Prestipino Dental Group is celebrating National Prosthodontics Awareness Week #NPAW

A Prosthodontist is a dental specialist who has received extensive, highly-focused training in tooth replacement and restoration. When you require a tooth replacement or oral surgery, consulting with and receiving treatment from a prosthodontist ensures that you receive high-quality, efficient treatment that meets your exact needs and produces long-term, beautiful solutions for your smile. Some of the procedures we commonly perform are Dental implants, dentures, crowns, bridges and veneers to help patients improve their oral health and quality of life!

We recently published an article that is currently in press in the Journal of Prosthetic Dentistry. The article is entitled, “Chairside management of an open proximal contact on an implant-supported ceramic crown using direct composite resin.” Since dental implants have become common practice to replace missing teeth, a phenomenon that clinicians face is how to manage the “open contact” on an implant crown next to adjacent natural tooth.  We would like to share some of the salient points of the article with you.

WHY DO OPEN CONTACTS OCCUR ON IMPLANT CROWNS ADJACENT TO NATURAL TEETH and WHAT ARE THE POTENTIAL COMPLICATIONS?

A specific clinical problem with an implant-supported restoration is the development of an open proximal contact next to an adjacent natural tooth. The open contact (Figure1) negatively impacts the surrounding gums and bone because it can result in food impaction, cavities, peri-implant complications and precipitates the need to close the space between the implant crown and natural tooth.1-6

Figure 1: Open contact (space) involvig the mesial aspect of upper right second premolar.

It is thought the cause of an open proximal contact between a previously restored implant crown and an adult tooth is caused by physiological drift 1,-6, 7 and continued cranio-facial growth.8   According to the literature, an open proximal contact between an implant crown and an adjacent natural tooth occurs more frequently on the mesial versus the distal. 1-6   This may be partly explained because implants behave like “ankylosed teeth” and lack adaptive capacities.1-6   

As a result, natural teeth exhibit “spontaneous mesial drift” that can cause a decrease in arch-length measurements indicating crowding or mesial drift of teeth with aging. Moreover, independent of implants, there are several well-documented studies confirming continued craniofacial development in the adult population.7-12 Their findings support the observations that the maxillary and mandibular teeth and bone continue to change even in adulthood.7-12  Furthermore, Daftary et al 6 recognized that continued craniofacial growth negatively influences the relationship between implant-supported  restorations to remaining teeth and jaw structures. They found that continued craniofacial development results in changes in occlusion, open proximal contacts as a result of teeth migration and esthetic changes.6

How to Manage an Open Contact between an Implant Crown and a Natural Tooth?

Greenstein et al13 proposed guidelines for the management of open proximal contacts adjacent to an implant-supported restoration.  Depending on the retrievability of the implant-supported restoration, ceramics can be reapplied to restore the loss of the proximal contact area.  However, the challenge of using this method is that both the clinician and dental laboratory technician need to understand the coefficient of thermal contraction between the core and ceramic veneer, as well as the temperature cooling rates to decrease the chances of chipping due to thermal stresses.14   Additionally, there is an added chair time and laboratory expense for both patient and doctor.

Extra-Oral Chairside Technique as a Viable Strategy

A simple, viable, and economic method to correct an open proximal contact adjacent to an implant- supported ceramic restoration is by an extra-oral chairside application of a direct composite resin. The use of this technique requires knowledge of the process of bonding to the ceramic. It is an ideal method to close the open proximal contact, but the process is simplified if the crown and or abutment are retrievable.  This method is similar to the intra-oral ceramic repair technique and it has been described as a clinical strategy to restore part of a failed or fractured restoration whether directly or indirectly.15 

Briefly, a strong resin bond can exist between the ceramic and composite materials. This bond can be achieved by airborne particle abrading, etching with hydrofluoric acid, and by applying a silane coupling agent and an adhesive resin bonding agent.


Figure 2: Contact closure with direct composite resin on the mesial aspect of upper right second premolar.

Figure3: Closed open contact on mesial contact surface of implant crown.

At PDG we provide a unique dental experience because we have a prosthodontist, Dr. Vincent Prestipino and a periodontist, Dr. Tassos Sfondouris working together in one practice.  By having both a Prosthodontist and Periodontist working as a team, we combine our expertise to provide solutions to simple andcomplex dental problems.Our training allows us to rebuild and maintain your smile for a lifetime!

In celebration of National Prosthodontics Awareness Week #NPAW, now is the time explore your options for a brand new smile. Visit our website at www.prestipinodentalgroup.com to learn more about what a Prosthodontist and Periodontist can do for you!

REFERANCES

1. Wei H, Tomotake Y, Nagao K, Ichikawa T. Implant prostheses and adjacent tooth migration: preliminary retrospective survey using 3-dimensional occlusal analysis. Int J Prosthodont. 2008; 21:302-04.

2. Koori H, Morimoto K, Tsukiyama Y, Koyano K. Statistical analysis of the diachronic loss of interproximal contact between fixed implant prostheses and adjacent teeth. Int J Prosthodont. 2010; 23:535-40.

3. Wat PY, Wong AT, Leung KC, Pow EH. Proximal contact loss between implant supported prostheses and adjacent natural teeth: a clinical report. J Prosthet Dent. 2011; 105:1-4.

4. Byun SJ, Heo SM, Ahn SG, Chang M. Analysis of proximal contact loss between implant-supported fixed dental prostheses and adjacent teeth in relation to influential factors and effects: a cross-sectional study. ClinOral Implants Res. 2015; 26:709-14.

5. Heij DG, Opdebeeck H, van Steenberghe D. Age as a Compromising factor for Implant Insertion. Periodontology 2000. 2003; 33: 172-84.

6. Daftary F, Mahallati R, Bahat O, Sullivan RM. Lifelong craniofacial growth and the implications for osseointegrated implants. Int J Oral Maxillofac Implants. 2013; 28:163-69.

7. Bishara SE, Treder JE, Damon P, Olsen M. Changes in the dental arches and dentition between 25 and 45 years of age. Angle Orthod1996; 66:417–22.

8. Forsberg CM, Eliasson S, Westergren H. Face height and tooth eruption in adults-A 20-year follow-up investigation. Eur J Orthod1991; 13:249–54.

9. Iseri H, Solow B. Continued eruption of maxillary incisors and first molars in girls from 9 to 25 years, studied by the implant method. Eur J Orthod 1996; 18:245–56.

10. Sarnas KV, Solow B. Early adult changes in the skeletal and soft-tissue profile. Eur J Orthod 1980; 2:1–12.

11. Tallgren A, Solow B. Age differences in adult dentoalveolar heights. Eur J Orthod 1991;13:149–56.

15. Bondevik O. Changes in occlusion between 23 and 34 years. AngleOrthod 1998; 68:75–80.

12. West KS, McNamara JA Jr. Changes in the craniofacial complex from adolescence to mid adulthood: A cephalometric study. Am J OrthodDentofacial Orthop 1999; 115:521–32.

13. Greenstein G, Carpentieri J, Cavallaro J. Open Contacts adjacent to dental implant restorations: Etiology, incidence, consequences and correction. J Am Dent Assoc. 2016. 147:28-34.

14. Swain MV. Unstable cracking (chipping) of veneering porcelain on all-ceramic dental crowns and fixed partial dentures. Acta Biomater 2009; 5:1668-77.

15. Opdam NJ, Bronkhorst EM, Loomans BA, Huysmans MC. Longevity of repaired restorations: a practice based study. J Dent 2012; 40:829-35.

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