Blog Prosthodontics
» SMILE -DESIGNING
A young lady with a responsible job, in an export company, Visited the Laungia Dental Hospital, for improving her smile profile.
» PATIENT’S PROFILE
A young employed lady named Amrit Paul, aged about 27 years, residing at College road Ropar.
» HISTORY
The patient is v. embarrassed, of her unpleasant smile,due to wide gap between her upper anterior teeth, which was also affecting her speech and bite. This resulted in an adverse effect on her personality and profession.
» DIAGNOSIS
After careful examination, it was found to be case of
(1) Congenitally bilaterally missing upper lateral incisors teeth, causing wide Diastema.
(2) High frenum attachment.
» LINE OF TREATMENT
(1) Surgery:- Frenectomy
(2) Endodontic:- Root canal therapy of abutment incisor teeth,due to likely exposure on crown cutting.
(3) Prosthodontic:- Bridge Fixation
» CONSENT
The entire line of treatment and the expenses involved were explained to the patient and a valid written consent was obtained from her.
TREATMENT
» SURGERY:- Frenectomy
Bilateral Infra orbital and incisive block were done using inj. 2% lidocaine as local anaesthetic. Frenectomy was done and the edges of incised mucosa were stitched together. There was no active bleeding and Perio Pack was not needed. Simple gauze cotton packing was given.
Post Operative care:- Patient was advised to remove gauze cotton pack after one hour and rinse with ice cold water.
Patient was given Cefadroxyl 500 mg BD for 5 days as prophylaxis. Paracetamol 1 tab BD and tab Ketanove SOS were given as analgesics.
After One week the Stitch was removed,and it was a successful Frenectomy without any adhesions or complications.
» ENDODONTICS:- Root canal therapy
In both the central incisors single sitting Root canal therapy was done due to lot of distal crown cutting required for ideal smile design.
PROSTHODONTICS :-
» Abutment preparation :-
» Bridge Cementation :-
A perfectly manufactured full porcelain bridge was received from the Dental lab. On this visit the temporary acrylic crowns were removed from the abutments and the Bridge cementation was done with glass ionomer. The Bridge fixation was done perfectly and snugly on to the abutments.
CONCLUSION :- It was a perfect case for Smile designing with a Prosthodontic Bridge with needed Surgical Frenectomy and single sitting RCT to take care of any exposures of distal crown cutting of incisors.Results were very satisfactory.
» PATIENT’S RESPONSE :-
» From Director’s Pen :-
FROM OUR INTERNATIONAL COMMITMENTS RECONSTRUCTION OF FAILED DENTAL BRIDGES DATED 08-04-2014
CASE STUDY & MANAGEMENT BY:- C.D.O. Dr. Parminderjit kaur.
» CASE PRESENTATION BY :-
» PATIENT PROFILE :-
» HISTORY :-
She has a history of good oral hygiene well aware about the Dental Prosthetics. Out of her three dental bridges she is using only one of them successfully.
» CHIEF COMPLAINTS :-
She has a complaint of two of her lower jaw bridges repeatedly failing and dislocated. She had tried to get them fixed up several times, but couldn’t succeed, and in due course she permanently lost, the smaller and posterior one of them.She has a history of good oral hygiene well aware about the Dental Prosthetics. Out of her three dental bridges she is using only one of them successfully.
» ON EXAMINATION :-
(1) She was wearing upper full porcelain joint crowns in relation to right & left upper central incisors (1/1 and 2/1). They were well fixed cemented over well prepared abutments without any gaps. They were in good aesthetic & functional relationship with the dental arches.
(2) She had lost permanently the bridge in relation to 34-38 of lower jaw.
(3) She was wearing a full porcelain bridge for lower anterior teeth irt 43-33.This bridge was completely dislodged from the ridge and it reoccurred even after repeated fixing up.
(4) On close examination the abutments 44,43,33,35 were badly prepared with over cuttings. So these abutments being quite reduced in height & volume failed to provide good anchorage & support to the bridge resulting in dislodgement.Again abutments 42,31,32 were found to be carious and likely to cause problems sooner or later.
(5) On the tooth 45 regular RCT had been performed. There was a Silver filling done for tooth 38. Pic. Showing originally badly prepared over-cut abutments.
» DIAGNOSIS :-
Repeated bridge dislodgement due to over cut and ill prepared abutments with some of them carious.
» TREATMENT PLAN :-
To correct the previous mistake done.It was decided to again prepare all the abutments scientifically for receiving a one (single) bridge for the lower anterior, teeth of both sides, along with the posterior teeth, of lower left side.Then to cement over a perfectly fabricated full porcelain Bridge by the lab.
» CONSENT :-
Patient was explained all the treatment to be done and the total expenses to be involved. A duly written consent was obtained from her.
» PROCEDURE :-
Bilateral Mandibular block anaesthesia was given with inj. Lidocain 2%. For the purpose of doing R.C.T. The abutment teeth 44,43,42,41,31,32,33,34,35 were all opened in a single sitting.The roots & apexes were minutely examined under magnified views of Digital x-rays.There respective canals were opened successfully and all the pulp materials were evacuated completely. The patient was put on antibiotic Cephalaxin 500 mg., and analgesic ketanov, twice daily for five days.The patient was called on alternate days for 3-4 sittings. Every time the root canals were disinfected with Hydrogen Peroxide, rinsed with normal saline and plug-sealed.
So zero inflammation of periodontal tissues, and complete sanitization of root canals were achieved.Then after obturation, normal post obturation filling with composite material, was done in relation to 41,31,32,33,34, & 35. While post core and build up was done, with gold plated screw posts & composite material, for achieving desired heights & shapes of 44,43,42,32,33,35 abutments.
The composite material was well exposed to light curing and all these abutments were meticulously and precisely finished up.Since the tooth 38 was healthy with silver filling, so no R.C.T. performed to it, but subjected to precise and adequate crown cutting, for converting in to ideal abutment.Now the lower jaw abutments were ready to receive a single bridge in relation to 45-38 Pic. Showing Precisely prepared abutments after R.C.T.and Post & core build up.
» IMPRESSION TAKING :-
(1) A good quality impression for the lower arches was obtained with putty impression material.
(2) Another good quality impression was taken for the upper arches with alginate impression material. Pic. Showing a precisely obtained impression of lower arches.Patient was explained all the treatment to be done and the total expenses to be involved. A duly written consent was obtained from her.
» BITE REGISTRATION :-
The third upper & lower quadrant had no teeth in occlusion, hence the need for bite registration. In a traditional way a Single wax strip of adequate height & width with adaptable shape for the lower arch was fabricated by heat softening.This single wax strip was placed over the lower arch.The bite was registered, in most retruded position of the lower arch, a most comfortable position for swallowing.The patient was asked, to bite on to the softened wax strip in this position, and thus obtaining the bite on to the wax strip.Vita shade guide was used for the shade matching of teeth for the bridge fabrication. Temporisation was done with self cure resin to cover-protect the vital & sensitive abutment 38.The patient was given an appointment after 3 days to receive her dental bridge.
» MODEL PREPARATION & FABRICATION :-
The models for the upper & lower arches were prepared with stone plaster in our own lab. These models of upper & lower arches, the bite registered on the wax strip along with the shade code and detailed instructions for Fabrication of a single full porcelain bridge were sent to the Dental lab.
» BRIDGE CEMENTATION :-
A full porcelain 13 units single bridge for the lower jaw was received after fabrication.Temporisation from the from the abutment 38 was removed.All the abutments were found healthy, asymptomatic and in good shape.The bridge was placed over the abutments and minor adjustments were done till the patient was completely satisfied with the occlusion and signalled it with a smile.Abutments were isolated with pre-fabricated cotton rolls and suction was used to keep the abutments dry.The bridge was cemented over to the abutments with glass ionomer luting agent and kept in position, pressed over for about seven minutes.Then all the cotton rolls were removed off. Pics. Showing a beautiful natural looking, aesthetic & functional bridge.
» PATIENTS RESPONSE :-
Immediately after fixation of the bridge, the patient did her few personal movements of the jaws checking her occlusion, checked in to the mirror by side of the dental chair and then she was all in pink Smiles thanking each and every doctor and snapping photos with them.
» AXIOM :-
For successful Dental bridges,good & lasting anchorage & support of abutment teeth, precise mandibulomaxillary relationship and aesthetic looks are mandatory.
» FROM DIRECTORS PEN :-
DISCUSSION:- For us, our every case is unique, giving challenges of research for precise Diagnosis, all the options of treatment plans, and finally picking up the solution in consultation with the patient & attendants.
(1) One of the alternative treatment plan, was removal of all the abutments and substitute enough number of them with surgical dental implant fixation.Then to fix-up a full porcelain bridge over these implant abutments.In the days of high-techs glamorous advertisements, this sounds high, with some amount of durability factor. But this involves too much surgery, comparatively quite costly,and a very time taking procedure.
(2) Another alternative plan was removal of all the abutments and after healing of the wounds to provide with a Removable partial denture.Indeed this is a very harsh option in the days of modern dentistry with an uncomfortable solution for any elite citizen.But its also a bitter reality, that still it would be most cost effective alternative, for economically compromised majority Indian rural population.
We have the privilege of catering our services to the humblest and most elite sections of the society. Our recipe differ as per age/sex/socioeconomic status/Geographical locations, but our attitude of service to man kind is same for all like the rays of sun. DENTAL IMPLANTS
» From Directors Pen :-
