Lower Left Lateral Incisor Failing, Mobile , “Vital” ( to patient! )

Poor bone support. Hopeless prognosis. Long term treatment plan: Reassess for Implant solution .

Immediate treatment plan: Extraction and immediate porcelain bonded Maryland Bridge using the patients own tooth as pontic to replicate appearance, stablise periodontal status and reassess options.

Administration - 1. Set as Biocopy Three unit bridge. 41, 42 43 all allocated as veneer abutments. Material E-Max

The purpose of this design is to fabricate a three unit Maryland “wing”, extract the 42 and remove the apical portion . remove the pulpal tissue and “retrograde root fill to prevent colour change,

Then the “wing” can be cemented onto the 41 43 and the 42 can be bonded back into the same alignment as it was originally as a “socket formed” pontic.

Dr Paul Moore BDS Gate Dental Clinic Galway Ireland

The Gate Cerec Splint? :

For immediate Marlyand, or lower incisor porcelain periodontal splints.

Buccal view: Lingual view:

Buccal view: Cerec Pre-op in lower image catalogue Lingual view: Cerec Pre-op in lower image catalogue

Copy of lower catalogue transferred to Bio-copy catalogue. ( select all and copy )

Edit model: addition to lingual surface to build up Maryland final contour of wing per pontic

The Lingual “prep margins” are drawn on the lingual surface of the 41 42 43 .

Take care to caver as much enamel as possible to secure a large fitting surface. Include as much

embrasure as possible and stay short of the incisal 2 mm

The Lingual “prep margins”should not overlap inter-proximally, but should be as close as possible to each other.

Do not encroach on the dentine of the root surface. The bond here will not be as good and it will inhibit inter proximal cleaning.

This is the tricky bit. - when asked to draw copy line, you have to manipulate the copy line to cover the “addition” that you did to the lingual surface of the bioscopy model. Remember this model was an exact duplicate of the lower model before you altered the lingual surface. This facilitates sticking and accuracy of fit.

The biocopy model can be made translucent at any time to see how the prep and the amended Biocopy model fit together.

The copied pontics merge together in a bridge proposal to form continuous porcelain splint.

Note the full enamel coverage, with 2 mm free incisally.

Occlusal view: slim, tooth coloured - may even be stained and glazed.

Lingual view of splint in place on translucent view of model.

Fitting surface of “Gate” Maryland Cerec max splint. Note large contact interproximally

Lingual surface of “Gate” Maryland Cerec max splint.

Smooth surface thoroughly to reduce post milling modifications.

Try in of E Max purple phase. Should be snug and almost self retentive.

Place this in the firing chamber - can be stained and or glazed at this stage.

Upto now all this has been done totally prep-less and without local anaesthetic.

Now using appropriate LA . ( this case we used inter proximal anaesthesia and removed the 42.) The tooth was extracted and the tip of the root was removed and rounded and shaped to “dip” into the socket 3 - 4 mm. this is a judgement made clinically depending on the bone level and soft tissue status.

The contents of the canal was removed and retrograde obturation completed to prevent discolouration of the tooth. The easiest retrograde rct you will ever do!

The three units of the “Gate” Maryland wing is silanised and the 41 43 etched and bonded.

The wing is bonded to the 41 and 43 using variolink.

If moisture control is a problem I would advise rubber dam for this stage. If you can manage to maintain moisture control, not using rubber dam will facilitate occlusal confirmation when you cement to prepared 42 into position.

I personally prefer to recommend Variolink for this cementation.

Lingual view at time of cementation

Remove any remain calculus ( ultrasonic and air polishing )

Lingual view of cleaned teeth prior to etching.

This concept can be used directly from One image set or indirectly from impressions and model for any lingual splint.

Here we have used the concept for a 6 unit all E-Max porcelain split.