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POOR PROSTHETIC DESIGN

Demajo - apple-15687_640

The replacement of missing teeth may be executed differently. These mainly differ in two ways; a removable prosthesis or a fixed one. A removable prosthesis comes in the form of a denture whilst a fixed prosthesis is either a bridge or an implant. A removable denture utilizes a framework, which engages in between the missing teeth and clips onto the remaining teeth present. A fixed bridge is cemented on one or more of the remaining teeth using them as anchors for the missing teeth. An implant is an independent unit, which does not rely on any other teeth and therefore does not cause any loading force or damage to other teeth.

 

A Case Study

A young woman in her late 30s with a history of a failed root canal treatment of the upper left lateral incisor requiring extraction has had the tooth replaced with a conventional fixed bridge. Figure 1 shows a conventional-porcelain fused to metal bridge anchored to the upper left central incisor and the upper left canine replacing the upper left lateral incisor. The bridge is also replacing some lost hard and soft tissue in the form of bulky pink porcelain filling the space in between both supporting teeth.

 

Demajo - Image 1

Intra-oral view before treatment

Advantages of this design

  • Quick production: 1-2days
  • Relatively cheap
  • Good lifetime track record for bridgework

Disadvantages of this design

  • Poor hygiene control
  • Poor aesthetics
  • Dependent on the supporting teeth; the central incisor and the canine
  • Continued loss of bone and consequent recession of the gum

Patient complaints

  • Indentation in the bone
  • Gum recession
  • Inability to clean properly
  • Poor aesthetics
  • Lack of confidence
Treatment Plan
  1. Consultation and Photography: an integral part of treatment planning
  2. Impressions for study models
  3. Replacement of metal-porcelain bridge with temporary acrylic resin bridge: this temporary bridge will be used throughout the whole duration of the treatment until the final definitive crowns are inserted
  4. Implant placement with simultaneous bone grafting in the position of the missing lateral incisor. The bone graft is used to replace the missing bone and bulk up both the hard and soft tissue improving aesthetics and hygiene maintenance
  5. Modification of the temporary bridge during the 4 month healing process of the implant and graft to shape the gingiva and achieve an aesthetic improvement.
  6. Impression and cementation of 3 new all-ceramic metal-free crowns on the central incisor, canine and implant.
  7. Review and maintenance plan

Demajo - Image 2

Extra-oral view after treatment

Extra-oral view after treatment

This implant treatment modality differs in time-frame from the previous conventional bridge by 4 months. The new expense is also more than double. Having said that, most patients with this dental history weigh out a gain in confidence and aesthetics more than anything else. Patients are also capable of maintaining better hygiene with single unit prosthetic designs. Patient motivation and goals are key to a successful treatment plan. Ask your dentist!

Dr Jean Paul Demajo

Dental and Implant Surgeon

Trained in London working in private practice in Malta


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