The patient has had a lower anterior tooth that had gradually lost all the attachment around it as a result of localized periodontal disease. This left the tooth mobile and hopeless and it was starting to become uncomfortable chewing with it.
Once we determined that the tooth was hopeless, we set out to make the mouth healthier by removing the tooth. Then, we used the removed tooth to make a bridge between the teeth that will act as an immediate bridge. To make this possible, we anesthetized the area and extracted the tooth. Because it was already mobile and had very little attachment remaining, there was not very significant bleeding. We then, sectioned the tooth to get it out of the unhealthy pocket so that the periodontal tissues below it can heal. Then, we backfilled the root canal space internally in the tooth with bonding agent and flowable composite. We made a channel in the two adjacent teeth and the extracted tooth, then, using unfilled bonding agent on the Ribbond, and normal (etch, Scotchbond Universal) bonding agent on the teeth, placed a thin layer of composite and bonded 2 strips of ribbond into the channel to reinforce the teeth being intracoronally splinted together. We then, placed additional composite over the top, and I added a small amount of flowable composite from the facial interproximally to finish. Then, I touched up the occlusion with an ortho disc and smoothed off the edges of the composite in the channel with a flame diamond.