This case shows a direct fibre FRC composite crown that I built up in a single appointment and then refined with an extra polish at a second visit a couple of days later.
The tooth in question is actually a lateral incisor that is in the place of the central incisor that was knocked out in childhood. The lateral incisor had a conventional porcelain fused to metal crown that lasted very well for many years but eventually succumbed to fracture of the underlying tooth. The remaining root was broken off below the gum and there was not sufficient remaining tooth tissue to create a special margin called a “ferrule” that allows us great strength and predictability with our cast crowns. To achieve this “ferrule” we would have needed to surgically remove gum (and maybe some bone) from around the root so that more of it was on show. This would have made the tooth look longer than it’s partner which would have not been ideal from an aesthetic point of view. It is likely that we would have needed to do a root canal filling as well and unfortunately the canal in this tooth is at least partially obliterated and previous attempts at a root filling had not found the canal openings.
We discussed all treatment options for this case which included crown lengthening surgery and root canal work followed by a new cast post and crown or the loss of the tooth and replacement with a denture a bridge or an implant retained crown. For various personal and technical reasons none of these options appealed to the patient so we elected to directly build in a crown and bonded it to the adjacent canine tooth for extra support. This approach is not a conventional one and carries with it a degree of unpredictability in terms of how long lasting it may be but it is the quickest, cheapest and least invasive option and one that leaves all other options available for later. The process was pain free and very manageable for the patient and allowed him to leave on the same day with a new tooth.
This case highlights a novel use for fibre reinforced composites and shows how it can provide alternative treatment options in circumstances where conventional techniques may be too lengthy or costly or unpredictable. I do not think as this sort of work as being “better” than the other options but I do think of it as being an acceptable alternative that can buy us time whilst other options are considered. If you would like to know if we can do similar work for you then please call us on on 01580 752202 and we will be happy to help.
