University J Dent Scie 2015; 1(2) : 12-14
Abstract: Planning and executing the restorative and esthetic rehabilitation in partially edentulous patients is one of the most challenging jobs faced by a dentist. This article describes rehabilitation of a 25 year old patient with partially edentulous maxillary and mandibular arches. The maxillary and mandibular arches were restored initially by Interim partial dentures at a newly established vertical dimension followed by fixed prosthesis in the mandibular arch thereby restoring esthetics and function.
1 2 3 Ankit Mehrotra, MDS, Garima Singh, MDS, Ankur Mehrotra1Assisstant Professor, Deptt. of Prosthodontics, Rama Dental College, Kanpur2 Assisstant Professor, Deptt. of Pedodontics, Rama Dental College, Kanpur3 Private Practitioner, Kanpur
INTRODUCTION : Partial edentulism is a common
problem faced by dentists which may occur due to
developmental disturbances, trauma, caries, periodontal loss
etc. Partial loss of teeth can lead to loss of esthetics and
function, superaeruption of teeth, decrease in the vertical
dimension, change in profile, drifting of teeth, irregular
resorption pattern of the residual bone and psycologic affect 1on the patient . Partial edentulism can be restored by
removable prosthesis, fixed prosthesis, combination of
removable-fixed prosthesis and implant prosthesis. In the
following article, treatment was performed in two stages i.e
Provisional treatment including a maxillary & mandibular
acrylic removable partial denture and Definitive treatment
where single piece porcelain fused to metal mandibular fixed
bridge was planned opposing existing maxillary acrylic
partial denture.
CASE REPORT: A 22 year old male reported to the clinic
with the chief complaint of poor appearance and difficulty in
chewing due to the missing upper and lower teeth and wants to
get them replaced (Fig.1 & Fig. 2).
Fig. 1. Maxillary partially edentulous arch
Fig. 2. Mandibular partially edentulous arch
Patient had been partially edentulous since 2 years and
recently got extraction of his carious 21 one month ago.
Dental examination revealed partially edentulous maxillary
a n d m a n d i b u l a r a r c h e s . T e e t h n u m b e r
15,25,36,34,42,43,44,46 were present. On further
examination, teeth numbers 17,27,37,47 were found to be
congenitaly missing and mandibular and maxillary arches
were smaller than the normal. Also, due to prolonged
edentulism of the mandibular anterior teeth, patient
developed Pseudo class III jaw relationship, with prominence
to the chin, forward placement of the mandible and decrease
in the vertical dimension (Fig. 3).
Fig. 3. Pre-operative Profile view (Pseudo Class III)
“SINGLE PIECE PORCELAIN FUSED TO METAL MANDIBULAR BRIDGE OPPOSING MAXILLARY ACRYLIC REMOVABLE PARTIAL DENTURE IN PARTIALLY EDENTULOUS PATIENT : A CASE REPORT.”
Journal of Dental Sciences
University
Key Words : Porcelain fused to metal,Partial edentulism, Prothesis,Single piece fixed partial denture
Source of support : NilConflict of interest : None
OriginalResearch
Paper
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University J Dent Scie 2015; 1(2) : 12-14
On the basis of clinical and radiographic examination,
implant supported maxillary fixed prosthesis with mandibular
porcelain fused to metal fixed partial denture was planned.
But, due to financial issues, provisional treatment plan i.e.
maxillary and mandibular interim removable partial dentures
with increased vertical dimensions for 1 month were planned
and then definitive treatment i.e. mandibular porcelain fused
to metal bridge opposing existing maxillary partial denture
will be executed.
Maxillary and Mandibular alginate impressions (Zelgan,
Dentsply) were made to fabricate the diagnostic casts.
Maxillary cast was mounted on a semiadjustable articulator
( Hanau Wide Vue) using Springbow ear piece type of
facebow whereas mandibular cast was mounted after bite
registeration was recorded at the established occlusal vertical
dimension. Occlusal vertical dimension and vertical
dimension at rest were assessed by phonetics evaluation 2 3(Pound and Silverman ), measurement of interocclusal space
4(Niswonger ) and evaluation of facial apperarance.
After the tryin, both maxillary and mandibular acrylic partial
dentures (Travelon, Dentsply) were placed and adjusted (Fig.
4).
Fig. 4. Maxillary & Mandibular Acrylic partial dentures
intraorally
Patient was instructed to wear these acrylic partial dentures
for maximum time except during night for 1 month. Patient
was monitored constantly for muscle tenderness, mandibular
movements, swallowing, speech and mastication. The acrylic
partial denture acted as an occlusal splint which assisted in
deprogramming the muscles of mastication and in assessing
the effect of increased occlusal vertical dimension on the TMJ
and surrounding musculature. Improvement in speech,
esthetics and comfort confirmed the patient's tolerance to the
new mandibular position with the restored occlusal vertical
dimension. On the basis of these observations it was decided
to proceed with the definitive treatment.
Defintive treatment included tooth preparations (Fig. 5) of
36,34,42,43,44,46 to receive porcelain fused to ceramic
bridge followed by gingival retraction and impression making
using polyvinyl siloxane impression material (Reprosil,
Dentsply).
Fig. 5. Mandibular Teeth prepared
Teeth were prepared with nearly parallel axial walls. This is
because more parallel the axial walls greater the mechanical 5friction thereby providing better resistance and retention .
The impression was poured in die stone (Kalabhai-Type IV
Dental Stone) and mounted on semi-adjustable articulator
(Hanau Wide Vue) against the maxillary cast (obtained later).
Alginate impression made of the maxillary arch with acrylic
partial denture in place followed by mounting the cast on a
semiadjustable articulator (Hanau Wide Vue) using
Springbow ear piece type of facebow. Bite registration done
taking reference to the occlusal vertical dimension
established for the maxillary and mandibular acrylic partial
dentures.
After mounting both the casts at the desired occlusal vertical
dimension, wax patterns were prepared, casted and tryin of
single piece metal framework to verify intra-oral fit, retention
and stability was done (Fig. 6).
Fig. 6. Single piece Mandibular Metal Tryin
Porcelain build up was done on the metal framework and
occlusion adjusted on the articulator. Pre-glaze tryin for the
single piece porcelain fused to metal bridge was performed
(Fig. 7).
Fig. 7. Pre-glazed PFM bridge
Occlusion checked in both centric and eccentric movements
and group function occlusion was achieved. Porcelain fused
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University J Dent Scie 2015; 1(2) : 12-14
to metal single piece bridge was finalized and glazed.
Porcelain fused to metal single piece bridge was
cemented by GIC luting cement and oral hygiene instructions
were given to the patient (Fig. 8).
Fig. 8. Final Prosthesis intraorally
He was advised to brush his teeth twice daily and gargle after
every meal. He was advised to remove his maxillary acrylic
partial denture at night to give rest to the mucosa and clean it
every morning before wearing.
Patient was followed up regularly and satisfied with the
esthetics, function and new vertical dimension thereby
reducing the chin prominence and achieving a Class I profile
(Fig. 9). There was no pain and discomfort in the TMJ region.
Fig. 9. Post-operative Profile view (Class I)
SUMMARY : Patient with partial edentulism was treated by
maxillary acrylic partial denture opposing single piece
porcelain fused to metal bridge in two stages. Treatment
improved the patients esthetics, oral function and established
a more favourable occlusion plane. Since the patient was
young his social confidence also improved significantly as a
result of dental treatment.
REFERENCES:
1. Rodney D. Phoenix, David R. Cagna, Charles F.
Defreest. Stewart's Clinical Removable Partial thProsthodontics. 4 ed. Quintessence Publishing 2008.
2. Pound E. The mandibular movements of speech and their
seven related values. J South Calif Dent Soc
1966;34:435.
3. Silverman MM. The speaking method in measuring
vertical dimension. J Prosthet Dent 1953;3:193
4. Niswonger ME. The rest position of the mandible and the
centric relation. J Am Dent 1953;3:193.
5. Langer A. Telescope retainers and their clinical
application. J Prosthet Dent 1980;44:516-22.
CORRESPONDING AUTHOR:
Dr. Ankit Mehrotra
117/L/453-A, Kakadev,
Kanpur - 208025 (Uttar Pradesh) India
E-mail: [email protected]
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