Dwi Warna Aju Fatmawati

Cantilever Bridge Design as Esthetic Restoration on

Post Endodontic Treatment: Case Report
Dwi Warna Aju Fatmawati
Operative Dentistry, Dentistry Faculty-Jember University
Jember-East Java-Indonesia
dwiwarna69@yahoo.com

Abstract
In dentistry, aesthetic and cosmetic had become patient demands, because it was related with beauty.
In aesthetic restorative and cosmetic treatment, dentists were not only concerned in beauty but also
must consider function of restoration. Thus, dentists must select materials and designs that had ability
on occlusion and mastication bearing for long time in oral cavity. Dentures or restoration treatment that
had similar color with tooth was known for a long time, because it can improve aesthetic and selfconfidence. The aim of this case report was to explore aesthetic restoration used in cantilever bridge on
post endodontic treatment subject. This bridge can be used as a more simple alternative treatment for
subject whose restorative was broken and used partial denture.
Keywords: aesthetic restoration, post endodontic treatment, cantilever bridge

Introduction

The scope of operative dentistry is to maintain and restore teeth for long life in oral cavity,
such as by endodontic treatment and rigid restoration. These treatments must consider
esthetic and periodontal tissue around the teeth. In dentistry, aesthetic and cosmetic
become patient demands, because it is related with beauty. In aesthetic restorative and
cosmetic treatment, dentists are not only concerned in beauty but also must consider the
function of restoration. Denture and restoration using materials that have color similar with
origin tooth are some of treatment in dentistry for improving performance, beauty, and self
confidence patients. Tooth loss causes uncomfortable, phonetic, mastication, and self
confidence disturbance.
Before determining the treatment, patient should be given explanation by dentist about the
procedures that will be done. It is related with the successful of the treatment, because the
treatment must consider indication and contraindication of the treatment, type of patients,
dental history, and financial. Tooth restoration is a way to improve tooth decay, anomaly
and post endodontic treatment as well as maintain tooth along life [1]. Endodontic
treatment usually cause widening tooth cavity and decreasing water composition, thus
tooth become brittle and fragile. Rigid restoration is treatment of choice for getting ideal
proximal contour and esthetic also preventing tooth fracture after endodontic treatment
[2].
Nowadays, fixed denture is very popular in community. Fixed denture is permanently
cemented on origin tooth, including cantilever bridge [3]. Cantilever bridge is one of fixed
bridge type that only supported by one tooth to be an anchorage for tooth on edentulous
area [4]. The aim of this case report is to explain alternative and simple treatment for
substituting broken restoration using removable partial denture.

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The Indonesian Journal of Dental Research

Proceeding of The International
Symposium on Oral and Dental Sciences



Dwi Warna Aju Fatmawati

Case report

Female teacher, 47 years old, want to restore anterior maxilla tooth because the restoration
was broken. Intra oral examination showed perforation profound caries on 23, found as wide
cavity in mesial and expanding to cervical region. Miller examination showed 25 mm result.
Painless or no respond on percussion and press test was determined. Gingival condition was
normal. There was removable partial denture at 22 (Figure 1).

Figure 1. a) Broken restoration on 23. b) Tooth 23 after removing broken restoration. c) Try in new
restoration on 23. d) Removable partial denture in 22. e) Tooth cavity after removing and cleaning
broken restoration. f) try in new restoration on 23

Explanation was given to the patient about non vital 23 and endodontic treatment must be
taken followed by post core and porcelain crown restoration. The alternative treatment used
cantilever bridge was given, thus patient did not need to use her removable partial denture.
The treatment procedures are: (1) aseptic and isolation procedure, (2) root canal cleaning and
reshaping in 24 mm working length, (3) try in #45 gutta percha in 24 mm working length, (4)
root canal filling, (5) temporary restoration procedure, (6) x-ray examination, and (7) control
(Figure 2).
Patient was monitored one week after endodontic treatment. In control, dentist examine
about the complaint, pree test, temporary restoration condition. After review, denture
preparation was done. The procedures were (1) aseptic and isolation, (2) temporary
restoration removal, (3) working length measurement and gutta percha removal using gate
glidden drill (GGD), (4) fabricated post core try in, (5) post core insertion and cementation
using type 1 glass ionomer, (6) wall built in tooth core-like form, (7) working models
preparation, (8) color matching using shade guide, and (9) temporary crown insertion. After
the bridge was ready, the procedures were (1) aseptic, (2) temporary crown removal, (3)
cantilever bridge try in, and (4) insertion (Figure 3).

The Indonesian Journal of Dental Research

Proceeding of The International
Symposium on Oral and Dental Sciences

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Dwi Warna Aju Fatmawati

Figure 2. a) 45 gutta percha try in in 24 mm working length; b) Temporary restoration; c) X ray examination after
root canal filling

Figure 3. a) Fabricated post core insertion; b) Built in core wall; c) Try in

cantilever bridge; d) Cantilever bridge 22 and 23 insertion.

Discussion

As a vital organ, tooth must be cared and treated. Nowadays patients are more considering
their teeth performance, especially anterior teeth. The advantage of fixed denture for post
endodontic treatment is an ability to maintain remaining teeth and mastication system. We
must take attention in marginal adaptation, restoration contour, smooth surface, embrasure,
pontic design, and biological effect on gingival and periodontal tissue [5]. Dentist must
consider about indication and contraindication of all treatment, because it determined
successful result [1]. Cantilever bridge was a potential alternative for post endodontic
treatment cases, because it provided comfort and good esthetic.

References

[1] Fatmawati, DWA. 2011. Macam-macam Restorasi Rigid Pasca Perawatan Endodontia.
Stomatognatic, 8: 96-102
[2] Jubhari EH. 2007. Upaya untuk Mengurangi Preparasi Gigi : Fung Shell Bridge. Jurnal
Kedokteran Gigi Dentofasial, 6: 27-9

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The Indonesian Journal of Dental Research

Proceeding of The International
Symposium on Oral and Dental Sciences

Dwi Warna Aju Fatmawati

[3] Shilingburg H, Hobo S, Whitsett L, Richard J, Brackett S. 1997. Fundamentals of Fixed

Prosthodontics 3rd Ed, Quintessence Publishing Co. Inc. North Kimberly Drive: 1
[4] Barclay CW, Walmsley AD. 2001. Fixed and Removable Prosthodontics 2nd Ed. Churchill
Livingstone. Tottenham. p. 115-22
[5] Lesmana RA. 1999. Faktor-Faktor Periodontal Dengan Gigi Tiruan Cekat. Jurnal Kedokteran
Gigi Universitas Indonesia, 6: 35-40

The Indonesian Journal of Dental Research

Proceeding of The International
Symposium on Oral and Dental Sciences

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