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

CONTENTSCONTENTS

Patient history Condition and background Current situation Possible treatment options Treatment option of choice Laboratory procedures References

PATIENT HISTORYPATIENT HISTORY

Female 61 years old Choir singer

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

CURRENT SITUATIONCURRENT SITUATION

Kennedy class IV 4

2 x Root canals

Red = Crowns

Black = Fillings

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

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

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

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

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

TREATMENT OPTION MOST TREATMENT OPTION MOST SUITABLESUITABLE

12 Unit porcelain bridge Current poor restorations Restoration of entire arch Improve aesthetics

TREATMENT OPTION OF TREATMENT OPTION OF CHOICECHOICE

2 x Crowns on post with cobalt-chromium removable partial denture

Decided by dentist and patient

LABORATORY PROCEDURESLABORATORY PROCEDURES

Posts Porcelain crowns Cobalt-chromium metal framework with

teeth placed for try-in Acrylic teeth secured on metal framework

POSTSPOSTS

Posts on 1.3 and 2.2

Out of the bite In-line with

adjacent teeth Sufficient space

for coping and porcelain

PORCELAIN CROWNSPORCELAIN CROWNS

Crowns on posts Prepared to

accommodate metal framework

Mesial surfaces of 1.3 and 2.2 parallel4

To accommodate guide plates

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

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

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

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.