Ribbond splinted bridge with 5 year follow up

Posted on March 02 2019

Introduction:

As per patient, bonded composite bridge is 12 years old. It was done intraoral using Ribbond as a fiber reinforcement. Bridge was holding strong until her grandchild bumped the pontic with his head.

 

Before

Step 1

Pontic is loose, but held in place by the intact Ribbond.

Before

Step 2

Look closely and you can see the Ribbond fibers at the mesial lingual of #8. Composite has chipped away, but the Ribbond is holding strong.

Carries removed

Step 3


All caries removed from #7. Left with an apple core prep.

Wide band in place

Step 4

Greater Curve "Wide" placed over #7.

Matrix cut back

Step 5


Matrix has been cut back for access, and retainer secured with Triad Gel to provide stability.

Matrix in place

Step 6

Matrix was held in place at the distal while my assistant light cured the first increment of flowable. This was necessary because the matrix at the contact opening would not lie up against the mesial of #6.

 

Matrix view

Step 7

Look closely and you can see the blade indent of the composite instrument. Matrix is now sealed against the mesial of #6.

Composite

Step 8

Filtek supreme Ultra dentin shade 3.5 provides the base.

Composite

Step 9

A2 body is placed over the incisal 2/3's.

Initial cut back

Step 10

Leave the matrix in place while doing the initial cut back. Cutting both stainless and composite will prevent accidental gouging.

#7 completed

Step 11

 

Tooth #9

Step 12

 Setup similar to tooth #7 with matrix cut back to provide access to the prep.

 

Alginate impression

Step 13

Alginate impression poured up with a polyvinyl model material. Gingiva and teeth poured with Mach-Slo and base made with Mega bite.

Mach-slo (Parkell)

Step 14


I use Mach-Slo (Parkell) to pour the teeth and gingiva. MegaBite (DenMat) for the base. MegaBite is hard like plaster and makes a solid base for the more flexible Mach-Slo.

Ribond fiber in place

Step 15

Ribond fiber coated with flowable composite then light cured.

Dentin placed

Step 16


Dentin shade 3.5 placed against the Ribbond on the cervical 2/3's and sloped toward the palate.

A2 Body

Step 17


A2 Body was placed over the incisal 2/3's. A stain line was painted into the depth of a groove made within the A2 body.

A2 Body

Step 18


A2 Body was pushed together burying the stain line within the A2 composite.

Bridge try in

Step 19

Don't obsess making the bridge perfect on the model. Make adjustments after the bridge is bonded. You can see that the incisal of the pontic is too long and some contouring will be needed.

Final Ribbond bonded bridge

Step 20


I made this bridge over my lunch hour so patient could have bridge the same day. Sorry, forgot to take an incisal view.

5 years later

Case holding up well in spite of the patient's poor home care. This is how she presented to the office 5 years later. Wanted everyone to see photo before my hygienist cleaned her teeth.

Conclusion:

I use this technique frequently for lower anteriors opposed by an upper denture. Much better than the patient dealing with a removable partial.

 

8 comments

  • Dennis Brown: March 19, 2019

    I bond the bridge to place with flowable composite. I sandblast the bonding surfaces of the composite bridge. I etch and rinse the enamel of the abutments. If there is exposed dentin surfaces that will be covered I place a bonding agent as well.

  • Dennis Brown: March 19, 2019

    My fee for the Ribbond Bridge is close to a crown fee.

  • Dennis Brown: March 19, 2019

    The model is poured up with polyvinyl. The same material you use to make impressions. No separating medium is required because composite will not bond to it. Also the model is flexible so it makes for easy removal of the bridge from the model.

  • Becky Machtel: March 07, 2019

    May I please ask what the substance is on the model which would prevent the composite from adhering to the stone? Thank you

  • Dennis Nordlund: March 06, 2019

    Beautiful result for a patient that seems to value her teeth less than her dentist does. How much time did you end up spending before lunch (restore 7 and 9), during lunch, and then after lunch to seat the bonded pontic? How does your fee for all of your skill and expertise compare to a single crown fee in your office? (More, I hope!)

    I always enjoy seeing your tremendous efforts for your very lucky patients!

  • Annie: March 06, 2019

    It rivals dkdocterry on Dtown and is an amazing service. There’s a reason why I just reordered bulk refills of both regular and wide greater curve bands. I reconstructed five teeth out of nothing in the past three days. I just saw another one I did in 2014 after patient was absent for a while. It looks way better than the fillings I did on the adjacent teeth that I didn’t use the bands on because I didn’t think I needed it. Greater curve, dkdocterry and Bioclear, in that order, have been the game changers in my dentistry. What I am doing for patients with additive instead of subtractive dentistry makes me sleep well at night.

  • Curtis J. Perry, DDS: March 06, 2019

    Excellent work, thank you for listing the additional materials used as well.

  • I Vance Wascom: March 06, 2019

    Dental practitioners see this type of case so often in their practice, great
    Service you provided, what etch and bond did you use to bond bridge to 7 and 9.

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