We’ve fallen and can’t get up!
A new patient was referred to me by a local periodontist. She’s in her 70s. Her husband fell down, and in the process of helping him, she fell on her face and fractured porcelain on teeth #9 and #10. They are part of a larger bridge, #6 – #14. Teeth #s 8, 10, and 12 are pontics. Teeth #s 7 and 9 aren’t so hot, as you can see.
The patient and her husband were due to return home (up north) for the summer. Her husband is still in the hospital.
Plan A, Plan B, Plan C
Treatment options discussed included:
- Sectioning the anterior segment of the bridge, placing two implants and a four-unit bridge 7 – 10.
- “Overcrowns” #’s 9 and 10.
- Composite repair.
Certainly, we could argue that an implant reconstruction would be the “best” and most predictable. However, sectioning bridges and leaving abutments intact can be fraught with pitfalls such as porcelain fracture and metal exposed in the wrong places.
Overcrowns work great in the right situations, especially over pontics. But, not so much over existing crown abutments.
Finally, there is doing a composite repair. Sometimes they work great. While bonding to porcelain (and metal) is more predictable today than years ago, it’s not something we can count on consistently.
Sometimes, Plan C is best… for now.
Given the complexity (time, money, etc.) of the implant option, and her current “life situation” with her husband in the hospital, we agreed that attempting to repair with composite would be the best fit for now.
I did not have time to take step-by-step photos of this case. But, I will briefly describe how I went about it.
I isolated with an Optragate. I used a diamond to lightly “prep” the remaining porcelain and then used an intraoral “sandblaster” to create a good bonding surface. I then used Apex Dental Materials’ Interface (combination of porcelain etch and silane) and applied to the prepped porcelain for one minute. Then dried (not rinsed). Next, I applied 3M’s Scotchbond Universal bonding agent. After that, I opaqued the exposed metal with some white composite tint (I can’t recall the brand at the moment). Then I built up the “dentin” with a dentin shade composite (3M’s Filtek Supreme Ultra). After that, I added body shade composite to full contour. Polished it up, and “off you go.”
Your mileage may vary.
This was an economical and quick solution to her immediate dental issue. And, it didn’t take her away from tending to her husband. She was very happy with the result.
An implant reconstruction would have been “best” for both the patient and my revenue “production.” So, I’m not the best “businessman.” But, I really believe this was a practical approach, given her immediate “life circumstances.” And, I believe it will serve her well.
She understands that it may not last, and it may need to be redone. However, she remarked, “I could have this redone many, many times and still spend much less than for the implants.” I explained that implants may be in her future, nonetheless.
What is your experience with composite repairs like this? Comment below!