Case Report

Single Anterior Tooth Replacement with Direct Fiber‑Reinforced

Composite Bridges: A Report of Three Cases
D Karabekmez, G Aktas1

Department of In today’s dentistry, with the development of adhesive techniques and the
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Abstract
Prosthodontics, Faculty of
Dentistry, Baskent University,
improvement of resin‑based materials, invasive restorative treatments have
Ankara, 1Department of been replaced by minimally invasive or noninvasive restorative procedures.
Prosthodontics, Faculty Fiber‑reinforced adhesive bridges are minimal‑invasive or noninvasive restorations
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 10/24/2024

of Dentistry, Hacettepe that can be applied for definitive restoration in single tooth loss or short spans,
University, Ankara, Turkey where teeth or implant‑supported fixed partial prosthesis cannot be applied. This
case series describes the rehabilitation of three patients with anterior single tooth
Received:
loss using the direct fiber‑reinforced adhesive bridge. In all patients, esthetic
25-May-2019; and functional deficiencies in the missing tooth regions were solved with this
Revision: minimally invasive technique, which is both cost‑effective and conservative of
07-Aug-2019; tooth structures. During the three-year follow-up of these cases, there was neither
Accepted: fracture nor decementation in the restorations. Also, no caries or sensitivity was
21-Nov-2019; noted in the support teeth.
Published:
04-Mar-2020 Keywords: Adhesive bridge, fiber‑reinforced composite, single tooth deficiency

Introduction treatment. However, it is contraindicated in long

spans, deep bites, the presence of large restorations of
I n conventional dentistry, invasive procedures such
as tooth preparation involving enamel or dentin
may cause irreversible damage to the tooth structure.
support teeth, and diastema cases.[5] The success rate of
resin‑bonded fixed partial prosthesis varies widely from
Depending on the development of adhesive bonding 60% to 95%.[6,7] In this paper, three cases of single tooth
techniques and composite materials, minimally loss rehabilitations in the anterior area performed by
invasive therapy was preferred instead of invasive using direct FRC bridges are reported.
options.[1] Recently, fiber‑reinforced adhesive bridges are
one of the minimally invasive treatment options posing
Case Reports
increased interest.[1,2] Fiber‑reinforced composite (FRC) Prior to the treatment, all patients were informed of the
bridges provide satisfactory esthetics are minimally procedure and informed consent was obtained.
invasive treatment, because of their ability to bond Case‑1
to abutment teeth.[3] Besides, it can be applied as a A 20‑year‑old male patient undergoing orthodontic
definitive restoration in single tooth loss or short span, treatment admitted to Hacettepe University, Faculty of
due to trauma or failed endodontic treatment, where Dentistry, Department of Prosthodontics, Turkey due
teeth or implant‑supported fixed partial prosthesis to the missing mandibular central teeth. In the clinical
cannot be applied. In addition, FRC bridges may be evaluation, it was noticed that there were two missing
applied in areas of potential tooth loss and for temporary
restoration prior to implant treatment.[4] Moreover, this Address for correspondence: Dr. D Karabekmez,
prosthesis can be applied when periodontal prognosis Baskent University, Faculty of Dentistry,
of the abutment teeth is uncertain, patients cannot Department of Prosthodontics, 82. Sokak No: 26 Bahçelievler,
Ankara 06790, Turkey.
receive local anesthesia or long‑term therapy and thus E‑mail: dkarabekmez@gmail.com, dkarabekmez@baskent.edu.tr
a fixed retainer is required to be used after orthodontic
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DOI: 10.4103/njcp.njcp_286_19

How to cite this article: Karabekmez D, Aktas G. Single anterior tooth

PMID: ******* replacement with direct fiber-reinforced composite bridges: A report of
three cases. Niger J Clin Pract 2020;23:434-6.

434 ©
Nigerian
2020 Nigerian
Journal of
Journal
Clinical
of Practice
Clinical Practice
¦ Volume| Published
23 ¦ Issueby3Wolters
¦ MarchKluwer
2020 ‑ Medknow
 Karabekmez and Aktas: Direct fiber‑reinforced composite bridges: A case series

the one tooth [Figure 1a]. After radiological evaluation,

it was decided that bone augmentation should be
performed for the implant surgery. Direct FRC adhesive
bridge, which is both aesthetic and minimally invasive,
was planned for a patient who does not wish to have
a b
an invasive treatment, such as a fixed-partial prosthesis
and implant restoration with bone augmentation. Thus,
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no invasive procedure was applied to the abutment

teeth. Phosphoric acid (37%) was applied to the palatal
surfaces of these teeth to provide adhesive bonding of
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restoration. Fiber band (Interlig Glass Fiber, Angelus)

c
was adapted carefully to the lingual area [Figure 1b]
d
by using a flowable composite (Filtek™ Supreme Ultra
Figure 1: (a): Case 1. The intraoral appearance of a missing tooth. (b):
Fiber band attached to abutment teeth. (c): Intraoral appearance of Flowable, 3M, USA) and resin cement (Choise, Bisco,
restoration completed by the direct method. (d): Intraoral appearance of France). Then, it was polymerized by using curing light.
restoration after 3‑years follow‑up
The composite resin pontic (Filtek Ultimate Universal
Restorative, 3M ESPE, Belgium) was formed by using
the incremental technique and with help of silicone
index that is prepared on the plaster model of the patient.
Further, occlusal contacts were checked. Finishing and
polishing were done by using composite finishing drills,
polishing discs, and rubbers [Figure 1c].
a b Case‑2
A 43‑year‑old female patient was admitted to the
Department of Prosthodontics, Hacettepe University,
Faculty of Dentistry, Turkey, to eliminate the left
maxillary lateral deficiency [Figure 2a]. After oral and
radiological examinations, the patient was informed
c d about fixed prosthetic treatment options. It was explained
Figure 2: (a): Case 2. The intraoral appearance of a missing tooth. (b): to the patient that the preparation was necessary on
Fiber band attached to abutment teeth. (c): Intraoral appearance of the teeth for fixed partial dentures and the periodontal
restoration completed by the direct method. (d): Intraoral appearance of
restoration after 3‑years follow‑up problem on the left central incisor could negatively
affect the prognosis of fixed prosthetic treatment.
Furthermore, the patient did not accept implant treatment
due to economic reasons. Therefore, direct FRC bridge
construction was proposed to eliminate esthetic and
functional deficiencies. Both maxillary central incisors
and the left canine were selected as abutments. All the
treatment stages for the patient [Figure 2b and 2c] were
a b same as for case-1, except for the choice of abutments.
Case‑3
A 64-year-old male patient was admitted to the
Department of Prosthodontics with esthetic and phonetic
problems, due to a missing mandibular right central
incisor [Figure 3a]. When the prosthetic treatment
c d options were evaluated after clinical and radiological
Figure 3: (a): Case 3. The intraoral appearance of a missing tooth. examinations, the necessary bone width for the implant
(b): Fiber band attached to abutment teeth. (c): Intraoral appearance of
restoration completed by the direct method. (d): Intraoral appearance of was measured as insufficient. Considering the current
restoration after 3-years follow-up periodontal condition of the patient, it was explained
to him that the clinical lengths of crowns of teeth were
mandibular central teeth but the short span was narrowed longer and the restoration could be far from a natural
mesiodistally by the orthodontic treatment that could fit image. The fiber band was applied to the lower right

Nigerian Journal of Clinical Practice ¦ Volume 23 ¦ Issue 3 ¦ March 2020 435

 Karabekmez and Aktas: Direct fiber‑reinforced composite bridges: A case series

lateral incisor and canine, lower left center, and lateral restorations. Direct glass FRC adhesive bridges in the
incisor teeth, to support the lower incisors with splinting anterior area provide sufficient stability, biological, and
and also to increase the adhesion surface of these teeth functional performance at least for 3 years.
to the restoration. All the clinical stages for this patient Declaration of patient consent
[Figure 3b and 3c] were same as for cases 1 and 2.
The authors certify that they have obtained all
appropriate patient consent forms. In the form the
Discussion
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patient (s) has/have given his/her/their consent for his/

Although FRC adhesive bridges applied by direct her/their images and other clinical information to be
technique have clinical limitations, they are known to reported in the journal. The patients understand that their
provide many advantages. These restorations are easy to names and initials will not be published and due efforts
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make and they can also be used as permanent restorations will be made to conceal their identity, but anonymity
in some cases, because they have noninvasive properties. cannot be guaranteed.
During the application, it can be arranged according to
the patient’s esthetic expectations. They can be applied Financial support and sponsorship
by chair‑side, they are economical, and easy to repair Nil.
when broken.[2,3] Conflicts of interest
Problems of FRC adhesive bridges can be minor, such There are no conflicts of interest.
as discoloration or small chipping of composite, or they
may be major, such as framework fracture or debonding References
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