reconstruction of a maxillary arch (kennedy class iv) involving crowns in combination with a...
TRANSCRIPT
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RECONSTRUCTION OF A RECONSTRUCTION OF A MAXILLARY ARCH MAXILLARY ARCH
(KENNEDY CLASS IV) (KENNEDY CLASS IV) INVOLVING CROWNSINVOLVING CROWNS
IN COMBINATION WITH IN COMBINATION WITH A METAL-BASED A METAL-BASED
REMOVABLE PARTIAL DENTUREREMOVABLE PARTIAL DENTURE
By Jako Fouche
In partial fulfilment of
BTech: Dental Technology
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CONTENTSCONTENTS
Patient history Condition and background Current situation Possible treatment options Treatment option of choice Laboratory procedures References
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PATIENT HISTORYPATIENT HISTORY
Female 61 years old Choir singer
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CONDITION AND CONDITION AND BACKGROUNDBACKGROUND
5 unit porcelain bridge Preparations failed Root canal treatments were done Acrylic partial overdenture made Problems with phonetics Wanted upgrade on aesthetics
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CURRENT SITUATIONCURRENT SITUATION
Kennedy class IV 4
2 x Root canals
Red = Crowns
Black = Fillings
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POSSIBLE TREATMENT POSSIBLE TREATMENT OPTIONSOPTIONS
5 unit porcelain bridgea. Post-retained
b. Post and Implant-retained
12 unit porcelain bridge 2 x post-retained crowns and cobalt-
chromium denture
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5 UNIT PORCELAIN BRIDGE5 UNIT PORCELAIN BRIDGE(POST-RETAINED)(POST-RETAINED)
ADVANTAGES
Excellent aesthetics Less bulky than
RPD2
Very natural feel2
DISADVANTAGES
Weak anchorage available
Previous preparations failed
Cost ±R4,500.00
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5 UNIT PORCELAIN BRIDGE5 UNIT PORCELAIN BRIDGE(POST + IMPLANT-RETAINED)(POST + IMPLANT-RETAINED)
ADVANTAGES
Excellent aesthetics Excellent stability2
Very natural feel3
Excellent anchorage
DISADVANTAGES
Only option involving trauma
Cost ± R5,000.00
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12 UNIT PORCELAIN BRIDGE12 UNIT PORCELAIN BRIDGE
ADVANTAGES
Best aesthetics Excellent blending of
tooth colour Removal of existing
crowns + fillings Restoration of entire
maxillary arch
DISADVANTAGES
Cost ±R8,500.00 Most expensive Possible heavy
metal poisoning
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2 X CROWNS ON POSTS WITH 2 X CROWNS ON POSTS WITH COBALT-CHROMIUM COBALT-CHROMIUM
DENTUREDENTURE
ADVANTAGES
Cost ±R2,500.00 Least expensive Good aesthetics Better distribution of
forces Good retention
DISADVANTAGES
Responsibilities involved4
Plaque accumulation5
Abrasive on anchored teeth5
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TREATMENT OPTION MOST TREATMENT OPTION MOST SUITABLESUITABLE
12 Unit porcelain bridge Current poor restorations Restoration of entire arch Improve aesthetics
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TREATMENT OPTION OF TREATMENT OPTION OF CHOICECHOICE
2 x Crowns on post with cobalt-chromium removable partial denture
Decided by dentist and patient
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LABORATORY PROCEDURESLABORATORY PROCEDURES
Posts Porcelain crowns Cobalt-chromium metal framework with
teeth placed for try-in Acrylic teeth secured on metal framework
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POSTSPOSTS
Posts on 1.3 and 2.2
Out of the bite In-line with
adjacent teeth Sufficient space
for coping and porcelain
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PORCELAIN CROWNSPORCELAIN CROWNS
Crowns on posts Prepared to
accommodate metal framework
Mesial surfaces of 1.3 and 2.2 parallel4
To accommodate guide plates
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COBALT-CHROMIUM METAL COBALT-CHROMIUM METAL FRAMEWORK WITH WAX-UP FRAMEWORK WITH WAX-UP
FOR TRY-INFOR TRY-IN
Horse-shoe shaped major connector
Anterior rests placed on 1.3 and 2.2
Posterior rests interproximally between 2nd premolars and 1st molars
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Acker’s clasps on 1st molars
One arm clasps on 2nd premolars
Finished and polished
Senator shade C3 teeth Placed after excessive
trimming Waxed-up Ready for try-in
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ACRYLIC TEETH SECURED ACRYLIC TEETH SECURED ON METAL FRAMEWORK ON METAL FRAMEWORK
(final procedure)(final procedure)
Final finishing and contouring of the wax-up
Pack and flask Cast with denture base acrylic Trim and polish Planned to be completed 15 October 2004
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REFERENCESREFERENCES
1. Johnson JF. Modern Practice in Crown and Bridge Prosthodontics. USA:WB Saunders. 1990.
2. Murray HV. Fixed Restorative Techniques. USA:North Carolina Press. 1989:151-197.
3. Naylor WP. Introduction to Metal Ceramic Technology. Illinois:Quentessence. 1992:27-41
4. Owen CP. Fundamentals of Removable Partial Dentures. South Africa:UCT. 2000:122-125;56-61
5. Stratton RJ. An Atlas of Removable Partial Denture Design. London:Quentessence. 1988:210-211;313-319.