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A Direct bridge repair

July 24, 2012 by Ian Kerr

This case highlights one of the problems associated with long span fixed bridges. This particular bridge is a 6 unit bridge that extends from the front tooth on the left all the way to the back tooth on the same side. It is a bridge that has been in place for quite  a few years and is doing reasonably well but has suffered a porcelain fracture on one of the front support teeth. This type of fracture does not affect the overall strength of the bridge and does not reduce its ability to function but clearly has an aesthetic impact. Both of the front support teeth have been root canal treated and are restored with cast metal posts meaning that they are rather fragile teeth and at risk of fracture if we attempt to remove the bridge. Clearly we could redo the whole bridge but this represents a major commitment in time and cost for the patient who, understandably, is keen to avoid this.

The technique shown utilises modern metal and ceramic primers to try and gain enhanced bonding between a direct composite “veneer” that is built up in the mouth. The metal is first roughened with a “sandblaster” or “microetcher” to increase the surface area and encourage greater bonding. Next the metal and ceramic primers are used to try and enhance chemical bonding between the composite and the bridge. A layer of “opaquer” is used next to block out the grey of the metal and this is then followed by a layer of fibre reinforced mesh which is designed to help resist the tensile forces acting upon the repair.  After this stage it is a relatively simple process to coat on various layers of composite filling material to build up the “veneer”.

Although the aesthetics achieved with this technique can be very pleasing it should be stressed that this sort of result is unpredictable in prognosis as the chemistry involved in the primers does not produce great bond strengths and the tensile forces that caused the fracture in the first place are likely to continue to act upon the repair. The technique is time consuming and the primers expensive meaning that repairs can attract a significant fee although these will be only a fraction of the likely replacement costs. Whenever I do a repair such as this I say that we are delaying the next stage but should also be planning for it as I do expect further fractures to occur. That said the delay that it gives us can be valuable particularly when such a fracture has occurred at a most inconvenient time, as they always seem to do!

Porcelain fracture revealing metal substrate
Opaque composite layer to block out metal “shine through”
Fibre reinforced composite “mesh” embedded in base of veneer
Final “veneer” build up in place.

If you have concerns over any of your bridge work then please do not hesitate to call the surgery on 01580752202  and we will be happy to help.

Filed Under: Blog Tagged With: Clinical Cases

About Ian Kerr

Dr Ian Kerr BDS qualified in 1989 from Newcastle University Dental School and has worked ever since in both private practice and hospital settings. Following a short stint in a busy general practice in the North East Dr Kerr went to live and work in Trinidad, where he learnt a wide range of surgical skills and developed an interest in the treatment of tempero-mandibular joint dysfunction (TMD). On returning to the UK in 1994 Dr Kerr worked in a prestigious private practice in Bromley in Kent. During his time there he completed extensive post graduate training in advanced restorative techniques and further advanced his interest in TMD.

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About StoneRock Dental Care

StoneRock Dental Care is a stunning dental practice in Hawkhurst, Nr Cranbrook on the Kent and East Sussex border. We provide every level of care, from routine family dental visits to complete cosmetic dental makeovers, including dental implants, teeth whitening, veneers, bridges and other cosmetic dental and facial aesthetic techniques.

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