“Why did my tooth fall out?”
A non-regular (shows up for emergencies only) patient presented with a chief complaint that his lower front tooth fell out. He needed a replacement ASAP, as he didn’t want to go to work without his front tooth. He didn’t have the tooth with him. What can we do?
Obviously, before we treatment plan any long-term solution, we need to step back and perform a comprehensive examination. But, what can we do in the mean time to address his chief complaint?
Options for a quick and easy (and temporary) solution would include a “flipper” (temporary treatment partial). But, most patients HATE wearing them… understandably. Prepping and placing a provisional fixed bridge is premature at this point. The adjacent teeth have issues, and the patient didn’t anticipate losing them (today), too. I decided to create a composite “pontic” and bond it to the adjacent teeth as a quick fix. Paging Dr. MacGyver! So, here is a series of photos demonstrating what I did:
I decided to create the pontic on a model first. Doing it directly intraorally makes it impossible to contour and polish the tissue-side of the pontic. We took the impression in alginate and poured it up in quick-set mounting stone. Here you can see the initial dentin layer before adding the enamel. Patient would wait during this process.
Incisal view of initial build up in opaque / dentin-shade composite.
Lingual view of initial build up in opaque / dentin-shade composite. You can see my thumbprint! I then built the pontic to contour with an enamel shade composite.
I then used Blu-Mousse to create a lingual index of the pontic on the model. I popped the pontic off the model, so I could shape and polish the tissue-side before bonding it intraorally.
Tried the Blu-Mousse index intraorally.
Tried in the pontic with the Blu-Mousse index.
I sandblasted the proximal surfaces of the pontic and the adjacent teeth. I applied silane (Interface by Apex) to the crown #23. Then bonded with Scotchbond Universal and a flowable composite.
Adjusted occlusion so that it was clear in centric and excursions. Done! Patient thinks I’m a genius! But, he gave me a quizzical look when I told him he was grinding his teeth.
I was able to convince (I think) the patient to come back for a comprehensive examination and treatment planning.
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