Restoring a lower right lateral on an elderly patient

By Dr Jansie van Rensburg

History

An elderly patient (86 years) visited the practice with a fractured lower right lateral.  The tooth broke off at “gum-level”.  The patient was very conscious about this situation but because of his age he was not interested in extensive dental treatment like implantology or Crown and Bridge work.  All treatment options were discussed with the patient and the patient requested us to restore the lower right lateral with a fibre reinforced composite restoration.  The patient was very pleased with the fact that the whole procedure could be completed in one session.  A peri-apical x-ray showed a root with no pathology and it was decided to build up the tooth onto the existing root of the lower right lateral.  An everStick® Perio fibre was bonded from the lower right 3 to the lower right one to reinforce the huge composite build up.  An extra piece of everStick® Perio fibre bonded more to the incisal edge between the canine and central was added for more reinforcement (not on picture).  The tooth was then restored with composite using Z100 from 3M ESPE (universal dentine and Shade A3).  The whole procedure took an hour and the patient left the surgery very content with a restored smile.

Note the decay on the canine typical of an elderly patient.  Remember at this age oral hygiene is not always optimum.

The decay on the mesial aspect of the canine was removed and left a welcome groove for retention into which the fibre could be bonded.

The everStick®perio fibre was bonded into position.  Another fibre (not on picture) was bonded more to the incisal part of the tooth between the canine and central for extra reinforcement

The end result.  The restored tooth is slightly wider than the other anterior teeth because all interproximal enamel was used to ensure very good bonding.  This is a very strong design and the strength of the restoration does not rely entirely on the fibre (also the interproximal bonding)