Endo and Anterior Bridge

Integrated Endodontic and Restorative Management of a Failing Bridge

Overview

In this video, we discuss a multidisciplinary approach to treating a failing 25-year-old bridge in the aesthetic zone. The session highlights the importance of patient-centred planning, transitioning from a complex diagnostic scenario to a successful long-term restorative and endodontic outcome.

The Case & History

A patient presented with recurring discomfort and intermittent buccal swelling associated with a long-standing fixed-fixed bridge in the anterior region. The bridge, which had been in place for 25 years, was showing signs of marginal failure and secondary caries around the upper left lateral incisor (UL2). The patient expressed dissatisfaction with the current aesthetics but was reluctant to pursue dental implants or surgical endodontics. Clinical assessment suggested a need for a comprehensive overhaul to address both the failing restoration and the underlying endodontic infection.

The Clinical Problem

The primary diagnostic challenge was assessing the restorability of the UL2, which contained a post and a paste root filling. A definitive prognosis could only be determined after dismantling the existing bridge and removing the post to evaluate the remaining tooth structure and ferrule. Furthermore, the clinician had to manage high aesthetic expectations in the "smile zone," necessitating a precise temporary restoration strategy. During treatment, the canal was found to have a wide apex (gauged to size 60), requiring a customised obturation approach to ensure a predictable seal before the final restorative phase.