Managing fractured marginal ridge

Posted on December 17 2019

Introduction:

Ribbond will not stop a tooth from fracturing but Ribbond can divert forces side ways. As a result, the tooth fractures laterally. A lateral fracture increase the odds the tooth can be restored. A vertical fracture is catastrophic.

 

Before

Obvious fracture across the mesial marginal ridge

Initial access

Hoping the fracture does not progress too deeply. Also, a dentin fracture extends through the OL groove.

Good news!!

I was able to get to the base of each fracture with a #4 round bur within 2 mm of the margins. You can see the depression left by the #4 bur at the mesial gingival margin. I did not remove the fracture close to the pulp. I reshaped the distal composite on #13 into a more ideal configuration.

Greater Curve Standard Brass in place

Contact opening made. Brass Wide would have been a better choice. The Wide would have extended above the marginal ridge of #13 making it easier to form the marginal ridge of #14.

Clean and prep the surface

Clean and Boost (Apex) used to clean and prep the surface. Futurabond (Voco) was the bonding agent. A strip of Ribbond was placed into a thin layer of Activa at the mesial. Another strip of Ribbond was placed at the floor of the OL groove.

Restoration finished

Activa was used to complete the restoration.

 

Final MOL composite

Keep anatomy to a minimum. Composites distribute and absorb forces better when surfaces are rounded. Able to achieve a tight contact with both width and depth. There was amble tooth structure remaining. I felt a crown would be over kill.

Conclusion:

A fracture that follows the long axis of the tooth is usually catastrophic. Ribbond is made out of the same material as bullet proof vests. It does not become one with composite. Because Ribbond is not completely bonded to the the composite, it is more successful at diverting fracturing forces laterally. As stated earlier, a lateral fracture increases the chances a tooth can be restored.

For more information on how Ribbond works well with composites visit http://www.ribbond.com/

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