Composite Rehabilitation with Harmonize™ & OptiBond™ Universal Dr Michael N. Mandikos BDSc (Hons), MS, Cert Pros, FRACDS
Dr. Mandikos is a registered specialist in Prosthodontics. He received his Bachelor of Dental Science Degree with First Class Honours, from the University of Queensland and his Certificate in Prosthodontics and Masters Degree in Biomaterials from the State University of New York at Buffalo (USA) in 1998. His research was in composite resin materials and he has published several research papers in Australian and international journals on clinical and dental materials topics, as well as many clinical technique articles and case studies. Dr Mandikos is a Visiting Specialist to the University of Queensland Dental School and formerly to the Royal Australian Air Force. He is a Reviewer for five international dental journals and is a product evaluator for several dental companies. He has presented continuing education programs at Dental meetings throughout Australia, Southeast Asia and the USA. Dr Mandikos is in specialist private practice limited to implant and restorative dentistry in Brisbane, Australia and he teaches at the Australian Dental Centre of Excellence.
BEFORE
Case History This gentleman presented with pain in his upper left quadrant. He had not been to a Dentist for many years and his dental experience had primarily been to have problematic teeth extracted (Fig. 1). As a result, he no longer had any of his molar teeth, but had been functioning well with his remaining premolar occlusion. After his examination appointment, it was clear that the two premolars in the upper left quadrant had significant apical pathology and could not be predictably treated. His remaining dentition showed generalised attrition subsequent to dental erosion from gastric reflux, and his lower anteriors showed recession and some loss of periodontal support (Figs. 2, 3).
AFTER
After discussion with the patient, he decided that he did not want to lose any more teeth and wear removable prosthetics, but he did not have the ability to afford extensive crown and bridgework to restore his dentition. He also requested that his existing (relatively new) crown on the upper left lateral incisor (#22) be retained. With these treatment constraints, it was decided to restore him to a Shortened dental arch1, 2 and that his treatment would occur in phases. The first phase was to return the lost tooth structure, occlusion, vertical dimension and aesthetics with the composite buildups. Phase two was to remove the two premolars (#24 and #25) and allow soft tissue healing. Phase three was to place a dental implant in the site of the #25 and restore it with a 2-unit cantilever bridge.