dwi warna aju fatmawati

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16 The Indonesian Journal of Dental Research Proceeding of The Internaonal Symposium on Oral and Dental Sciences Dwi Warna Aju Fatmawa Cantilever Bridge Design as Esthetic Restoration on Post Endodontic Treatment: Case Report Dwi Warna Aju Fatmawati Operative Dentistry, Dentistry Faculty-Jember University Jember-East Java-Indonesia [email protected] Abstract In dentistry, aesthetic and cosmetic had become patient demands, because it was related with beauty. In aesthetic restorative and cosmetic treatment, dentists were not only concerned in beauty but also must consider function of restoration. Thus, dentists must select materials and designs that had ability on occlusion and mastication bearing for long time in oral cavity. Dentures or restoration treatment that had similar color with tooth was known for a long time, because it can improve aesthetic and self- confidence. The aim of this case report was to explore aesthetic restoration used in cantilever bridge on post endodontic treatment subject. This bridge can be used as a more simple alternative treatment for subject whose restorative was broken and used partial denture. Keywords: aesthetic restoration, post endodontic treatment, cantilever bridge Introduction The scope of operative dentistry is to maintain and restore teeth for long life in oral cavity, such as by endodontic treatment and rigid restoration. These treatments must consider esthetic and periodontal tissue around the teeth. In dentistry, aesthetic and cosmetic become patient demands, because it is related with beauty. In aesthetic restorative and cosmetic treatment, dentists are not only concerned in beauty but also must consider the function of restoration. Denture and restoration using materials that have color similar with origin tooth are some of treatment in dentistry for improving performance, beauty, and self confidence patients. Tooth loss causes uncomfortable, phonetic, mastication, and self confidence disturbance. Before determining the treatment, patient should be given explanation by dentist about the procedures that will be done. It is related with the successful of the treatment, because the treatment must consider indication and contraindication of the treatment, type of patients, dental history, and financial. Tooth restoration is a way to improve tooth decay, anomaly and post endodontic treatment as well as maintain tooth along life [1]. Endodontic treatment usually cause widening tooth cavity and decreasing water composition, thus tooth become brittle and fragile. Rigid restoration is treatment of choice for getting ideal proximal contour and esthetic also preventing tooth fracture after endodontic treatment [2]. Nowadays, fixed denture is very popular in community. Fixed denture is permanently cemented on origin tooth, including cantilever bridge [3]. Cantilever bridge is one of fixed bridge type that only supported by one tooth to be an anchorage for tooth on edentulous area [4]. The aim of this case report is to explain alternative and simple treatment for substituting broken restoration using removable partial denture.

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Page 1: Dwi Warna Aju Fatmawati

16 The Indonesian Journal of Dental ResearchProceeding of The International Symposium on Oral and Dental Sciences

Dwi Warna Aju Fatmawati

Cantilever Bridge Design as Esthetic Restoration on Post Endodontic Treatment: Case Report

Dwi Warna Aju Fatmawati

Operative Dentistry, Dentistry Faculty-Jember University Jember-East Java-Indonesia

[email protected] Abstract In dentistry, aesthetic and cosmetic had become patient demands, because it was related with beauty. In aesthetic restorative and cosmetic treatment, dentists were not only concerned in beauty but also must consider function of restoration. Thus, dentists must select materials and designs that had ability on occlusion and mastication bearing for long time in oral cavity. Dentures or restoration treatment that had similar color with tooth was known for a long time, because it can improve aesthetic and self-confidence. The aim of this case report was to explore aesthetic restoration used in cantilever bridge on post endodontic treatment subject. This bridge can be used as a more simple alternative treatment for subject whose restorative was broken and used partial denture. Keywords: aesthetic restoration, post endodontic treatment, cantilever bridge

Introduction The scope of operative dentistry is to maintain and restore teeth for long life in oral cavity, such as by endodontic treatment and rigid restoration. These treatments must consider esthetic and periodontal tissue around the teeth. In dentistry, aesthetic and cosmetic become patient demands, because it is related with beauty. In aesthetic restorative and cosmetic treatment, dentists are not only concerned in beauty but also must consider the function of restoration. Denture and restoration using materials that have color similar with origin tooth are some of treatment in dentistry for improving performance, beauty, and self confidence patients. Tooth loss causes uncomfortable, phonetic, mastication, and self confidence disturbance. Before determining the treatment, patient should be given explanation by dentist about the procedures that will be done. It is related with the successful of the treatment, because the treatment must consider indication and contraindication of the treatment, type of patients, dental history, and financial. Tooth restoration is a way to improve tooth decay, anomaly and post endodontic treatment as well as maintain tooth along life [1]. Endodontic treatment usually cause widening tooth cavity and decreasing water composition, thus tooth become brittle and fragile. Rigid restoration is treatment of choice for getting ideal proximal contour and esthetic also preventing tooth fracture after endodontic treatment [2]. Nowadays, fixed denture is very popular in community. Fixed denture is permanently cemented on origin tooth, including cantilever bridge [3]. Cantilever bridge is one of fixed bridge type that only supported by one tooth to be an anchorage for tooth on edentulous area [4]. The aim of this case report is to explain alternative and simple treatment for substituting broken restoration using removable partial denture.

Page 2: Dwi Warna Aju Fatmawati

17The Indonesian Journal of Dental ResearchProceeding of The International

Symposium on Oral and Dental Sciences

Dwi Warna Aju Fatmawati

Case report Female teacher, 47 years old, want to restore anterior maxilla tooth because the restoration was broken. Intra oral examination showed perforation profound caries on 23, found as wide cavity in mesial and expanding to cervical region. Miller examination showed 25 mm result. Painless or no respond on percussion and press test was determined. Gingival condition was normal. There was removable partial denture at 22 (Figure 1).

a b c

d e fFigure 1. a) Broken restoration on 23. b) Tooth 23 after removing broken restoration. c) Try in new restoration on 23. d) Removable partial denture in 22. e) Tooth cavity after removing and cleaning

broken restoration. f) try in new restoration on 23

Explanation was given to the patient about non vital 23 and endodontic treatment must be taken followed by post core and porcelain crown restoration. The alternative treatment used cantilever bridge was given, thus patient did not need to use her removable partial denture. The treatment procedures are: (1) aseptic and isolation procedure, (2) root canal cleaning and reshaping in 24 mm working length, (3) try in #45 gutta percha in 24 mm working length, (4) root canal filling, (5) temporary restoration procedure, (6) x-ray examination, and (7) control (Figure 2). Patient was monitored one week after endodontic treatment. In control, dentist examine about the complaint, pree test, temporary restoration condition. After review, denture preparation was done. The procedures were (1) aseptic and isolation, (2) temporary restoration removal, (3) working length measurement and gutta percha removal using gate glidden drill (GGD), (4) fabricated post core try in, (5) post core insertion and cementation using type 1 glass ionomer, (6) wall built in tooth core-like form, (7) working models preparation, (8) color matching using shade guide, and (9) temporary crown insertion. After the bridge was ready, the procedures were (1) aseptic, (2) temporary crown removal, (3) cantilever bridge try in, and (4) insertion (Figure 3).

Page 3: Dwi Warna Aju Fatmawati

18 The Indonesian Journal of Dental ResearchProceeding of The International Symposium on Oral and Dental Sciences

Dwi Warna Aju Fatmawati

a b cFigure 2. a) 45 gutta percha try in in 24 mm working length; b) Temporary restoration; c) X ray examination after

root canal filling

a b

c dFigure 3. a) Fabricated post core insertion; b) Built in core wall; c) Try in

cantilever bridge; d) Cantilever bridge 22 and 23 insertion.

Discussion As a vital organ, tooth must be cared and treated. Nowadays patients are more considering their teeth performance, especially anterior teeth. The advantage of fixed denture for post endodontic treatment is an ability to maintain remaining teeth and mastication system. We must take attention in marginal adaptation, restoration contour, smooth surface, embrasure, pontic design, and biological effect on gingival and periodontal tissue [5]. Dentist must consider about indication and contraindication of all treatment, because it determined successful result [1]. Cantilever bridge was a potential alternative for post endodontic treatment cases, because it provided comfort and good esthetic. References [1] Fatmawati, DWA. 2011. Macam-macam Restorasi Rigid Pasca Perawatan Endodontia.

Stomatognatic, 8: 96-102 [2] Jubhari EH. 2007. Upaya untuk Mengurangi Preparasi Gigi : Fung Shell Bridge. Jurnal

Kedokteran Gigi Dentofasial, 6: 27-9

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19The Indonesian Journal of Dental ResearchProceeding of The International

Symposium on Oral and Dental Sciences

Dwi Warna Aju Fatmawati

[3] Shilingburg H, Hobo S, Whitsett L, Richard J, Brackett S. 1997. Fundamentals of Fixed Prosthodontics 3rd Ed, Quintessence Publishing Co. Inc. North Kimberly Drive: 1

[4] Barclay CW, Walmsley AD. 2001. Fixed and Removable Prosthodontics 2nd Ed. Churchill Livingstone. Tottenham. p. 115-22

[5] Lesmana RA. 1999. Faktor-Faktor Periodontal Dengan Gigi Tiruan Cekat. Jurnal Kedokteran Gigi Universitas Indonesia, 6: 35-40