Published on March 8, 2014
Clinical Case presentation Ali Al Enezi 2014
• 65 years old • Non smoker • Don’t have history with any systemic disease or allergy. • Only complain from Peptic ulcer. • Medications: omeprazole 1-2/day.
I lost some of my posterior teeth long time ago. And now I want it to be replaced • He is not able to eat properly . This was since he lost some of his posterior teeth. • Chief complaint Expectations to have the best available treatment option for his teeth. He want it to be (fixed).
Clinical Examination Extra-oral exam • • • Nothing abnormal was detected. No sign of Pain or tenderness in the head and neck area. TMJ: no clicking or tenderness in TMJ area or muscles of mastication.
Intra- oral examination
Intra- oral examination
Periodontium • • • • fair Oral hygiene. Staining & general plaque accumulation. Normal pocket depth around his teeth (1-3 mm). Generalized mild to moderate gingival recession in upper and lower teeth.
DIAGNOSIS 523.00: plaque induced gingivitis. 521.09: secondary caries. 38,36,47 525.1: Loss of teeth due to extraction: 15,14,37,35,44,45,47. 521.81: fractured DB cusp : 17 522.6: Chronic apical periodontitis 41 521.20: Abrasion in the buccal surface 16,34,44
chief complaint - not eating properly since he lost multiple posterior teeth. - Ugly smile - Many missing and heavily restored teeth - Discolored upper incisor Main problems
Treatment options • Single implants restoration • Removable denture • Fixed bridge restoration
Meta-analysis of fixed partial denture survival (Scurria, Bader et al. 1998) 10 years: 92% 15 years: 75% *(failure was defined as fixed partial denture removal)
Discolored crown with metal core “Zirconia opacity is very useful in adverse clinical situations, for example, for masking of dyschromic abutment teeth”. (Paolo Manicone, 2007).
Disease Control Phase • Patient motivation & Oral hygiene instructions. • scaling and root planning. dental polishing • endodontic treatment for 41 • Composite restorations : 17,16,27, 38. • Referral to the hygienist for oral hygiene care.
• Zirconia based single crown #21 Before After
Before porcelain fused to metal bridges: • (13-16,h14,15) • (43,44-47,h4546). porcelain fused to metal bridge: • (36-34 h35) After
(Fair to Good) All the teeth showed good periodontal condition and bone support. However, having many large filling and fixed prosthesis are factors that could affect the prognosis Prognosis
Caries 18% Prosthesis fracture Need for Endo- therapy 2% 11% most common fixed partial denture complications Tooth fracture Loss of retention 3% 7% Periodontal disease Esthetics 4% 6% (Goodacre, Bernal et al. 2003): average 8 years of observation.
• 46 years old • Non smoker • No history with any systemic disease or allergy.
• not happy with his smile as it shows metal screw in the upper anterior region (Chief complaint). • He want to close the diastema between the upper central incisors. Chief complaint Expectations • He wishes to get restorations for the missing teeth that will fit very well with other existing teeth. • to restore the esthetic appearance of his smile.
DIAGNOSIS 523.42: Chronic periodontitis, generalized. 525.51: Partial edentulism (14-18). 525.64: Fractured dental restorative material with loss of material (tooth 12). 524.30: Unspecified anomaly of tooth position (diastema between 11.21)
chief complaint Metal screw in upper interior effect esthetic appearance - Failure in old crown restoration - long edentulous posterior area - Deep gingival pockets (more than 7 mm upper centrals. Main problems
Phase 1: • • Proposed treatment plan • Composite veneer (11,12). (post & core) and crown restoration (21) Removable partial denture Phase 2: (After 6 months of 1st phase). • Re-evaluation of periodontal condition. • Bridge restoration supported by implant (14-16,h15) • Implant insertion with crown restoration 46. • Porcelain veneer (11,21).
(Willhite, 2005) proposed three criteria for successful diastema closure: 1. increase emergence profile with natural contours at the gingiva and tooth interface. 1. a completely closed gingival embrasure. 1. a smooth subgingival margin that does not catch on or shred dental floss.
The objectives of prosthodontics treatment 1. Elimination. 1. Preservation. 2. Replacement. ( McGivney et al, McCracken's Removable Partial Prosthodontics, 2000).
• Composite veneers (11,21) • E.Max crown for 12
Removable partial denture
Before and after
Prognosis dependent on patients ability to sustain stable periodontal condition, this will be evaluated throughout phase 1. Prognosis for removable denture: fair to poor (due to inability of patient to accept this as definitive treatment), Crown restoration 12 : good prognosis (dependent on quality of remaining tooth structure, ferule, periodontal support, lack of heavy occlusal loading, etc). Prognosis
More references: • • • • • • • Chu, C. H., et al. (2011). "Treating a maxillary midline diastema in adult patients: a general dentist's perspective." J Am Dent Assoc 142(11): 1258-1264. Spear, F. and J. Holloway (2008). "Which all-ceramic system is optimal for anterior esthetics?" J Am Dent Assoc 139 Suppl: 19S-24S. Scurria, M. S., et al. (1998). "Meta-analysis of fixed partial denture survival: prostheses and abutments." J Prosthet Dent 79(4): 459-464. Goodacre, C. J., et al. (2003). "Clinical complications in fixed prosthodontics." J Prosthet Dent 90(1): 31-41. Manicone, P. F., et al. (2007). "An overview of zirconia ceramics: basic properties and clinical applications." J Dent 35(11): 819-826. Beaumont, A. J., Jr. (2002). "An overview of esthetics with removable partial dentures." Quintessence Int 33(10): 747-755. Chang, Y.Y., Maximizing esthetic results on zirconia-based restorations. Gen Dent, 2011. 59(6): p. 440-5; quiz 446-7.
Christensen, G.J., Porcelain-fused-to-metal versus zirconia-based ceramic restorations, 2009. J Am Dent Assoc, 2009. 140(8): p. 1036-9. Eliasson, A., C.F. Arnelund, and A. Johansson, A clinical evaluation of cobalt-chromium metalceramic fixed partial dentures and crowns: A three- to seven-year retrospective study. J Prosthet Dent, 2007. 98(1): p. 6-16. Heintze, S.D. and V. Rousson, Survival of zirconia- and metal-supported fixed dental prostheses: a systematic review. Int J Prosthodont, 2010. 23(6): p. 493-502. Tinschert, J., et al., Structural reliability of alumina-, feldspar-, leucite-, mica- and zirconia-based ceramics. J Dent, 2000. 28(7): p. 529-35. Zarone, F., S. Russo, and R. Sorrentino, From porcelain-fused-to-metal to zirconia: clinical and experimental considerations. Dent Mater, 2011. 27(1): p. 83-96.
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