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

12

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

13

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: drankitmehrotra@gmail.com

14