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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 7  |  Issue : 1  |  Page : 49-51

Biologic pre-extraction prosthesis (BPP): A provisional esthetic solution


1 Senior Lecturer, Department of Periodontics, Madha Dental College and Hospital, Chennai, Tamil Nadu, India
2 Reader, Department of Pedodontics and Preventive Dentistry, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India
3 Professor and HOD, Department of Periodontics, Madha Dental College and Hospital, Chennai, Tamil Nadu, India
4 Intern, SRM Dental College and Hospital, Chennai, Tamil Nadu, India

Date of Web Publication30-Jun-2017

Correspondence Address:
Sankar Annamalai
Department of Pedodontics and Preventive Dentistry, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmd.ijmd_41_16

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  Abstract 

The successful management of hopeless teeth in the anterior esthetic zone has become more challenging. Furthermore, extraction of anterior teeth has a far-reaching impact on an individual psyche. Immediate dentures and many other approaches have been described as a temporary replacement to give a feel good effect to the patient. This article presents a novel technique for provisionally replacing the anterior teeth with the use of unsalvageable natural teeth which are going to be extracted as biologic preextraction prosthesis. Furthermore, treatment with this technique led to overall improved esthetics, psychological wellbeing, and reduced treatment cost.

Keywords: Natural tooth pontic; prosthesis; provisional prosthesis


How to cite this article:
Rangarajan P, Annamalai S, Selvakumar J, Anjana M. Biologic pre-extraction prosthesis (BPP): A provisional esthetic solution. Indian J Multidiscip Dent 2017;7:49-51

How to cite this URL:
Rangarajan P, Annamalai S, Selvakumar J, Anjana M. Biologic pre-extraction prosthesis (BPP): A provisional esthetic solution. Indian J Multidiscip Dent [serial online] 2017 [cited 2021 Mar 7];7:49-51. Available from: https://www.ijmdent.com/text.asp?2017/7/1/49/209273


  Introduction Top


In this contemporary era of fitness and elegance, we find it challenging to meet the expectations of our dentally aware patients. Certain situations require the dentist to remove the anterior tooth. These conditions may include dental trauma, advanced periodontal disease, extensive root resorption, and endodontic failure. Loss of teeth causes adverse esthetic, functional and psychological sequelae. To immediately restore this “loss,” immediate dentures have proved to be an integral part of prosthodontic treatment modality. Irrespective of the permanent treatment options available, patients usually refuse delayed replacement and expect an immediate alternative solution in the postextraction phase with the primary aim to restore the esthetics.

Conventional solutions to this problem have included the fabrication of a provisional restoration using the adjacent teeth as abutments, removable temporary acrylic prostheses, and resin-bonded bridges.[1],[2],[3] Removable temporary partial dentures made from denture base resin in the immediate postextraction phase are unesthetic due to the presence of clasps, bulky, nonfunctional, discomforting to the patient,[4] might even impede the healing process, and jeopardize the periodontal health of the remaining dentition.[5] Furthermore, it requires additional laboratory steps. This article describes the innovative technique of using the unsalvageable periodontally compromised teeth that are going to be extracted as biologic preextraction prosthesis (BPP).


  Case Report Top


A 37-year-old female patient reported to the dental office with a complaint of mobile mandibular central incisors. The medical history of the patient was nonsignificant. Dental history revealed a history of oral prophylaxis before 3 years. On clinical examination, the mandibular central incisors showed Grade III mobility, with generalized loss of attachment [Figure 1]. Radiographic examination revealed extensive bone loss in relation to 31, 41. Both clinical and radiographic examinations indicated extraction of the mandibular central incisors followed by prosthodontic rehabilitation. Because of the high esthetic demands of the patient, the decision was made to create an immediate provisional esthetic solution.
Figure 1: Periodontally compromised mandibular central incisors

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After formulating the treatment plan, resective periodontal surgery was instituted for the patient. The mandibular central incisors are splinted before extraction of root fragment to the adjoining teeth using multiflex orthodontic wire and flowable composite resin (Filtek Supreme XT, 3M ESPE). Since multiple tooth pontics were involved, additional support was desired for which flowable composite was placed in the interproximal areas in such a way that the interproximal embrasures were open to maintain adequate plaque control with no damage to the underlying gingival tissues. Once stabilized, the splinted teeth were checked for occlusal prematurities in centric as well as excursive movements using an articulating paper and adjusted.

The root of the tooth was then resected at the cementoenamel junction [Figure 2] in comparison to the adjoining teeth using Airotor (NSK, Japan). The resected root fragment was extracted atraumatically and primary closure was achieved [Figure 3] with 3-0 black braided silk. All pulpal remnants of the splinted natural tooth pontics were removed through the retrograde approach and filled with glass ionomer cement type II (GC, Fuji, Japan).
Figure 2: Clinical view showing splinted crown and resected root of mandibular central incisors

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Figure 3: Clinical view showing primary closure of the extracted site

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  Discussion Top


Immediate replacement of lost anterior teeth preferably using fixed prosthesis prevents psychological and social trauma to the patient. In the clinical case discussed above, we have described a novel technique of extraction of periodontally compromised tooth without affecting esthetics. Since we have used autogenous nontransposed natural teeth as prosthesis before extraction, we coined the term Biologic Pre-extraction Prosthesis (BPP). The major advantage of BPP technique is that the patient is at no point of time is edentulous, and hence the esthetic, psychological, and social well-being of the patient is not compromised. If the atraumatic extraction of root portion is difficult after splinting, the procedure can be reversed by first extracting the teeth then resection of the crown and splinting extraorally and then splinting the prosthesis to the abutment teeth intraorally. This prosthesis can be coined with the term biologic immediate dentures (BID).

According to Ashley and Holden,[2] the major advantage of retaining the patient's natural crown is that the patient can better tolerate the effect of tooth loss. The use of natural teeth as pontics helps in achieving better esthetics and strength as compared to acrylic or composite teeth. Esthetic requirements such as easy contour ability, color compatibility, translucency, and color stability can be achieved. Natural teeth serve as an excellent yet transient treatment option for immediate replacement following extraction in the anterior esthetic zone. The patient satisfaction of continuing to have their natural teeth in the postextraction period [Figure 4], taking care of their esthetic needs and simultaneously providing with time to choose from the various final treatment options available is immense.
Figure 4: Postoperative extra oral smile view

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  Conclusion Top


Even though the techniques BPP or BID consumes chair side time, it avoids multiple sittings for the patient and provides patient satisfaction with their own natural teeth pontic as a provisional prosthesis. However, appropriate patient selection, their motivation levels, plaque control, and precision during placement should be kept in mind to achieve the desired objective. This technique can be easily implemented by each one of us in our day-to-day practice and can enhance the esthetic and psychological needs of the patient.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Daly CG, Wilkinson EJ. Use of patient's natural crown as the pontic in a composite resin-retained temporary bridge. Aust Dent J 1983;28:301-3.  Back to cited text no. 1
    
2.
Ashley M, Holden V. An immediate adhesive bridge using the natural tooth. Br Dent J 1998;184:18-20.  Back to cited text no. 2
    
3.
Sa firstein JJ, Owens BM, Swords RL. The resin retained natural tooth pontic: A transitional esthetic solution. J Tenn Dent Assoc 2001;81:31-3.  Back to cited text no. 3
    
4.
Tüzüner T, Kusgöz A, Nur BG. Temporary management of permanent central incisors loss caused by trauma in primary dentition with natural crowns: A case report. Dent Traumatol 2009;25:522-6.  Back to cited text no. 4
    
5.
Bissada NF, Ibrahim SI, Barsoum WM. Gingival response to various types of removable partial dentures. J Periodontol 1974;45:651-9.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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Abstract
Introduction
Case Report
Discussion
Conclusion
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