Immediate Bonding Technique

One of most common problems encountered in the daily clinical practice is the provisionalisation of edentulous spaces following extractions of the teeth. Immediate bonding is an option not widely spread in the daily dental practice, despite certain advantages in situations with need for single tooth replacement.

It is a type of provisionalisation in which the extracted tooth is bonded with composite resin with the adjacent teeth.
There are certain advantages with the use of this type of provisionalisation. By using the natural tooth as pontic the risk for challenges of tooth size, shape and colour is minimised. (Chhabra et al. 2008) Except for the low cost of the technique, the immediate bonding natural tooth pontic protects the extraction socket and forms an ovate pontic contact surface. (Dimaczek and Kern. 2008) With recent advancements in adhesive technology, new and stronger composite materials, and the development of a bondable polyethylene fiber, it is possible to create a conservative, highly aesthetic prosthesis that is bonded directly to the teeth on either side of the missing tooth without their preparation. (Eskitaşcioglu et al. 2004)
Portera (1981) suggests the replacement of a lateral incisor (due to periodontal disease) as an absolute indication for the immediate bonding technique. Eskitaşcioglu et al. 2004 suggest immediate bonding technique as an indication prior implant placement and Breeding and Dixon in 1995 describe the technique (with a few alterations) for the provisionalisation following the stage I and II implant surgery. One should note that all the mentioned studies are case reports and based on the replacement of anterior upper teeth.

TECHNIQUE 

Dimaczek and Dixon provide a very well illustrated case report of immediate bonding and brief details on the technique. The key points of the technique are the atraumatic extraction of the tooth, the reverse removal of the pulpal tissue to avoid later discolorisation of the tooth, trimming of the root up to the point that it is 3-4 mm in the soft tissues to compensate for the recession during the healing and bonding of the crown with the adjacent teeth by using standard protocols. The technique can be facilitated with the use of pre fabricated keys for the precise placement of the tooth in the correct position and metal splints or wires to enhance the flexural strength of the bonding.

CONSIDERATIONS

One should keep in mind that the case reports describing the technique, present cases of upper anterior teeth. Despite the long term success which is up to two years (Dimaczek and Kern, 2008) there are no information in the literature regarding replacement of posterior teeth. Specific occlusal schemes, such as deep overbite and class II div II occlusion could present with difficulties for the correct placement of the tooth. Bruxism is a condition that generally compromises the prognosis of any type of restorations in the mouth. Finally, crown condition in terms of carries and restorations in the teeth to be used for the provisionalisation could present with problems in the use of adhesive materials.






Breeding and Dixon. A bonded provisional fixed prosthesis to be worn after implant surgery. The Journal of prosthetic dentistry (1995) vol. 74 (1) pp. 114-6
Chhabra et al. Natural tooth pontic: A temporary immediate provisional for a difficult esthetic situation. The Journal of Indian Prosthodontic Society (2008) vol. 8 (2) pp. 122
Dimaczek and Kern. Long-term provisional rehabilitation of function and esthetics using an extracted tooth with the immediate bonding technique. Quintessence international (Berlin, Germany : 1985) (2008) vol. 39 (4) pp. 283-8
Eskitaşcioglu et al. Use of polyethylene ribbon to create a provisional fixed partial denture after immediate implant placement: a clinical report. The Journal of prosthetic dentistry (2004) vol. 91 (1) pp. 11-4
Portera. Immediate fixed temporization utilizing extracted natural dentition. The Journal of prosthetic dentistry (1981) vol. 45 (3) pp. 286-8