparation which runs contrary to the minimally invasive concept. CBW is the best alternative to traditional and implant restoration. The advantages of CBW include: It is a minor procedure. There is excellent adhesion. It is widely prescribed and affordable. It produces great esthetics. CBW allows dentists to
February 2008 Journal of Dental Technology 33

Figure 3

deliver highly esthetic bridges using conventional technology. It is a combination of adhesive and bridge anchoring systems that has been in use for more than 20 years. A primary focus of this innovative system is preservation of healthy, vital teeth. The anchors of CBW bridges could be inserted into teeth with composite restorations. Also, studies have shown that anchors in composite restorations are as durable and retentive as ones inserted in the enamel of a tooth (C.L. Davidson et al.,1986). With CBW there is: No gross reduction of healthy teeth as in traditional bridgework. No surgery and long (three to six months) recovery as with implants. No crown margin to hide and no gum inammation.

Retention of natural, pre-existing occlusion and articulation. Reversibility and reparability. Much shorter treatment time Affordability due to lower cost of material and delivery Superior esthetic result - CBW requires no signicant reduction or cutting of abutment teeth, no big metal retainers and leaves the abutments virtually whole and intact with no crown margin to hide.

Figure 4

In an in-vitro study at the University of Nijmegen in the Netherlands, the authors conclude that ,CBW has high mechanical strength with 1700 n/m, three times higher than the maximal load on chewing surfaces. As in any work, a proper diagnosis and treatment plan are fundamental

Figure 5 Figure 6

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34 Journal of Dental Technology February 2008

for success. A proper working model is essential. Working models are the universal language between a dentist and a laboratory technician. An accurate model and a color photo is the way respected professionals speak, dentist and technician. Hydrocolloid or alginates impression materials are ordinarily used as they have a reputation of accuracy even for nal crown and bridge applications. In the case presented hydrocolloid was used. The case is prepared in the laboratory using the working model by choosing a site and preparing anchor retainers in the abutment teeth, then a keyway pattern is made to register the preparations for transfer to the mouth (Figure 3). Then the pattern is tried in the mouth (Figures 4 and 5) for guidance in preparing the anchor site

Figure 9

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Figure 13

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February 2008 Journal of Dental Technology 35

Figure 16

cavities on the parallel proximal surfaces of the abutment teeth. In Figures 6-8 we see the established anchors. Parallelism in the anchor sites is of prime importance to successful outcome. (It is still possible to use CBW in cases where there is not alignment of the long axis of the abutment teeth, but it is a bit more difcult and requires a good understanding of the technology. Torsion stresses are compensated in such cases by the use of nonparallel anchors to assure a good t). In Figure 8 the anchors are in place. In Figure 9 pick-up caps are on. In Figure 10 the caps have been captured in a silicone impression. The technician inserts the pattern on the anchor analogs (Figure 11) xing them to the framework to avoid deformation upon pouring the model

Figure 20

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36 Journal of Dental Technology February 2008

Figure 24

Figure 23

Figure 26

Figure 25

(Figure 12). The anchors are made of plasmas which imparts strength for handling and nishing. A metal torsion body is then tted to the nished model via plastic caps which engage the plasmas anchors and which will later be lost in burn-out (Figures 13-16). Then the framework is waxed followed by pouring and adjustment (Figure 20). After nal build-up and occlusal adjustment the cases is glazed (Figures 21-22). There are nuances in the laboratory work we should note. We created a non-rotation element for stabilizing the construction and polished the abutment teeth for anchor placement. They can also be glazed. The lingual or palatal anchor surfaces are left unglazed in keeping with proper esthetics (Figures 23 and 24). Metal bushings are established after nal polish (Figures 25 and 26) to create an amortization effect and avoid a rigid

Figure 27

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February 2008 Journal of Dental Technology 37

bond, retaining some natural mobility in the abutment teeth. Conventional bridges force a rigid bond of retainer teeth, a problem easily resolved by the CBW bridge. Figures 27-29 show the seated bridge. This work was performed in 2005 and the patient is still satised with the outcome. Proving that there is proper planning and procedural quality, the CBW provides a solid alternative to conventional techniques. I have been using CBW since 1999 to excellent effect. Successful outcome and avoidance of problems depends upon carefully following each step. The right clinical decision is the one that results in the best and ideal treatment. CBW is one way to accomplish ideal treatment in keeping with minimally invasive philosophy.

Acknowledgements:
S.O. Chikunov, DMD, presented the clinical example in the Art Oral Clinic (Moscow). D.M. Nikonyenko, dental technician, fabricated the model at Phoenix Dental Labs (Moscow).

About the Author:

Chikunov practices at the Art Oral Clinic in Moscow, Russia.

Dental Forum Publishing (Russia), 2007

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