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.
Top Related