Amalgamating Esthetics, Function and Comfort in Full Mouth Rehabilitation – A Case Report

Abstract

A 49-year-old female patient reported with chief complaints of pain, low esthetics and missing teeth. History, clinical examination and Orthopantomograph (OPG) [Table/ Fig-1] revealed following oral conditions and problems. Maxillary anterior arch presented old discolored composite fillings with chipped margins. Gingival inflammation, gingival pockets and bleeding on probing was observed in relation to teeth #11, 12, 13, 21, 22, 23, 31, 32, 33, 41, 42, 43, 46 and 47. Pain on percussion was observed in relation to teeth # 12, 22, 42 and 46, with recurrent swelling in # 12, 42 and 46. Radiograph revealed inadequate root canal filling in #22, radiolucency with bone loss around #12, periapical radiolucency with grade II furcation involvement in #46 and RC treated root stump with periapical radiolucency in relation to #42. Faulty restorations with chipped edges and/or overhanging margins were observed in relation to #11, 12, 13, 17, 21, 22, 23, 33, 34, 36, 43 and 47. Teeth #15, 18, 25, 28, 35, 38, 45 and 48 were found to be missing. Marginal inaccuracies were observed in porcelain fused-to-metal (PFM) crowns in #14, 31, 32 and 41.There were PFM bridges at #24/25/26 and 44/55/46. Teeth #12 and 22 were labially tilted with distal rotation giving her unpleasant looks. There were marked occlusal discrepancies with open bite on right side of the arches. Lower midline had a right shift in the old PFM crowns [Table/ Fig-2]. Examination of the TMJs presented normal jaw opening and range of motion. No joint sounds and signs or symptoms of instability were evident. An evaluation of vertical dimensions suggested no alteration in vertical. tReatMeNt pLaNImpressions for study casts were made, along with a centric relation occlusal record utilizing face-bow transfer. Following mounting of the study casts, it became apparent that there was edge-toedge contact between #13 and 43, whereas only palatal cusps of #16 and 17 were in centric relation contacts. Interdisciplinary consultations with the departments of Orthodontics, Oral Surgery, Periodontology, and Conservative & Endodontics were made before planning prosthodontics management. Orthodontic treatment to realign teeth # 12 was advised by the respective department. However, since patient had some major social family commitment in the near future, she expressed her disapproval for any long term treatment like orthodontic correction of the mal-aligned teeth. A poor prognosis was predicted for any prosthodontic correction of the same. Periodontally and endodontically affected teeth and segments were predicted with fairly good prognosis upon treatment. Patient did not give consent for implant placements for missing teeth for the reasons of time and finances. The comprehensive treatment plan after consultation with various specialties and consent of the patient was undertaken as under. Dentistry Section aBstRaCtRestoration of aesthetics, function and comfort in badly compromised dentition and its supporting tissues often poses a great challenge. The long term success of such cas...

Comparison between the retentive force and clasp deformation of acetal and conventional cobalt- chromium frameworks in removable partial denture: In vitro study

“…Also, it has a sufficiently high resilience and modulus of elasticity to allow its use in the manufacture of retentive clasps. Acetal resin is also strong, resists fracturing, and is flexible so, does not wear during occlusal forces and consequently will maintain vertical dimension over long periods of time (7) .…”