13 ORAL REHABILITATION WITH FIXED REHABILITATION WITH FI¢  acrylic partial denture, interocclusal records
13 ORAL REHABILITATION WITH FIXED REHABILITATION WITH FI¢  acrylic partial denture, interocclusal records
13 ORAL REHABILITATION WITH FIXED REHABILITATION WITH FI¢  acrylic partial denture, interocclusal records
13 ORAL REHABILITATION WITH FIXED REHABILITATION WITH FI¢  acrylic partial denture, interocclusal records

13 ORAL REHABILITATION WITH FIXED REHABILITATION WITH FI¢  acrylic partial denture, interocclusal records

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  • ABSTRACT: The wear and loss of anterior and posterior teeth results in the loss of normal occlusal plane

    and the reduction of the vertical dimension. This case report describes functional and esthetic oral

    rehabilitation of a 55 year old female with severely mutilated dentition and loss of vertical dimension. It

    was planned to increase the vertical dimension to restore collapsed bite. As there was loss of upper and

    lower posteriors, acrylic removable partial dentures were fabricated instead of splint at increased vertical

    dimension to restore the collapsed bite and to deprogram the muscles. Once the patient was adjusted to new

    occlusal vertical dimension definitive treatment with fixed and cast partial dentures were planned for

    anterior and posterior teeth respectively. A satisfactory clinical result was achieved by restoring the vertical

    dimension with this combined approach of fixed and removable prosthesis.

    1 2Dr.AbhinavAgarwal, Dr. VarunSingla, 1,2Reader, Dept. of Prosthodontics & Crown and Bridge,

    K.D. Dental College and Hospital, Mathura (U.P.)

    INTRODUCTION:

    Oral rehabilitation of dental arches with severe attrition is a

    distinct restorative challenge.1 Stress-induced grinding

    habits can seriously compromise mastication and esthetics,

    and a reduction in the vertical dimension of occlusion can

    result in facial collapse compromising function and esthetics.

    The problem becomes very complex as functional or esthetic

    improvements require modification of the acquired vertical

    dimension. Management of worn dentition using fixed or

    removable prostheses is complex and among the most

    difficult cases to restore. Assessment of the vertical

    dimension is important for the management, and careful

    comprehensive treatment plan is required for each individual

    case.2,3,4,5,6

    This clinical report describes the treatment of a patient who

    was clinically monitored to evaluate the adaptation to a

    combined approach of fixed and removable prosthesis after 6

    weeks trial period with acrylic removable partial dentures and

    temporary restorations for muscle deprogramming.

    CASE REPORT:

    A Female patient aged 55 years came to department of

    prosthodontics with severely mutilated dentition and missing

    posteriors (fig.01).

    On intraoral examination- there was loss of vertical

    dimension 12,14,16,17,24,26,27,35,36,37,46,47 teeth were

    missing & 11,13,22 were grossly decayed. Patient had past

    history of dental treatment but she was unable to explain about

    previous procedures and could not produce any records also.

    On radiographic examination 11,13,21,22,23,25,34,41,42,45

    were found to be endodontically treated (fig.02).

    FIGURE 1: Pre-operative

    FIGURE 2: OPG

    ORAL REHABILITATION WITH FIXED AND REMOVABLE PROSTHESIS IN SEVERELY MUTILATED DENTITION – A CASE REPORT.

    Journal of Dental Sciences

    University

    University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 66

    University J Dent Scie 2018; Vol. 4, Issue 3

    Case Report

    Keywords :

    Tooth wear, Vertical

    dimension, cast

    partial dentures.

    Conflict of interest: Nil

    No conflicts of interest : Nil

  • Treatment procedure-

    Diagnostic impressions were made with alginate [Zhermack

    ,tropicalgin]. Impressions were poured in die stone

    [Ultrarock,kalabhai]. Face bow transfer was done (fig.03) and

    upper cast was mounted on semiadjustable articulator

    [Artex]. Interocclusal record was made with jet bite [coltene

    whaledent] and lower cast was mounted. Diagnostic wax up

    [Belle sculpturing wax,Kerr] was done to visualize outcome

    of the treatment(fig.04).

    It was planned to raise the vertical dimension by 3 mm due to

    collapsed bite. Acrylic removable partial dentures were

    fabricated wrt 14,16,17,24,26,27,35,36,37,46,47 with

    increased vertical dimension and delivered to patient (fig.05).

    FIGURE 3: Face-bow transfer

    FIGURE 4: Diagnostic wax-up

    Patient was asked to wear the prosthesis for 6 weeks. During

    this period post and core build up was done wrt 11,13,22

    (fig.06). Glass fiber post( RelyX,3M) was chosen as it has

    modulus of elasticity close to human dentin hence there are

    less chances of root fracture compared to metal posts. It has

    got more translucency so curing light can pass deep it to root

    canal and it can be efficiently cured with resin cement.

    Composite material [ Filtek Z250,3M] was used for core build

    up.

    FIGURE 5: Acrylic partial denture

    FIGURE 6: Post& core

    All remaining teeth were prepared in upper arch and 45 was

    prepared in lower arch (fig.07).Temporary crowns were made

    with tooth colored acrylic resin using putty index of

    diagnostic wax up and cemented with temporary cement

    [RelyX,3M](fig.08).

    FIGURE 7: Tooth preparation

    FIGURE 8: Temporization

    After 6 weeks once the patient was comfortable with the

    temporary crowns at increased vertical dimension final

    University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 67

    University J Dent Scie 2018; Vol. 4, Issue 3

  • impressions were made with putty wash technique using light

    body and putty elastomeric impression material

    [Aquasil,Dentsply]. Final impressions were delayed for one

    week as gingiva around the abutments was inflamed. Patient

    was asked to maintain oral hygiene and also advised to apply

    gum astringent gel to reduce inflammation. To maintain the

    same vertical dimension as provided in temporary crowns and

    acrylic partial denture, interocclusal records of both side of

    arches were made one by one after removing temporary

    crowns and acrylic partial denture on one side first followed

    by other side. PFM crowns (fig.09) were cemented wrt

    11,12,13,14,15,21,22,23,24,25,45 using glass ionomer

    cement[GC Fuji Type-1] (fig.10).

    FIGURE 9: PFM crowns with rest seats

    FIGURE 10: Cementation of PFM crowns

    Later cast partial dentures were planned to replace upper and

    lower posteriors therefore rest seats were planned in porcelain

    fused to metal crowns during fabrication of wax patterns to

    receive rests (fig.09). First alginate impressions [Zhermack

    ,tropicalgin] of both the arches were made and custom trays

    were fabricated. Later border molding of both upper and

    lower arch was done for the distal extension areas and final

    impressions were made with monophase elastomeric

    impression material [Aquasil Monophase,Dentsply] (fig.11)

    Impressions were poured with die stone to obtain master cast

    which was duplicated to make refractory cast

    [Wirovest,Bego]. Cast partial denture frameworks were

    designed on refractory cast and later casted with

    [ ,Bego] and tried in

    the patient's mouth (fig.12)& (fig.13). Jaw relation was

    chrome

    cobalt partial denture alloy Wironium Plus

    recorded and trial was done. Later cast partial dentures were

    placed in patient's mouth and required adjustments were done

    (fig.14). Occlusion was assessed for any premature contacts.

    FIGURE 11: Final impressions

    FIGURE 12: Cast partial dentures framework

    FIGURE 13: Framework after acrylization

    FIGURE 14: Post-operative

    DISCUSSION:

    Full moth rehabilitation for mutilated dentition is a difficult

    and complex procedure. Tooth wear has a multifactorial

    etiology therefore reason for tooth wear should be identified

    for the long term success of treatment. So to identify the cause

    of tooth wear complete medical and dental history was

    University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 68

    University J Dent Scie 2018; Vol. 4, Issue 3

    https://www.bego.com/ https://www.bego.com/conventional-solutions/alloys/product/Product/show/906/

  • recorded from patient. On examination patient did not have

    any signs and symptoms of bruxism. Patient had severe gastro

    oesophageal reflux which attributed to severe erosion of the

    teeth.7

    In this case report a combined fixed and removable approach

    was planned due to unhealthy condition of abutments and loss

    of upper and lower posterior teeth. Due to collapsed bite it was

    decided to increase vertical dimension. But if we are planning

    to increase the occlusal vertical dimension it should be within

    physiological limit of the patient. Excessive increase in

    vertical dimension is not advisable.8,9,10 Acrylic removable

    partial dentures were fabricated and given to patient for 6

    weeks to restore occlusal vertical dimension and for muscle

    deprogramming.

    Patient had few anterior teeth which were severely decayed

    hen