Single-Visit BridgeRibbond single-visit bridges provide strength, durability, and immediate convenience. Ribbond bridges are cost effective and reliable. Excellent for emergencies, implant temporization, congenitally missing laterals and patients who cannot afford conventional lab fabricated bridgework. Use natural tooth, denture tooth, or composite build-up.
Watch the Video
If clearance permits, a bridge can be made without preparation of the abutments. If there is not adequate space, shallow preparations might be necessary. The following shows the construction of a long-term bridge framework. For provisional bridges one layer of Ribbond can be used.
Making Ribbond Framework
Prepare teeth for bonding and place a thin layer of composite on the teeth.
Wet the Ribbond with bonding resin and place it spanning from one abutment to the other. Place the Ribbond so that it will be under the incisal edge of the pontic. Remove excess composite and cure.
Place a thin layer of composite lingual to the first piece of Ribbond in the pontic section of the Ribbond framework.
Wet a second piece of Ribbond and place it against the composite in the pontic section of the framework. Cure.
The second Ribbond layer attaches over the first composite layer only to the proximal lingual angles of the teeth adjacent to the pontic.
Cover Ribbond on abutments with composite. Cure.
- Cut off the root of the extracted tooth and fill pulp chamber with composite.
- Ribbond framework.
- Prepare an undercut lingual groove on the extracted tooth.
- Bond natural tooth pontic to Ribbond framework with composite.
- Choose and shape denture tooth to fit in the edentulous area.
- Build Ribbond framework.
- Prepare an undercut lingual groove in denture tooth to fit the Ribbond framework.
- Use a small round burr to drill small holes in the pontic for extra mechanical retention. Sandblast groove for better mechanical retention.
- Bond denture tooth to pontic with composite.
- Build Ribbond framework.
- Build composite pontic onto Ribbond framework using standard composite technique.
Periodontal SplintRibbond is perhaps best known for making periodontal splints. Ribbond splints are strong, highly bondable and esthetic. A Ribbond splint takes less time than traditional methods, is more esthetic, less bulky and exceptionally failure resistant.
Watch the Video
This video shows a mandibular splint that is placed on the lingual surfaces of the teeth. For maxillary splints, we recommend bonding the Ribbond into a small groove prepared on the facial.
Optional tooth preparation
If desired, the splint can be buried by cutting a channel in the teeth at the level of the interproximal contacts and placing the Ribbond at the base of the channel. This will make it more resistant to debonding and will maximize the longevity, esthetics and comfort of the splint.
Measure the teeth and cut the Ribbond. Make a pattern by closely adapting a piece of tinfoil or dental floss to the teeth. Cut the Ribbond to the measured length.
Prepare lingual surfaces and labial interproximals for bonding. Prepare the teeth for bonding in your standard manner (clean, acid-etch, apply a thin layer of bonding adhesive, remove excess adhesive, and cure)
Optional block-out and stabilization technique. After acid etching, apply a vinyl polysiloxane block-out gingival to the area to be splinted. This stabilizes the teeth during splint construction and makes clean up easier. Photos in these instructions show this block-out technique.
Wet the Ribbond with resin and blot off excess. Wet the Ribbond with an unfilled bonding adhesive or composite sealant and gently massage the resin into the fibers with an instrument and blot off the excess with a patient bib. Do not cure yet.
Apply filled composite to the teeth. Apply a thin layer of Ribbond Securing Composite or a paste-like, medium viscosity, translucent, filled composite resin at the level of the contact area. If using a paste like viscosity composite, use an instrument to flatten the composite to approximately 0.5 mm thick and contour to the surfaces of the teeth. Do not cure yet.
Adapt the Ribbond. Holding the wetted Ribbond with metal pliers, position one end of the Ribbond against the composite on the tooth. Press the Ribbond through the composite against the teeth with your finger or an instrument.
Adapt the Ribbond in the interproximal contact. To avoid pulling out the Ribbond that has already been adapted, hold the adapted part in position with a finger or an instrument. Place the Ribbond deep into the adjacent interproximal contact with an instrument. Continue until the entire length is adapted. Do not cure yet.
Remove excess composite with a composite instrument. Prior to curing, remove excess composite with an instrument.
Tack-cure the splint. Tack-cure the Ribbond for 5 seconds per tooth.
Cover the Ribbond splint with a flowable composite. Use a syringe or use a applicator brush to paint a layer of flowable composite over the Ribbond. If the composite slumps, you might need to apply multiple layers of flowable composite doing short light cures between layers. Do not use Ribbond Securing Composite for this covering layer.
Note: If a channel preparation is used, cover the Ribbond with a filled composite resin.
Light-cure the covering layer of composite. After placing a sufficient layer of covering composite, thoroughly cure for 30-seconds per tooth.
Check occlusion, finish and polish. Remove excess composite and polish with a composite-resin polishing paste.
The finished splint is thin, comfortable and esthetic
Fiber Reinforced Composite Restoration
Ribbond mitigates the harmful effect of C-factor. Shrinkage of the composite against the tooth is dramatically reduced preventing gap formation, leakage, and sensitivity. Ribbond also bridges cracks and reinforces structurally compromised teeth.
Photos courtesy of: Wendell Robertson, D.D.S.
Watch the Video
This video shows a large composite restoration reinforced with Ribbond. This is an alternative to a crown.
The tooth is prepared for bonding and a bonding adhesive is applied.
The proximal wall is built-up with composite. A flowable composite is placed in the bed of the preparation and is also placed against the interior walls of the prepared tooth. Ribbond pieces are wetted with bonding resin and the Ribbond pieces are pressed through the flowable composite against the tooth surfaces covering as much of the interior tooth surfaces as possible.
The Ribbond pieces are cured and composite is incrementally placed into the preparation.
To further reduce the risk of the tooth fracturing a piece of Ribbond is placed in the composite approximately 1.5 mm below what will become the occlusal surface of the tooth.
The occlusal surfaces are built-up with composite.
Here are two presentations by Dr. Graeme Milicich presented at the Academy of Biomimetics annual meetings.
- A Ribbond-direct Composite on an Endo premolar
- A technique discussion on Ribbond cores for premolars and molars
Why and how Ribbond composite restorations work
Published research articles confirm that incorporating Ribbond into composite restorations provides the following benefits:
INCREASED MICRO-TENSILE BOND STRENGTH
The micro-tensile bond strength of the composite is significantly increased when Ribbond is closely adapted and bonded against the cavity walls.
MITIGATING THE HARMFUL EFFECT OF C-FACTOR
The increased micro-tensile bond strengths decreases the negative c-factor effects. This phenomenon is especially evident with deep and narrow Class I restorations.
MINIMIZES POLYMERIZATION AND DECREASES SHRINKAGE AND LEAKAGE
Polymerization shrinkage can result in leakage, and sensitivity. Closely lining the preparation with Ribbond significantly reduces and minimizes these harmful effects of polymerization shrinkage. Because the Ribbond is closely adapted to the cavity walls, there is less volume of composite to shrink and less polymerization shrinkage results in less leakage and less sensitivity.
BRIDGING CRACKS ON PULPAL FLOOR
Ribbond bridges the cracks that are commonly seen in the pulpal floor of old amalgam restorations. Ribbond acts like staples across the cracks and holds the parts of the tooth on both sides of the crack together.
RELIEVES CAUSES OF SYMPTOMS OF SPLIT TOOTH SYNDROME
Split tooth syndrome has been predictably successfully relieved when Ribbond has been used as a buccal-lingual cross cusp splint under the occlusal surface to bridge cracks. The cross cusp Ribbond splint prevents the parts of the split tooth from moving.
INCREASED FRACTURE TOUGHNESS
Ribbond fiber reinforcements greatly increases the fracture toughness of dental composite restorations. Ribbond’s unique combinations of fixed nodal intersections and tough ultra-high molecular weight polyethylene fibers inhibits and prevents crack propagation it composite resin.
STRESS DISTRIBUTION AND ENERGY ABSORPTION MECHANISM
Ribbond acts as a stress distribution and energy absorption mechanism. It minimizes the stress concentrations by distributing forces over a greater area, which prevents crack formation and propagation. It also absorbs the energy from repeated occlusal impacts.
Studies demonstrate that if a crack starts in a Ribbond lined composite restoration, the crack is redirected. If this crack leads to failure, the restoration/tooth complex fails safely and the tooth can be retreated. In the case of standard composite restorations techniques; when the restoration/tooth complex fails, it tends to fail catastrophically and the tooth must be extracted.
The links below reference published studies supporting these performance characteristics.
C-Factor - Effects of fiber reinforcement on adaptation and bond strength of a bulk-fill composite in deep preparations
This study compares the use of a common bulk-fill composite, placed with and without Ribbond at the cavity interface. It demonstrates that the polymerization of a bulk filled composite results in gaps at the cavity interface when used in two increments or in bulk. These interface gaps are not visible to the naked eye, but they can lead to post-operative sensitivity, leakage and recurrent decay. Other Optical Coherence Tomography (OCT) studies by the lead author have demonstrated this phenomenon with a variety of bonding agents and composites, so this is not unique to a single brand or type of composite. All composites shrink and this shrinkage causes stress that can shorten the lifespan of the restoration and contribute to bond-interface gap formation, leakage and post-operative sensitivity. When Ribbond is well adapted into the cavity, interface gaps between the restoration and the tooth are nearly eliminated! The authors suggest that the Ribbond absorbs polymerization shrinkage stress, resulting in an intact bond interface. Other studies have confirmed increased fracture strength and a resistance to catastrophic fracturing of teeth restored with laminated Ribbond. With this study, we learn that by laminating Ribbond to the internal aspect of moderate to large composite restorations, we create the additional benefit of preventing bond interface gaps.
- C-Factor - The Effect of C-factor and Flowable Resin or Fiber Use at the Interface on Microtensile Bond Strength to Dentin
- Crack bridging;
- Cross cusp splinting
- Monoblock in root canals
- Micro leakage in over-flared canals
- Additional micro-leakage photos
Orthodontic RetainerFor post orthodontic retainers with 1/2 mobility or less, Ribbond offers the Orthodontic Ribbond. Using the same technique for making a periodontal splint, it is possible to make low bulk, bondable and esthetic retainers.
Prepare the teeth for bonding using your standard bonding procedure. Apply a thin layer of a paste composite at the level of the interproximal contacts.
Wet the Ribbond with unfilled bonding resin (sealant). Adapt the Ribbond into the composite. Like a bonded bracket, the fixed Ribbond retainer must be closely laminated against the tooth.
Hold the adapted Ribbond against the tooth with your finger. Use an instrument to place the Ribbond into the interproximal contacts closely against the adjacent teeth. Continue one tooth at a time until the entire Ribbond retainer is placed.
The placement of a Ribbond retainer is different than a wire. The Ribbond is closely adapted against the teeth and deep into the interproximal contacts.
After placement, remove extra composite and cure.
Using applicator brushes, instruments or needle tipped syringes apply a thin coat of flowable composite over the Ribbond. Cure.
Esthetic and comfortable, the Ribbond retainer is complete.
Diastema Closure Maintenance
- Esthetic — No gray show-through
- Durable — Does not harden and fracture like wire
Cut a shallow preparation in the teeth with a #4 round diamond, at the level of the interproximal contacts, and prepare teeth for bonding.
Place a thin layer of paste composite in the preparation. Wet the Ribbond with bonding resin and press the Ribbond through the composite and against the base of the preparation.Cure.
An additional layer of composite is applied so that the retainer is flush with the surrounding tooth structure.The finished retainer "disappears" within the composite and has no bulk
Unlike a metal wire Ribbond offers superior esthetics and is not visible.
Reinforcing Acrylic Orthodontic Appliances
Ask your laboratory to include Ribbond to prevent fracture failures.
Trauma StabilizationRibbond is perhaps best known for making periodontal splints. Ribbond splints are strong, highly bondable and esthetic. A Ribbond splint takes less time than traditional methods, is more esthetic, less bulky and exceptionally failure resistant.
Gently reposition the avulsed or luxated tooth.
Measure the length of Ribbond needed with dental floss. The Ribbond should extend to 3/4 of the distance across the abutments at the level of interproximal contacts.
Remove the Ribbond from the protective plastic sleeve with cotton pliers. Cut the Ribbond to the length of the dental floss template.
Wet the Ribbond with unfilled bonding adhesive or pit and fissure sealant. Blot off the excess with a lint free gauze or patient bib. The Ribbond may now be touched with powder free gloves or clean fingers.
Use waxed dental floss to contaminate the interproximal contacts of both the abutments and the traumatized tooth. This will prevent composite from bonding at the contacts.
Clean and etch the teeth at the level of the interproximal contacts. To maximize ease of removal, etch only enough surface area necessary for retention. Apply a bonding resin and cure. To insure semi-rigidity, do not etch or bond in the interproximal region.
Apply a minimal amount of filled composite on the teeth. Do not place any composite at the contacts.
Press the Ribbond through the composite against the teeth. Maintain Ribbond taut in interproximal region. Do not allow composite in the interproximal region during placement of the Ribbond. Cure.
Reposition traumatized tooth and apply composite. Reposition traumatized tooth with your finger, and hold it in position as you attach the Ribbond to the traumatized tooth with composite. Press the Ribbond closely against the tooth and cure. Be sure to get no composite in interproximal region.
Completed truma splint. The finished splint is esthetic, thin, smooth, and non-irritating to the injured lip.
Check occlusion, finish and polish. Remove excess composite and polish with a composite-resin polishing paste.
Ribbond does not polish well.Do not cut into Ribbond fibers.
The finished splint is thin, comfortable and esthetic.
Because Ribbond also bonds to acrylic and bis-acryl, it is commonly used for making reinforced provisional bridges. For longer-term bridges, multiple layers of Ribbond make a strong stress bearing laminate structure to act as a framework. For simple provisionals, one piece is commonly used to prevent cracks from propagating through the resin past the Ribbond. Although a crack may start, the Ribbond prevents catastrophic failure and maintains the integrity of the bridges.
Measure distance between outsides of abutments.
Place a thin layer of composite on preps for retention. Do not acid etch.
Wet Ribbond with unfilled bonding resin.
Wetted Ribbond changes from white to translucent.
Push Ribbond through composite, against the teeth, and polymerize. If using acrylic, wet polymerized Ribbond with monomer.
Keep Ribbond towards gingival region in pontic.
Confirm placement of Ribbond within vacuum formed matrix.
Inject provisional bridge composite gingival to Ribbond.
Place loaded tray over abutments.
Ribbond visible on occlusal surface of abutments.
Composite provisional bridge Finished
Endodontic Post & Core
Recommended by many well-known lecturers, the Ribbond endodontic post and core technique minimizes the chance for root fracture and has the following advantages:
- Compared to preformed posts, there is no additional tooth removal after endodontic treatment. This maintains the natural strength of the tooth.
- Eliminates the possibility of root perforation.
- Because it is made when the Ribbond is in a pliable state, it conforms to the natural contours and undercuts of the canal and provides additional mechanical retention.
- There are no stress concentrations at the tooth-post interface.
- The Ribbond post and core is passive and highly retentive.
- Because Ribbond's translucent fibers take on the color characteristics of the composite it allows for the natural transmission of light through teeth and crowns. This provides an exceptionally esthetic result.
Other than the normal endodontic treatment, further shaping is not required to accommodate the size and shape of a preformed post. The following is a brief description of the procedure. The Ribbond instruction manual, included with a purchase, clearly describes this technique in full detail.
- Prepare the canal for normal dentin bonding.
- Inject a dual cured moderately filled composite such as a luting composite into the canal.
- Use the special Ribbond post and core instrument to carry the wetted Ribbond through the luting composite in the canal to the apical end of the canal.
- Apply composite to the protruding Ribbond ends and roughly form them into the shape of the core and cure.
- Build up the core with composite, cure it and shape it
Condensing Ribbond into canal
Finished core build up
Finished with crown