Structurally compromised teeth. Part II: A novel approach to peripheral build up procedures

Abstract

Objective: To introduce the "Peripheral Build-Up technique - PBUt" as a foundation restoration strategy for structurally compromised teeth (SCT).

Clinical considerations: Several strategies have been proposed over time (cervical marginal relocation, doughnut, and preformed ring techniques) to enable the management of restorative procedures in challenging situations such as the presence of deep subgingival defects. The PBUt is a versatile, completely additive direct technique that share some strategical concepts with these techniques to approach critical clinical situations while supplying a wider field of application thanks to distinct operative expedients. The clamp insertion modality, the extension of the proximal wall and the matrix customization/stabilization strategies adopted in PBUt endorse the possibility to manage the most apical and peripheral border of the residual tooth structure when located up to >1.5 mm above the bone crest. The periodontal response has to be then monitored over time. Moreover, thanks to the peripheral and apically-extended addictive approach, it allows a massive preservation of residual sound tooth structure and improves the resistance and retentive physical/geometrical features of the abutment tooth. The PBUt operative workflow is herein explained.

Clinical significance: The Peripheral-Build-Up technique (PBUt) advocates some innovative clinical restorative steps for the management of SCT with coronal and deep subgingival defects.

Keywords: additive technique; build-up; foundation restoration; proximal matrix; residual tooth structure; structurally compromised teeth.