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Provisional Cosmetic Bridge
This 58 year old male patient who smokes heavily, has moderately advanced periodontal disease under marginal control had been diagnosed with a non-restorable upper left central incisor that had been temporarily repaired and was slated for extraction. The practicality of an implant replacement had been explored and declined.
The periodontal disease had […]
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Closed Osseous Crown Lengthening Followed by Minimal Indirect Veneer Preps
This patient wanted to have a fuller and brighter smile and display less gingiva when she laughed.
The maxillary teeth were all lingually inclined and there was an adequate band of attached gingiva.
The gingival marginal tissue has been lased with a diode laser (Navigator by […]
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Welcome
Hello, I am Rhys Spoor and I offer a hearty welcome to a forum on the artistic side of cosmetic and restorative dentistry. We are in a wonderful time when the only thing that limits our ability to replace or enhance the natural dentition is our imagination.
The intent of this forum is to share […]
Pre-treatemnt photograph of the mandibular area dentiton. All four incisors had been endodontically treated and were failing. The left lateral incisor had a draining fistula.
The site has been prepared for the fabrication of the provisional (see more detail of the technique under the blog archives “Provisional Cosmetic Bridge”). The whitish surface on the gingiva is due to brief application of Superoxyl (37% Hydrogen peroxide) which allows for adequate hemostasis while provisional material sets without staining.
A wire was suspended between the abutment teeth for the provisional bridge. 2mm Connect fiber (Kerr) was wrapped over the top of the abutments and coated with a flowable composite Zenith Luxaflow)The incisors have been reduced to the gingival level to allow for the creation of the proper form of the provisional. The roots of the incisors were removed at the time of implant placement in the areas of the lateral incisors.
At approximately 6 months later, the alveolar ridge collapsed more than expected. The titanium endosseous implants are discernible in the positions of the lateral incisors.
The base of the alveolar ridge is only 0.6mm thick between the areas where the implants were placed. The buccal frenum is noted by pulling the lower lip down and away.
A diode laser (Odyssey by Ivoclar) was used to cut the frenum, reducing the muscle pull on the future graft site for ridge augmentation.
The modified provisional with pink composite (Cosmodent) added on the gingival to simulate gingival tissue. A combination of medium and light pink were used with addition blue and red composite tints (Kerr Kolor Plus).
The modified provisional in place prior to attempting bone ridge augmentation. The laser incision will heal uneventfully and will release some of the muscle pull on the graft site.