Technique tips – a provisional minimally invasive bridge

Having lost UR5 and a lot of the buccal plate (Figure 1), the patient, a 50-year-old male, requested an implant to replace the missing tooth. He did not wish to wear a denture. The UR6, already crowned and root-filled, could have been considered as a bridge abutment for a definitive mesial cantilever bridge, but the long-term prognosis of such a compromised tooth was considered suboptimal as a bridge abutment. UR6 was considered to be of suboptimal prognosis as an abutment.

Regarding the implant site, it was considered that this would require grafting at the time of implant placement. A temporary replacement for UR5 would therefore need to be removed and replaced on a number of occasions. A conventional adhesive bridge was considered as the transitional replacement for UR5, but was considered to be too retentive and difficult to remove. UR4 had previously been successfully restored with a large disto-occlusal composite. Accordingly, this was reduced by approximately 1mm with minimal removal of tooth tissue, to accommodate the occlusal coverage; there was no palatal preparation and a Rochette style bridge was constructed in a laboratory following impressioning and bite registration. In this case, the pontic was made from composite resin which would allow for alteration during the subsequent treatment stages (Figures 2, 3). This was cemented with resin-modified glass ionomer cement. This bridge can be removed by drilling the cement from the holes, but should be sufficiently retentive so as not to keep decementing (Figure 4).