July 2009

Fate of full mouth management

R.Sathyanarayanan

preop1

 

preopxray

 

 

 

This patient reported with multiple mobile teeth pain in relation to lower anterior teeth. Panoramic radiograph revealed generalized progressive periodontitis with bone loss till middle third of tooth in existing dentition. Clinical examination and investigations confirmed 13,11,22,23 in maxillary quadrant can be salvaged. In the mandibular quadrant 33,43 and 34 can be saved.

Treatment plan included root canal therapy for existing dentition and ceramic bridge from 13-23 and acrylic partial denture for remaining maxillary posterior teeth. The decision of acrylic was taken based on the cost. Mandibular treatment plan included overdenture with overdenture post in 33 and 43 and metal coping in 34. The decision to go ahead with coping was taken in view for future intervention and future support in case change is necessary.

 

operative1

This image is after the tooth preparation and over denture post in mandibular canines and metal coping in left mandibular first premolar.

 

postop1

Post operative image shows ceramic bridge, maxillary and mandibular acrylic prosthesis in postion.

 

postop2

Patient failed to report for further follow up as everything was satisfactory!! Four years later, he reported with a complaint of loose bridge.

 

postop3

 

postop4xray

 

 

 

Clinical examination revealed gross destruction of tooth structure on all abutment. However the was no periapical pathology and bone support was good. It was decided to save the roots of maxillary and mandibular teeth. Since the treatment was not affordable for the patient, only maxillary segment was taken for repair and rehabilitation. Mandibular segment included temporary closure of orfice of 33 and 43 with glass ionomer and repair of old acrylic prosthesis.

 

postop5

Gingival management and root planning was done as the first step. Patient was educated for oral hygiene and the importance of maintaining the same for successful prosthesis. This image shows fabrication of cast post and core on all root stumps.

 

postop6

 

This image shows ceramic bridge with attachment on both sides.

 

postop7

 

postop8

Completed cast partial denture and ceramic bridge in maxillary segment.