British Journal of Orthodontics

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The Orthodontic/Restorative Interface. Restorative Procedures to Aid Orthodontic Treatment Jayne E. Harrison B.D.S., F.D.S. (R.C.P.S.) & David E. J. Bowden M.D.S., F.D.S.R.C.S., F.D.S. (Ed.), D.D.O. To cite this article: Jayne E. Harrison B.D.S., F.D.S. (R.C.P.S.) & David E. J. Bowden M.D.S., F.D.S.R.C.S., F.D.S. (Ed.), D.D.O. (1992) The Orthodontic/Restorative Interface. Restorative Procedures to Aid Orthodontic Treatment, British Journal of Orthodontics, 19:2, 143-152, DOI: 10.1179/bjo.19.2.143 To link to this article:

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British Journal of Orthodontics/Vol. 19/1992/143-152

Technique Update The Orthodontic/Restorative Interface. Restorative Procedures to Aid Orthodontic Treatment lAYNE E. HARRJSON, B.D.S., F.D.S. (R.C.P.S.) Orthodontic Department, Liverpool Dental Hospital, Pembroke Place, Liverpool L3 5PS DAVID E. J. BoWDEN, M.D.S., F.D.S.R.C.S., F.D.S. (Eo.), D.D.O. Maxillofacial Unit, Orthodontic Department, Chester Royal Infirmary, Chester CHI 2AZ Received for publication February 1991

Abstract. Res~orative proced~res whic~ complement orthodontic treatment and which may be carried out by the ort~odontzst are summarzzed. T~e l~J?ortance of planning, with the restorative requirements in mind and the maz~tenance ofP_rep~red spa_ce ( mdwz~ua/ tooth or abutment positions) in all three planes ofspace during the P~~wd of rete~twn: ~~ ~escrzbed. T~e zmportance of liaison regarding the timing of the placement of the defimtwe restoratwn, if zt zs to be earned out by another dental surgeon, is stressed. Index words: Restorative, Grinding, Tooth Modifications, Space Maintenance.

Introduction As part of the multi-disciplinary approach to dental health care the orthodontist may be asked to realign teeth to aid restorative procedures. When planning tooth movements, the orthodontist must have in mind the requirements of the restorative procedures. In complex cases a joint or multidisciplinary approach to treatment planning is essential. The proposed position and angulation of abutment teeth must be assessed to take account not only of the occlusion, but also the properties of the materials to be used in the restoration. At the very least, spaces must be prepared which allow replacement by teeth of adequate dimensions in all planes of space in order to provide a functional, aesthetic restoration (Fig. 1). Reid and Stirrups (1987) describe a case where one lateral incisor is missing and the contralateral one is diminutive. This illustrates how orthodontic treatment must provide space to meet the requirements of the restorative materials, and how close collaboration between the restorative dentist and the orthodontist can produce a successful solution to a difficult problem of orthodontic retention. The orthodontist should also be aware of procedures whereby tooth modification can correct space requirements and of methods to fill spaces which will improve aesthetics, function, and hopefully, compliance during treatment. 0301-228X/92/005000+00S02.00

Following orthodontic treatment it is important to have an adequate period of retention to allow the investing bone and periodontal tissues to reorganize, thus resisting new occlusal forces and helping prevent relapse (Ceen and Rubler, 1985). During the time between the completion of orthodontic treatment and the provision of the final restoration, tooth position should be maintained in all planes of space by a functional, hygienic, aesthetic, and durable temporary restoration or prosthesis. Failure to maintain occlusal and interproximal contacts leads to over-eruption, and drifting of opposing and adjacent teeth. Poor gingival contour of the retainer increases plaque retention which may cause gingival inflammation and enamel decalcification. In the short term this may be reversible, but in the long-term may produce irreversible damage to the dental tissues. Situations where restorative techniques can aid orthodontic treatment and retention include modification of canines, first pre-molars, and diminutive teeth, or maintenance of space and/or realignment prior to restoration. Modification of canines When a lateral incisor is mtssmg, one of the treatment options is to reposition and modify the canine to resemble the missing incisor. © 1992 British Society for the Study of Orthodontics


J. E. Harrison and D. E. J. Bowden

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prosthesis and the problems associated with its long-term maintenance. Nordquist and McNeill (1975) observed that removable and fixed prostheses result in greater plaque accumulation than the natural dentition. They also conclude that using the canine to replace the incisor is preferable to prosthetic replacement. When assessing a canine for its suitability to resemble a lateral incisor, the shape and colour of the tooth must be considered (Zachrisson, 1978). Canines have great morphological variation, but typically have a pointed incisal tip and are bulky labiopalatally, both features making them unlike the lateral incisors that they are replacing. Canines are usually darker, yellower, and less translucent than the central incisors that they will be adjacent to (Schwaninger and Shaye, 1977). These features detract from the aesthetics of the labial segment, and may interfere with lateral and protrusive movements. It is possible to modify a canine to resemble a lateral incisor using a combination of grinding and/ or composite additions. Reshaping to create correct spatial proportions should be carried out at the start or early in treatment. Grinding

Tuverson ( 1970) suggests that grinding may be required on all surfaces in order to obtain a satisfactory aesthetic and functional result. Maxillary canines are on average 1·5 mm wider than maxillary lateral incisors, so having established the desired width from the aesthetic and space requirements, mesiodistal reduction can be performed. The tip of the canine should be reduced and the incisal angles rounded. Reduction of the labial surface will reduce the bulk of the tooth, but it may darken it. The palatal surface should be reduced to allow an

8 FIG. I (A) Pre-treatment mirror view, IJ. is ectopically placed, J.l is rotated and mare developmentally absent. (B) After active

orthodontic treatment. 31113 have been aligned and adequate space in all planes of space has been created for prostheses to especially with regard to the overbite where space replace needs to be allowed for the metal wings of the acid etch retained bridges. (C) Etch retained bridges in situ to replace



Tuverson ( 1970) and Zachrisson ( 1978) conclude that it is preferable, when the characteristics of the malocclusion permit, to use the canine·to resemble the missing incisor, thus avoiding the need for a

FIG. 2 Modification of canines by grinding (A) (i) Interproximal reduction should be greater distally to flatten the natural distal bulge of the canine. (ii) The tip of the canine should be reduced to a level just shorter than the central incisor. (iii) The incisal angles should be rounded, the distal more than the mesial. (B) (i) Reduction of the labial surface. (ii) Reduction of the palatal surface.

BJO May /992

adequate overjet and overbite to be established (Fig. 2). A 502 diamond bur may be used for the gross inter-proximal, incisal and labial reduction, and a 514 diamond bur for the palatal reduction. The fine reduction and polishing can be achieved using white polishing stones (e.g. 618, 661) followed by sandpaper discs, e.g. Soflex® (3M Dental Products, Loughborough, England). It may be helpful to gain initial access for the diamond burs or discs by opening space with a tooth stripper. Zachrisson and Mjor ( 1975) report that when grinding is confined to enamel there are no histological changes in the dentine or the pulp. To minimize the chance of damage, they suggest that abundant water should be used to cool the burs during grinding. If enamel reduction is excessive, sensitivity may result and topical fluoride varnish, e.g. Duraphat® (Woelm, Pharma GMBH, Eschwege, Germany) should be applied to the ground surfaces after reduction. This is an irreversible method of modification, but has been shown to be atraumatic, and can provide a good aesthetic and functional result in carefully selected cases. Thordarson and Zachrisson (1991) report on 35 canines that have been reshaped an average of 15 years previously. No significant differences were seen between the reshaped teeth and controls with regard to mobility, reaction to percussion, temperature sensitivity or electric pulp testing. Only one tooth showed a generalized yellow discolouration. They conclude that canines can be reshaped without discomfort to the patients and with minor or no long-term ill effects. Plaque accumulation may be increased by the enamel furrows produced during enamel reduction and stripping, so surfaces must be polished (Radlenski et al., 1988). Rodgers and Wagner (1969) have shown the benefit of the uptake of topical fluorides by recently stripped enamel surfaces. Composite additions

Atypically shaped canines, where grinding would not produce a good result, may be modified by composite additions (Zachrisson, 1978). The older composites, e.g. Adaptic® (Johnson and Johnson, Dental Products Co, East Windsor, NJ 08520, U.S.A.), Concise® (3M Healthcare Ltd, Loughborough, England), had the disadvantages of poor abrasion resistance, a tendency to stain and, because they were chemically cured, a short working time. Recent developments have produced composites that have increased wear resistance and are light cured, which gives increased working time

Restorative Procedures


and a command set, e.g. Herculite® (Kerr UK Ltd, Peterborough PE3 858, England), Prisma® (De Trey Division, Dentsply Ltd, Weybridge, Surrey, England). The enamel is prepared as for acid etch technique. Composite bond (unfilled resin) is applied to the etched enamel surface and light cured for the appropriate time (15-20 seconds). Composite is applied to the prepared enamel surface either in increments of light-cured composite or in a crown former containing chemically-cured composite. Isolation is removed, any excess composite trimmed, and the occlusion, and contact areas are checked. This is a reversible, non-invasive, repeatable procedure that can be carried out before, during, and/or after the orthodontic treatment. If the composite is added before active orthodontic treatment, the orthodontist knows from the outset the exact dimensions of the tooth involved. The orthodontic bracket is attached to the composite in a conventional manner following tooth modification. The aesthetics are potentially good and the shape may easily be modified by grinding or further additions as required during treatment. Space maintenance is, thus, reinforced in all dimensions and a good gingival contour can be obtained. If the composite addition is used as a long-term restoration, the material is prone to abrasion, fracture, and staining. If a porcelain veneer is to be provided, it may be difficult and/or time consuming to remove all the composite from the tooth to allow adequate impressions of the tooth to be taken. For the best aesthetic results and ease of handling it is better to use the light activated composites because they have improved wear resistance, a longer working time and command set. With the increasing use of light-cured composites to bond brackets the availability of a light source may be less of a problem than in the past. Grinding and composite additions

This method involves reduction of half the enamel thicKness around the incisal third of the canine which is then built up with composite to the desired shape (Fig. 3; Yankelson, 1973). This is an irreversible procedure that leaves the canine a shape that will always need some form of restoration and is not recommended unless all other methods fail. Modification of first premolars When maxillary incisors or canines are missing, the resultant space may be closed by repositioning the remaining teeth to form an intact labial segment. This means that the first premolar takes up the


J. E. Harrison and D. E. J. Bowden



BJO Vol. /9 No. 1


FIG. 3 Modification of canines by grinding and composite additions. (A) Unmodified canine. (B) Reduction of half the enamel thickness from the incisal third of the canine. (C) Composite added to reshape the canine to resemble an incisor.

canine position and as the first premolar is narrower mesio-distally and less bulbous labially than the canine the canine eminence becomes flattened. The palatal cusp of the first premolar may interfere with the occlusion and if it is visible, results in poor aesthetics. For these reasons the first premolar may have to be repositioned, and modified to obtain an optimal aesthetic and functional result. This may be achieved by buccal repositioning, mesial overrotation, and/or reduction of the palatal cusp (Zachrisson, 1978). To recreate the canine eminence, the first premolar should be placed more buccally. Care must be taken not to move it too far to prevent the labial alveolar plate being thinned or even perforated. Excessive toothbrushing in this area may produce gingival recession which, if coupled with a bony dehiscence or thin labial cortical plate, can produce a Stillmans cleft which can be aesthetically unacceptable and compromise the longevity of the tooth. Care must be taken not to overload the fine roots of the first premolar during lateral excursive movements. If the forces generated in occlusion are too great for a tooth to tolerate, it may become mobile (Ericsson, 1986). It is, thus, necessary to create group function on the working side to achieve a satisfactory functional result. The aesthetics and occlusion of the upper labial segment can be improved considerably by rotating the first premolar mesio-palatally. This hides the palatal cusp and improves the occlusion with the lower canine. If the palatal cusp is of such a size or shape that over-rotation cannot camouflage or free it from the occlusion, it should be reduced slightly in height.

FJG. 4 Angulation and mesio-distal positioning of lateral incisors. (A) In the natural dentition the roots of the central incisors diverge slightly, but when a lateral incisor is in the central incisor position, an unsightly black triangular embrasure space may be created if its root diverges. (B) The root of the lateral incisor should be parallel and close to the central incisor to reduce the embrasure space. This allows the crown/veneer to be wider distally and the normal proportions of the central incisor can be simulated.

crowns. Acid etch retained composite has increasingly been used as a reversible addition to teeth, though development of the porcelain veneer technique has meant that this is now the favoured final restoration. This is mainly due to the more desirable durability, aesthetics, marginal integrity, tissue compatibility, and reduced plaque adhesion of porcelain compared with acrylic and composite. Ideally, porcelain veneers are not placed until the patient is about 16 years old, due to the often significant increase in clinical crown height that may occur until this age, which would require replacement of the veneer and, thus, possibly damage the enamel (Millar, 1987). When a lateral incisor that is going to be crowned/veneered to resemble a central incisor is moved mesially, care should be taken over its angulation and its mesio-distal position within the available space (Zachrisson, 1978). Careful detailing will improve the aesthetics of the restoration (Fig. 4). Diminutive teeth may be modified before, during, and/or immediately after orthodontic tooth movement by acid etch retained composite additions, a stock or custom made temporary crown, or a hollowed out denture tooth on a removable retainer.

Modification of diminutive teeth

In the past, teeth that were smaller than those that they were replacing had their morpholo~y modified using acrylic, porcelain, or bonded porcelain

Acid-etch retained composite additions

This has proved to be a simple, effective and popular method of re-shaping teeth (Evans and

Restorative Procedures

BJO May /99]


Nathanson, 1979; Asher and Lewis, 1986; Zachrisson, 1978). Temporary stock crown

A temporary stock crown may be adapted to fit the diminutive tooth using a self-curing acrylic resin, e.g. Sevriton® (De Trey Division, Dentsply Ltd, Weybridge, Surrey, England), (Kaiser and Cavazoo, 1985). This is a quick, easy, and non-invasive method that can help to maintain space and improve aesthetics. The crown can easily be removed to allow replacement or impressions to be taken. However, it is difficult to achieve a good gingival contour with a stock crown on a diminutive tooth. If a temporary crown of correct vertical and incisal mesio-distal dimensions is chosen, the gingival dimensions will be too great. Over-contouring around the gingival margin produces a 'plaque trap' which may cause gingival inflammation and/or enamel decalcification, and this would obviously be detrimental to dental health. Custom-made temporary crown

This involves waxing up an ideal crown form on a model to allow a mould via an alginate impression, to be made of the ideal dimensions. Self-cured acrylic such as Protemp® (ESPE, Fabrik Pharmiazentischer Praporte, GMBH and Co. KG, D-8031, Seeflod Oberbay, Germany) is then poured into the alginate mould and adapted to fit the tooth (Kaiser and Cavazos, 1985). This method may be modified to produce a labial facing which can be cemented to the tooth during treatment (Fig. 5). Such a tooth may be attached to an archwire via a bracket stuck to the facing with self-cured acrylic. The custom made temporary crown can achieve ideal crown form, occlusion and gingival contour which reduces the chance of damage to the dental tissues. The crown may be removed easily for replacement, impression taking, or bracketed for continuing orthodontic treatment. It does however, require increased laboratory time and materials which may not usually be available in orthodontic practices. Hollowed out denture tooth

A hollowed out denture tooth can be incorporated into a removable appliance and fitted over the diminutive tooth (Salvatoriello, 1982). It maintains space in all dimensions, but it is not recommended since it is unhygienic and may induce gingival inflammation or decalcification of the underlying enamel.

5 Custom-made labial facings. (A) 212 realigned to replace UI that were lost due to trauma. (B) Specifically prepared acrylic labial facings with attached brackets. (C) Labial facings in situ and incorporated into the archwire. This allows the orthodontist to continue treatment knowing that the position of 2g and space required for the final veneers will be maintained throughout the rest of treatment. FIG.


As an adjunct to the above, a gingivectomy may be performed to increase clinical crown height (M one-

148 J. E. Harrison and D. E. J. Bowden

feldt and Zachrisson, 1977). This is particularly useful to improve anterior aesthetics when a lateral incisor has been moved mesially to replace a central incisor. Often there is a marked difference between the clinical crown height of a central and lateral incisor, and if the lateral incisor is veneered to simulate the width of a central incisor, the natural proportions of the tooth will be lost and it will look very square. The proportions can be restored by increasing the clinical crown height. As reported by Palomo and Kopczyk (1978), crown height may be increased surgically by an apically repositioned flap or a simple gingivectomy. The apically repositioned flap has the advantage that access may be gained to the underlying osseous structures which allows the bone to be recontoured to the desired level before the flap is repositioned. A simple gingivectomy is only suitable where there is false pocketing. A simple gingivectomy can be performed using a surgical blade or electrocautery. Glickman and lmber ( 1970) compared the two techniques on teeth of adult dogs. When the gingivectomy is shallow, no significant difference was found clinically or histologically between the two techniques after 12 weeks healing, but the tissue that had been subjected to electrocautery showed increased inflammation at the 2-week stage. When the gingivectomy was deeper and close to the crest of the alveolar bone a significantly different clinical and histological picture was seen. On the blade-treated teeth healing was uneventful with only mild inflammation and slight recession. On the electrocauterized teeth by 6 weeks there was still significant inflammation and oedema present, with evidence of marked recession and bone necrosis. At 12 weeks, all the teeth were healed, but there was significantly more recession around the teeth that had undergone electrosurgery. From these experiments, we can conclude that electrosurgical removal of gingival tissue should be reserved to cases where there is false pocketing and only a small increase in clinical crown height is required. The procedure should be delayed until the patient is about 16 years old and 3-4 weeks before the impressions for the definitive restoration are taken. This allows for any natural increase in clinical crown height and healing to take place before the definitive restoration is provided (Fig. 6).

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Maintenance of space and realignment

FIG. 6 Gingivectomy. (A) L! was lost due to trauma and 1'1 transplanted into its space. Initial crown is very square due to the reduced clinical crown height. (8) Clinical crown height has been increased. (C) The surgery has enabled a porcelain crown of greater clinical crown height to be placed.

Recent advances in etch retained bridges of the Maryland or Rochette type have favoured the opening or maintenance of space especially anteriorly (Asher and Lewis, 1986). The apparent ad van-

tage of these bridges is that they require little tooth reduction which makes them ideal for young patients where the pulp is still large and vulnerable


to trauma during preparation for conventional bridgework. Recent reports, however, suggest that they have high debond rates with caries developing under debonded metal wings (Gilmour, 1989) and consequent abutment tooth movement. It is important for the orthodontist to remember in cases where an etch retained bridge is to be the final restoration, that at least 0·5 mm space is provided between the opposing natural teeth to allow for the thickness of the metal bridge wings. In adults teeth may need to be realigned to provide an ideal path of insertion for a partial denture or conventional bridge (Tulloch, 1982; Ceen and Rubler, 1985; La Sota, 1988).

Restorative Procedures


FIG. 8 Wire and composite retained denture tooth. The denture tooth pontic (P) is attached to the palatal surface of the abutment teeth with rectangular wire (RW) lying just above the gingival margin and twisted wire (TW) placed more incisally. The wires are secured to the pontic with cold cure acrylic and to the palatal surface of the abutments with composite.

Anterior space maintenance

Once the required amount of space/realignment has been achieved, the teeth must be maintained in position to prevent relapse. Retention of anterior teeth can be achieved using a removable appliance with added denture tooth, wire, and composite or pin retained denture tooth. Removable appliance with added denture tooth

When sufficient space is available, a denture tooth can either be added to an existing removable appliance or a new partial denture retainer (Fig. 7). Attention must be paid to the design of the retainer. Denture teeth, particularly lateral incisors, are easily fractured so that space may be lost if patients do not return for attention. Stainless wire spurs on each side of the filled span may be used on the retainer as a safeguard for such an eventuality. Acrylic extensions onto the palatal aspect of the future abutment teeth will preserve vertical space if an etch retained bridge is to be fitted. This provides a simple method of retention that maintains space

F10. 7 An intra-oral view of a removable appliance with added denture tooth to replace ~1-

in all dimensions and is easily removed to allow later tooth preparation and impression taking. However, when wearing a removable prosthesis plaque retention is greater (Nordquist and McNeill, 1975) and patient compliance is less (Bates, 1986) than when wearing a fixed prosthesis. Whilst an adequate period of retention must be completed, the retainer design may, due to increased plaque retention, cause gingival inflammation and decalcification of the palatal cervical enamel. A self-cleansing definitive design must be employed as soon as possible. Wire and composite retained denture tooth

Direct fixation with composite alone does not allow any movement between the pontic and abutment teeth and has been abandoned. In order to reduce the failure rates the denture tooth can be retained by wire and composite. This allows some 'physiological' movement between the pontic and abutment teeth, with the aim of reducing stress concentration, bond failure and composite fracture (Fig. 8) (Artun and Zachrisson, 1984). A stone model of the teeth in their final position is made and a denture tooth of the appropriate shade is selected to fit the edentulous space. Slots are cut in the palatal surface of the denture tooth to accommodate the wires and the denture tooth is secured into position on the model with sticky wax. Rectangular wire (0·0 16" x 0·022") is bent to seat along the gingival margin of the palatal surface of the abutment teeth and multi-strand wire (0·0 135") is bent to lie further incisally. The wires are secured to the model with sticky wax and to the denture tooth with cold cure acrylic. When the acrylic is set, the bridge is removed from the model, and any excess acrylic and the sticky wax is removed. The bridge is then tried in the mouth. The occlusion, contact areas, and position of the wires are checked. The


J. E. Harrison and D. E. J. Bowden

tooth surfaces to be bonded are isolated, cleaned, and etched. The bridge is positioned and the wires are attached to the prepared abutment teeth with composite. The isolation is removed, the occlusion is checked, and any excess composite is removed. The patient is advised on home care and oral hygiene. This retainer can be made by an orthodontic technician and uses available orthodontic materials. It is easily placed at the end of orthodontic tooth movement and fully maintains space in all three dimensions. The authors reported lower failure rates than with directly bonded acrylic pontics and attributed this to the differential movement that is allowed between the pontic and the abutment teeth. The bridge is easily removed to allow tooth preparation and impression taking, and can be used as a mould to make a temporary fixed/fixed or cantilever bridge. The bulk of the composite and wire maintains the inter-incisal space required for the metal wings of an acid-etch retained bridge, but limits its use to patients with adequately prepared space. Wire fracture or composite debond may lead to failure, but this is highly dependant on the functional occlusion. Ferguson (1988) describes an indirect method of fixing multistrand wire retainers. This method is inadequate to retain abutment teeth prior to restorative treatment as it fails to maintain vertical space. It can, however, be combined with the method described to help overcome the problems of accurate location and fixation in the mouth. Pin retained denture tooth

A denture tooth is attached to the abutment teeth by dentine pins and composite (Fig. 9; Jacobsen, 1981 ). This maintains space in all dimensions and provides an ideal mould for a temporary fixed bridge. It is an invasive procedure that should be reserved for

BJO Vol. /9 No. 2

FIG. I 0 Denture tooth and associated acrylic attached to orthodontic band.

patients that are going to be provided with a bonded porcelain bridge and whose teeth are going to be reduced inter-proximally. It is useful, especially if there is close opposing tooth contact so that there is inadequate space for a wire and composite retained denture tooth. Posterior space maintenance When maintaining space in the buccal segments, aesthetics are not as important and alternative methods may be used. Retention of posterior teeth can be achieved using a sectional archwire (Tulloch, 1982) or a band with attached wire loop. These methods are simple conversions of orthodontic appliances and maintain the abutment teeth in their correct mesio-distal position. They do not, however, prevent over-eruption of opposing teeth into the edentulous space. If this occurs, it may restrict the space available for any prosthesis. This problem can be overcome by attaching a denture tooth to the archwire that spans the edentulous space or to the orthodontic band (Fig. 10). Denture tooth on a sectional archwire

FIG. 9 Pin retained denture tooth. Dentine pins (DP) are placed into slots cut into the palatal side of the prmsimal surfaces of the abutment teeth adjacent to the edentulous space and a denture tooth pontic (P) is secured to them with composite.

This method maintains space in all dimensions. It prevents tipping of abutment teeth and over-eruption of opposing teeth. It can also be used during treatment as soon as adequate space is available. The improved aesthetics and increased patient compliance that this method offers when used in the labial segments has been reported by Sandler et al. (1988). A stone model of the teeth is made and a denture tooth of the appropriate shade is selected to fill the edentulous space. The tooth is trimmed to give a good occlusion with the opposing teeth and secured

Restorative Procedures

BJO May /992


Asher, C. and Lewis, D. H. (1986) The integration of orthodontic and restorative procedures in cases with missing maxillary incisors, British Dental Journal, 160, 241-245. Bates, J. F. (1986) Partial denture design: Modern concepts, Dental Update, 13, 90-95. Ceen, R. F. and Rubler, C. G. (198S) Orthodontic intervention as an aid in restorative dentistry, Dental Clinics of North America, 29, 279-291.

FJG. 11 Denture tooth. on an archwire. Once adequate space denture teeth are has been created for a bridge to replace added to the archwire to maintain the space and improve the aesthetics until treatment is finished.


to the model with stick wax. The labial surface of the tooth is roughened slightly and a bracket is attached at the correct height and angle, to the denture tooth with self-cure acrylic e.g. Sevriton® (De Trey Division, Dentsply Ltd., Weybridge, Surrey). The denture tooth is removed from the model and is transferred to the mouth where it is secured by engaging and tying in the arch wire to the bracket (Fig. 11 ). Summary

Prepared spaces and repositioned teeth may be affected by continuing tooth movement during the period of retention. Methods have been suggested whereby the orthodontist may, by the use of temporary restorations or by attention to the detail of the retaining appliances, satisfactorily deal with the sometimes difficult transfer of patients from the orthodontist back to the referring general dental practitioner or restorative colleague to provide the definitive restorative procedure. Good communication is essential to define responsibilities, and agree a plan of action regarding the timing of restorative procedures and the period of retention. Acknowledgements

Grateful thanks are expressed to Mrs A. Richardsan and Mrs P. Prothero who typed the manuscripts, and to Mr R. Howell for permission to show the case illustrated in Fig. 6. References Artun, J. and Zaehrlsson, B. U. (1984) New technique for semi-permanent replacement of missing incisors, American Journal of Orthodontics, 8S, 367-375.

Eriesson, I. ( 1986) The combined effects of plaque and physical stress on periodontal tissues, Journal of Clinical Periodontology, 13,918-922. Evans, C. A. and Nathanson, D. (1979) Indications for orthodontic-prosthetic collaboration in dental treatment, Journal of the American Dental Association, 99, 825-830. Ferguson, J. W. (1988) Multi-strand wire retainers: an indirect technique, British Journal of Orthodontics, IS, 51-54. Gllmour, A. S. M. (1989) Resin bonded bridges-a note of caution, British Dental Journal, 167, 140-141. Glickman, I. and lmber, L. R. (1970) Comparison of gingival resection with electrosurgery and periodontal knives, Journal of Periodontology, 41, 142-148. Jaeobsen, P. H. (1981) The missing incisor, Part I. Intermediate replacement, Dental Update, 8, 587-590. Kaiser, D. A. and Cavazos, E., Jr (198S) Temporisation techniques in fixed prosthodontics, Demal Clinics of North America, 29, 403-412. La Sots, E. P. (1988) Orthodontic considerations in prosthetic and restorative dentistry, Dental Clinics of North America, 32, 447-456. Millar, B. J. (1987) Porcelain veneers, Dental Update, 9, 381-390. Monefeidt I. and Zaehrisson, B. U. (1977) Adjustment of clinical crown height by gingivectomy following orthodontic treatment, Angle Orthodontist, 47, 256-264. Nordquist, G. G. and McNeill, R. W. (1975) Orthodontic versus restorative treatment of congenitally absent lateral incisors-long term periodontal and occlusal evaluation, Journat of Periodontology, 46, 139-143. Paiomo, F. and Kopczyk, R.A. (1978) Rationale and methods for crown lengthening, Journal of American Dental Association, 96, 257-260. Radienski, R. J., Jager, A., Sehwestka, R. and Bertzbaeh, F. (1988) Plaque accumulation caused by interdental stripping, American Journal ~f Orthodontics, 94, 416-420. Rodgers, G. A. and Wagner, M. J. (1969) Protection of stripped enamel surfaces with topical fluoride applications, American Journal of Orthodontics, 56, 551-559. Reld, J. and Stirrups, D. R. (1987) A new solution to a difficult problem of orthodontic retention, British Journal of Orthodontics, 14, 281-283.


J. E. llarrison and D. E. J. Bowden

810 I 'o/. 19 No. l

Salvatoriella, F. W. (1982)

Tuverson, D. L. (1970)

An aesthetic space retainer, Journal of Clinical Orthodontics, 16, 765.

Orthodontic treatment using canines in place of missing maxillary lateral incisors, American Journal t!f Ortlwdomics, 58, I09 127.

Sandler, P. J., Reed, R. T. and Murray, A. M. (1988) Space maintenance for an upper central incisor during treatment: An aesthetic solution, British Journal o{Ortlwdontics. 15,41-43.

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restorative interface. Restorative procedures to aid orthodontic treatment.

Restorative procedures which complement orthodontic treatment and which may be carried out by the orthodontist are summarized. The importance of plann...
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