BACKGROUND: This case report highlights the successful management of a challenging case of partial edentulism with Implant and teeth supported fixed partial denture.
The 28 year old male has chief complain of multiple missing teeth, difficulty in speaking, chewing, ill looking face and loss of confidence. The clinical and radiological examinations were carried out. Primary periodontal treatments were performed which included Motivation, Education, Scaling and Root Planing. The extraction of supra-erupted, attrited 11, 12, 13, 21, 22, and 23 were completed. Recalled him after two weeks. Again Oral hygiene measures were demonstrated. Two weeks latter Five Bio3 self threaded two stage Implants (3.8X13.0mm, 3.3X10mm) were placed in different positions at different time interval. After 16weeks by stage II surgery the cover screw were removed and the healing cap were screwed in to the place. The gingiva was allowed to heal and mature for 4 weeks which subsequently replaced by abutments. Finally the porcelain-fused-to metal crown bridges were delivered. The patient was instructed in maintenance and hygiene procedures associated with the fixed dentures.
It is the successful management of such damage dentition and regains the esthetic, functions as well as enhances the level of confidence of the patient. This is a great challenging job.
Mutilated dentition, Implants, Fixed Prosthesis.
After the loss of some natural teeth, the inter-and intra-arch relationships of the remaining dentition might be affected. The adjacent teeth tend to adapt physiologically to the changes by drifting or tipping towards the resultant space, while the antagonist teeth has the tendency to overerupt.1,2In addition to limit the space for any future prosthesis,occlusal interferences and disfigurement can be introduced .Subsequently, the rehabilitative treatment will be complicated by including invasive adjunctive therapies such as crown lengthening surgery , elective endodontic treatment ,orthodontic movement ,and increasing the vertical dimension of occlusion.3 The patient's occlusal vertical dimension, centric relation, esthetics and phonetics need to be determined and maintained throughout the restorative process.4
This clinical case report illustrates the successful management of partial edentulism with Implant and teeth supported fixed partial denture which ultimately restore the occlusion and pleasant esthetic.
The 28 year old male has referred to Impantologist to ged rid him from problems of missing teeth and associated structures. He has chief complain of multiple missing teeth, difficulty in speaking, chewing, ill looking face and loss of confidence. He was medically fit. The clinical examination was performed to find the status of soft and hard tissues. Teeth 31, 32, 33,41,42,43 were missing. The upper anterior teeth were unopposed and almost contacting the residual ridges (Fig: 1) .
The teeth 24 was mobile, drifted distally and deemed non- restorable. The remaining teeth were no mobile. The maxilla and mandible were partially edentulous. Measuring the vertical dimensions in anterior segment revealed excessive loss of vertical dimension of occlusion (VDO).There was no sign of temporomandibular disorder. The plaque Index, PPD and CAL of remaining teeth were measured. Radiological examinations were carried out using IOPA X-Rays, Panaromic view of maxilla and mandible; dentalCT (Dentascan).The study models were fabricated to record the centric occlusion. The treatment plan was explained to the patient and he has given written consent and ready for proper management.
Primary Periodontal treatment including Motivation and Education, Scaling and Root Planing were performed. The extraction of supra-erupted, attrited 11, 12, 13 and21, 22, 24 were completed. Recalled him after two weeks. Again Oral hygiene measures were demonstrated and emphasized before considering any rehabilitative treatment.Two week’s latter surgical guide was prepared before the placement of Implants. Five Bio3 self threaded two stage Implants (3.8X13.0mm, 3.3X10mm) were placed in different positions at different time interval (Fig: 2).
Implantation protocol was preferred according to standard manufacture’s guideline. After proper healing provisional removal prosthesis were delivered to maintain the functions and occlusion. Then 16weeks latter by stage II surgery the cover screw were removed and the healing cap were screwed in to the place. The gingiva was allowed to heal and mature for 4 weeks which subsequently replaced by abutments (Fig: 3).
finally the porcelain-fused-to metal crown bridges were delivered (Fig: 4, 5and 6.). The patient was instructed in maintenance and hygiene procedures associated with the fixed dentures. He was fully satisfied with extensive management and revives his lost smile. The routine recall appointments were scheduled on a 6-month basis and no complications occurred during the 28 months follow-up period.
The prosthetic rehabilitation of partially edentulous patients can engender a challenge for the clinician when there is reduced and inadequate interocclusal space. In the present case the upper anterior, unopposed; supra erupted teeth were removed because they were damaging the lower anterior ridges and reduce the space for fabrication of artificial teeth on edentulous area. The occlusal scheme may be deformed due to early loss of teeth when the opposing dentition supraerupts towards the edentulous space.5 The extrusion of opposing teeth and/or the alveolar extrusion of the edentulous areas reduce the space needed for fabricating the partial denture.5 Before any prosthetic reconstruction can commence, lost intermaxillary space must be regained.6
The use of dental implants to replace missing teeth has become the standard of care for edentulous spaces. With the presence of restricted interocclusal clearance, screw-retained restorations have been proposed because it may not be possible to develop adequate retention to retain restorations on implants with cement.7,8 Screw-retained restorations can be secured to implants with as little as 4 mm of space from the surface of the implant to the opposing occlusion.8In this case the interarch distance was 6mm but interdental space (mesio-distal)was sufficient to placed the Implants of 3.75 and 3.30mm diameter. The smallest interdental space that can be accepted without damaging the periodontal support of neighbouring teeth is around 7mm, if implants of 4mm diameter are to be used 9.In the maxilla 10 unit bridge have 6 abutments and in mandible 12 unit bridge have 5 abutments including two mandibular first molar. The molar teeth have sufficient surface aeria and anchorage for the long term success of implant and teeth supported bridge. According to Ante’s law “The root surface area of the abutment teeth has to equal or surpass that of the teeth being replaced with pontics”10.
Thus, the successful management of such damage dentition and regain the esthetic, function as well as enhance the level of confidence of the patient is a great challenging job.Fruthermore, long term follow-up and majority of such cases are necessary for the standardization of the process.
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