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Case Report

Natural Tooth Pontic with Splinting of Periodontally Weakened

Teeth Using Fiber-Reinforced Composite Resin
Gauri Srinidhi, Srinidhi Surya Raghavendra1
Periodontist, Private Practice, Karvenagar, Department of Conservative Dentistry and Endodontics, Sinhgad Dental College, Pune, Maharashtra, India
1

Abstract
Replacement of missing anterior teeth due to periodontal reasons is challenging due to the poor support of abutment teeth. This prevents the
use of fixed partial dentures (FPDs). Fiber-reinforced splinting provides a viable alternative to the dentist while choosing a treatment plan in
replacing missing anterior teeth in periodontally compromised patients as opposed to conventional modalities like FPDs or removable partial
dentures. Replacing missing teeth using either patients own tooth or a denture tooth as pontic can be done by splinting adjacent teeth with
fiber reinforced composite. The splinting has an additional advantage of stabilizing adjacent mobile teeth. This case report details the case
selection, procedure with follow-up of a case where the natural extracted tooth of the patient was used as pontic to replace a missing anterior
tooth. The splinting was done with fiber reinforced composite resin. Fiber-reinforced composite resin splinting of patients extracted natural
tooth is economical, fast, and easy to use chairside technique with the added benefit of periodontal stabilization.

Key words: Fiber reinforced composite resin, natural tooth pontic, splinting, tooth mobility

Introduction teeth with or without lingual wire reinforcements and resin

Treatment planning for a case of generalized chronic
periodontitis that has resulted in pathological migration and
diastema formation in maxillary and mandibular anterior is
challenging. The periodontally weakened teeth often drift to a
position that is esthetically unpleasant as well as functionally
unstable. The altered forces acting on teeth worsen the
migration. Many of these patients want the correction of
diastema and an esthetically pleasant look but are not ready to
sacrifice the periodontally hopeless teeth. The ultimate goal of
successful management of mobile teeth is to restore function
and comfort by establishing a stable occlusion that promotes
tooth retention and the maintenance of periodontal health.
Tooth loss in the anterior region is a very traumatic experience
to the patient. Their primary concern is the compromised
facial esthetics that accompanies tooth extraction. Immediate
esthetic replacement of the tooth will be required, and this can
be in the form of temporary, semi-permanent or permanent
treatment modalities. Patients always desire secure, fixed tooth
replacement prosthesis.
Previous attempts at chairside tooth replacement involved the
use of pontics derived from extracted teeth, acrylic resin denture
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DOI:
10.4103/2277-4696.156531
composites.[1] A new class of materials designed for reinforcing
dental resins has been introduced. These products are fiber
reinforcing ropes, braids, ribbons, and bundled fibers. These
fibers upon embedding into the resin provide for an increase in
physical properties and more durable tooth stabilization.
There have been case reports documenting the use of natural
tooth pontic along with fiber reinforced composite.[2] Placement
of an immediate and indirect periodontal, prosthetic splint has
been reported frequently. The use of gas plasma treated woven
polyethylene fabric to reinforce composite resin[3,4] has been
tried and found to be effective.
We have described a case in which a periodontally hopeless
tooth was extracted, and the edentulous space replaced using
the crown of the extracted tooth and splinted to the neighboring
teeth with fiber reinforced composite resin. This treatment
modality has the advantage of being flexible to include any
other teeth that may be lost in future unlike the splinting using
fixed partial denture (FPD) and has been reported in earlier
studies.[1,2] It improves the comfort level of the patient by
stabilizing the mobile teeth.
Case Report
A 58-year-old female patient reported with a painful and
grade III mobile mandibular right central incisor. The tooth
Address for correspondence: Dr. Srinidhi Surya Raghavendra,
Department of Conservative Dentistry and Endodontics, Sinhgad Dental
College and Hospital, Pune, Maharashtra, India.
Email: srinidhi73@gmail.com

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Srinidhi and Raghavendra: Natural tooth pontic splinted with fiber reinforced composite splint

had to undergo extraction for pain relief and infection control. pontic was attached to the fiber splint, taking care to see that
However, replacement was patients main concern. Adjacent the fiber splint was placed in the prepared groove [Figure4].
teeth showed severe recession, severe bone loss, and variable The fiber splint was covered with composite resin and cured,
degrees of mobility but patient was unwilling to consider taking care to see that the ends of the fiber are covered.
extraction at the present stage. This was followed by a thorough finishing and polishing of
the restoration [Figure 5]. Care was taken to eliminate any
Treatment plan
The patient was advised to undergo supra and subgingival
scaling and was reviewed 2 weeks later. Response of the tissues
to periodontal therapy after scaling was good. There was good
compliance with the oral hygiene instructions. The mandibular
right central incisor was having hopeless periodontal prognosis
and needed extraction.
Various treatment options available were removable partial
denture (RPD), FPD or splinting with natural teeth pontic.
The abutment teeth available were periodontally weak. RPD
with supporting clasps on the abutment teeth would have made
them weaker. An FPD using two abutments on either side was
a viable treatment option. It was not acceptable to the patient
due to high expense involved.
Splinting of the mandibular anterior using fiber splint and the
inclusion of the extracted natural tooth as pontic in the splint Figure 1: Marking for groove placement
was considered. This option had the advantage of stabilizing
periodontally weak abutments. It also was flexible to allow any
other treatment needed in future (like endodontic/periodontic/
extraction) for questionable abutments. The patient found the
treatment plan appealing because of the comparative low cost
and possibility of having a fixed prosthesis.
Treatment
The mandibular right central incisor was extracted under local
anesthesia. The extraction was uneventful. The extracted tooth
was scaled and polished thoroughly to remove all the deposits
on them. After healing of extraction socket, impressions were
made and study models prepared. The extracted tooth was
trimmed so as to rest passively on the edentulous ridge in
mandibular central incisor area. The tooth was endodontically
instrumented from the apical area and sealed with composite.
The tooth was prepared by making a groove of 0.75 mm depth Figure 2: Acid etching of abutment teeth
in the lingual mid 1/3rd area with a round abrasive point (BR
40, Mani, Japan) and arranged on the edentulous ridge of the
study model. The pontic was passively touching the edentulous
ridge and had no incisal contact point with opposing teeth. The
adjacent teeth were marked and grooved to a depth of 0.75 mm
in the middle third of lingual aspect with round abrasive point
(BR 40, Mani, Japan) [Figure 1].
Lingual surfaces of mandibular laterals and canines were acid
etched (Dentsply, USA) for 15 s [Figure 2]. After application
of bonding agent (Prime and Bond NT, Dentsply, USA) and
curing with LED curing unit (Apoza, Taiwan), flowable
composite (Charisma, Kulzer) was placed in the lingual
groove area. The fiber splint (Interlig, Angelus, Brazil) was
immersed in the flowable composite and cured one tooth at
a time [Figure3]. The other teeth were covered with foil to
prevent premature polymerization. The trimmed natural tooth Figure 3: Placement of fiber reinforced splint on abutment teeth

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Srinidhi and Raghavendra: Natural tooth pontic splinted with fiber reinforced composite splint
Figure 4: Natural tooth pontic placed and splinted
occlusal contact on the splint. The patient was trained to use
an interdental brush to keep the splinted teeth clean. She was
put on supportive periodontal therapy, that is, maintenance
recall schedule.
Discussion
Tooth splinting may be indicated for individual mobile teeth
as well as for an entire dentition in cases where extraction
and implant therapy is not a viable alternative. These can be
successfully managed by retaining the tooth through more
conservative methods like splinting. The overall objective of
splinting is to create an environment where the tooth movement
can be contained within physiological limits, thereby
improving patient comfort and the restoration of function.
Provisional splints are indicated for a limited time period.
They will provide information as to whether teeth stabilization
will have benefits before planning comprehensive treatment.
Examples include ligature wires, nightguards, and interim
fixed prosthesis, composite resin splints (with or without wire
and fiber support). Definitive splints are placed only after
completion of periodontal therapy and achievement of occlusal
stability. They are intended to increase functional stability and
improve esthetics on a long term basis.[5]
When a periodontally compromised tooth in the visible or
esthetic zone is planned for extraction, the primary concern
of the patient is of esthetics. There are various options which
can be given to the patient like acrylic RPDs or the extracted
natural teeth can be used as a pontic. The acrylic RPDs are
bulky and uncomfortable to the patient. Prefabricated denture
teeth can be used as a pontic when bonded to the adjacent teeth.
They present challenges with regard to color matching, size and
shape matching. They may require substantial modifications
to achieve an acceptable appearance. Implant supported
prostheses may not be the best option due to severe localized
soft and hard tissue loss.[6]
Using the natural tooth as a pontic offers the benefits of being
the right shape, size, and color. Moreover, the patient gets an
Journal of Dental and Allied Sciences Jan-Jun 2014 Volume 3 Issue 1
Figure 5: Postoperative view
added boost on seeing his own tooth being used instead of an
artificial one. These natural tooth pontics can be splinted to
the adjacent teeth by composite resins, with or without wire
reinforcement.[7] One of the alternatives of splinting is with the
use of fiber reinforced composites. The most popular fiber types
are ultra-high molecular weight polyethylene (UHMWPE)
and glass fibers.
The use of a UHMWPE leads to very low friction coefficient,
high wear resistance, and high impact strength. It is woven
into a ribbon for dental application. The polyethylene
reinforcement fiber has a flexible white mesh appearance
and is treated with cold plasma gas in order to increase its
reactivity and wetting ability. This enables chemical and
physical interactions with composite resins.[8] Interlig by
Angelus, Brazil used here is a braided, intertwined glass fiber
impregnated with dental resin.
The reinforcing capacity of fibers is dependent on their
adhesion to the resin, orientation of the fibers and their
impregnation with the resin. The advantages of fiber reinforced
composite material for periodontal splinting include:
a. Ease of application with minimal tooth preparation.
b. Low to moderate cost as compared to fixed prostheses.
c. Can easily be removed when splinting is no longer
considered necessary.
d. Easily repaired in case of failure through re-bonding and
re-application of material.
e. Ease of accommodation of oral hygiene practices by the
patient.[9,10]
The most common type of failure seen is the exposure of the
ends of the fiber and debonding of the fiber from the tooth.
This is especially seen when we are replacing many teeth
and stabilizing with fiber. The lingual grooving to a depth
of 0.75 mm on the abutment teeth and the pontics enable the
fiber to be placed perfectly within the tooth surface without
any protruding area. Placing a flowable composite and then
embedding the fiber in that helps the integration of the resin
with the fiber. This is due to the gas plasma treatment done
to the fiber. Trimming the pontic teeth is important so that
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Srinidhi and Raghavendra: Natural tooth pontic splinted with fiber reinforced composite splint

there is no pressure on the edentulous ridge, and oral hygiene References

maintenance can be done by the patient.
It must be emphasized to the patient to avoid heavy biting
pressure on the splinted teeth. All eccentric movements should
be recorded and relieved. In case of accidental trauma to that
area and loss of the pontic, the option of using an artificial
denture tooth can be used. Long-term follow-up is essential to
evaluate the fiber reinforced resin splint as an alternative to the
conventional partial denture or the fixed prostheses.
Conclusion
Tooth mobility alone does not necessarily indicate the existence
of an underlying pathologic condition. The etiology of the
mobility should be established first. Following this, splinting of
teeth to improve the periodontal stability can be done. The teeth
can be splinted using provisional or definitive modalities, and
the diastema occurring can be managed using denture teeth or
patients own extracted teeth. Using a natural tooth pontic is an
excellent, acceptable treatment option for situations in which
anterior teeth need to be removed and reflects the dentists
concern for the patients compromised facial esthetics. Using
a fiber-reinforced composite resin as a splint is a conservative,
esthetic and cost effective method for replacement of mobile or
missing anterior. It can be adapted for use with patients own
natural mobile tooth which is extracted and used as pontic or
it can be used with artificial denture teeth which act as pontics.
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of a maxillary central incisor associated with severe facial bone loss:
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difficult esthetic situation. J Am Dent Assoc 2001;132:1552-3.
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How to cite this article: Srinidhi G, Raghavendra SS. Natural tooth pontic
with splinting of periodontally weakened teeth using fiber-reinforced
composite resin. J Dent Allied Sci 2014;3:43-6.
Source of Support: Nil. Conflict of Interest: None declared.

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