Bondsteel Fixed Partial Denture: A Provisional Indirect Technique for In-the-Field Dental Emergencies

Military Medicine, Mar 2008 by Henry, Robert G, Yang, T Moses, Wang, Jennifer

ABSTRACT This article presents a modified resin-bonded fixed partial denture technique of replacing a single missing anterior tooth under limitation of material and time. This technique involved a small section of an oral surgery arch bar that was bent and fitted passively into the grooves that were prepared in the Ungual of the abutment teeth. A polycarbonate crown was fitted passively on the arch bar by a thin layer of Vaseline. The polycarbonate crown was then filled with acrylic resin to bond the polycarbonate crown and the arch bar together. The result provides an esthetic appearance and a 4-month clinical success without complication. Thus, this technique is a short-term solution for clinics that have limited resources for a definitive treatment.

INTRODUCTION

For anterior single tooth replacement, there are three major treatment options: (1) an implant crown, (2) a fixed partial denture (FPD), and (3) a removable partial denture (RPD). The first two options require an extensive amount of precision and accuracy; therefore, they are expensive and time-consuming treatments. In addition, these two treatments are invasive, involving a surgical procedure placing the implant into the bone or irreversibly reducing enamel and dentin for a FPD to be placed on the teeth for replacement. Although the RPD is very conservative, it is a removable appliance, which many patients find objectionable and which may have esthetic problems as well.

An alternative to the traditional FPD was introduced in the early 1980s, the resin-bonded FPD (RBFPD).13 The initial purpose for the development of the RBFPD was to create an esthetic and functional restoration which would conserve tooth substance, minimize periodontal involvement, be reversible, and be less costly.4

The RBFPD relies on the success of adhesive bonding from the tooth to a metal interface, traditionally made of a nickel-chromium alloy. Typically, the RBFPD was prepared for cementation by either electrolytic etching or sandblasting of the lingual (intaglio) surface. Resin cements (adhesive resins) are used to cement the RBFPD into place. The RBFPD has been shown to be successful in a large number of cases with clinical long-term success rates of 49 to 57% from 7.5 to 10 years5 and 76 to 80% in a 10-year follow-up study in periodontally compromised patients.6 Primary reasons for failure include problems with debonding, caries, and graying of abutment teeth due to metal show-through and overcontoured retainer components.7-9

Alternatives to the RBFPD have been developed and described in the literature including the metal-modified ceramic RBFPD,10 the zirconium RBFPD,11 and the fiber-reinforced composite RBFPD.12-20 The "Bondsteel fixed partial denture" is a provisional single RBFPD that was created under limitations of resources and time constraints. Clinical indications for a Bondsteel FPD include: (1) missing single anterior tooth, (2) healthy abutment teeth without caries, and (3) limited occlusal contract. A Bondsteel FPD consists of an artificial polycarbonate crown bonded to an arch bar that has been bent to conform to the lingual surface of the abutment teeth and cemented in place using acrylic resin. This technique is quick and minimally invasive, uses materials found in most dental offices, and has been effective in situations when a fiber-reinforced composite or cast metal is not available. This clinical report describes a case of treating a patient using the Bondsteel FPD technique.

CLINICAL TECHNIQUE

At Camp Bondsteel, one of the U.S. Army camps in Kosovo, a 44-year-old male was elbowed in the mouth while playing basketball. The tooth affected was the maxillary right central, which was covered with a gold crown. The clinical and radiographic examination revealed extensive decay around and underneath the shell crown (Fig. 1). The tooth in question could not be restored; the patient was told that the tooth should be extracted and he agreed. The patient's main concern was not the extraction of the tooth, but the type of replacement he could have because he worked every day in a job that dealt with U.S. troops, civilians, as well as other foreign national troops.

Because of the limited treatment options available, the patient was offered an acrylic-wire partial RPD, or a transitional RBFPD. The patient chose the RBFPD because he did not want a removable appliance. In addition, he needed a replacement immediately. A transitional acrylic-wire partial would have had to be sent to Germany, which would have required a minimum of 4 weeks of waiting time.

The Bondsteel FPD was prepared as follows: (1) the occlusion was checked and marked using standard red-blue articulating paper to mark anterior centric and excursive contacts. (2) Small rest preps were made on the lingual of the maxillary right lateral and the maxillary left central, below the area of contact and into the enamel using a footballshaped diamond bur (Fig. 2). These rest preps were placed to have a positive vertical stop and to create an area to place the metal flange of the Bondsteel FPD arch-bar ends. (3) The maxillary right central was then extracted atraumatically with elevators and forceps, and a gel-foam reabsorbable sponge was placed in the socket (Fig. 3). (4) Alginate impressions (irreversible hydrocolloid) of the maxillary and mandibular arches were taken. (5) Stone models were poured from the impressions and the Bondsteel FPD was indirectly prepared on the cast.