Dentists occasionally are faced with the difficult esthetic situation of having to remove an anterior tooth because of trauma, advanced periodontal disease, root resorption or failed endodontic therapy. Although a permanent replacement, such as a metal-framework removable partial denture, may be planned after the tissues have healed, the options available for a good esthetic temporary prosthesis are limited. Acrylic removable partial dentures placed immediately after the tooth is extracted are bulky, may be uncomfortable for the patient and may impede healing. Prefabricated acrylic denture teeth used as a pontic bonded to the adjacent teeth can present challenges in regard to matching color, size and shape, and often require substantial modifications to achieve an acceptable appearance.
Using the natural tooth as a pontic offers the benefits of being the right size, shape and color.
Using the natural tooth as a pontic offers the benefits of being the right size, shape and color. Moreover, the positive psychological value to the patient in using his or her natural tooth is an added benefit. When the crown of the tooth is in good condition, it can be temporarily bonded easily to the adjacent teeth with light-cured restorative material. I have used this technique several times with satisfying results.
TECHNIQUE
If it appears that the crown may be difficult to position for bonding to the adjacent teeth, make a positional relation using a fast-setting occlusal relation material before extraction. Most of the time, a positional relation is not necessary; however, note the position of the tooth in the arch and its relationship to the other teeth. Remove the tooth and suture the gingival mucosa. Separate the crown from the root and clean out any caries or debris remaining in the pulp chamber. For added mechanical retention, place grooves on the lingual aspect of the extracted crown.
Abrade a piece of ligature wire with a sandpaper disk and bond the wire to the prepared crown with light-cured restorative material. The ligature wire is positioned along the lingual curvature of the tooth (not in the groove) and extends 4 to 5 millimeters on each side of the tooth to provide added strength (Figure 1
). Fill the apical and pulp-chamber openings with light-cured restorative material and shape the pontic so that it is not in contact with the healing tissues (Figure 2). This will make the area easily accessible for the patient to clean. Using light-cured restorative material, attach the assemblage to the adjacent teeth and adjust it to remove any occlusal interferences. The opposing teeth should not be in contact with the natural tooth pontic at rest or in function.
