Conservatively replacing missing anterior teeth with resin bonded ceramic restorations.

OBJECTIVE: This article describes improvements in materials and adhesion technologies that have facilitated new, minimally invasive treatment for the replacement of missing anterior teeth. CLINICAL CONSIDERATIONS: In the first of two case reports presented, the treatment of a 13-year-old female patient with a missing right lateral mandibular incisor is described. The patient was told she could not have an implant placed until she was 25 years of age and space post orthodontics was inadequate for implant placement. Treatment options included: a provisional removable appliance (flipper), an Essix appliance, or a resin-bonded one-wing lithium disilicate bridge with only slight modification to the right central incisor and a lingual wing on the canine. The second case report describes an adult female patient who had an impacted maxillary left canine that could not be pulled into position and wanted a replacement for the missing No. 11. This article demonstrates how the use a two-abutment bridge consisting of an inlay in the first premolar and a lingual wing with a proximal retention groove and a vertical path of insertion is a viable alternative to an implant or a conventional bridge to replace a maxillary canine with minimal removal of tooth structure. CONCLUSION: With the advent of new ceramic materials and improved adhesion minimally invasive prosthesis can be fabricated to replace missing teeth in the esthetic zone. Usually, one wing with a zirconia framework is recommended but Lithium disilicate can also be used depending on occlusal forces. CLINICAL SIGNIFICANCE: Resin-bonded fixed dental prostheses (RBFDPs) can be used on occasion as a viable alternative to implants but case selection and adherence to appropriate adhesive techniques are key to longevity.