July 2009

Re-establishing the vertical height

R.Sathyanarayanan

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This patient reported in 2003 for the management of grossly attrited teeth. Clinical examination revealed generalized attrition with loss of vertical face height. Treatment plan included root canal therapy for all maxillary teeth followed by interim bridge for three months to increase the vertical height. Following successful re establishment of vertical height, permanent ceramic bridge with cantilever posterior teeth was planned.

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Root canal therapy was successfully carried out and tooth preparation was done.

 

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Provisional bridge was given with re established vertical height for 3 months. Patient was comfortable adapted to the new vertical dimension.

 

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Radiograph revealing maxillary and mandibular bridge in position.

 

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Intra oral view of completed bridge after 6 months. Chipping of ceramic from lingual aspect of 11 and 21 was noted.

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Three year recall revealed failure of treatment plan with fractured ceramic on the incisal aspect of all crowns, fractured cantilever pontics of maxillary teeth. Revised treatment was formulated with ceramic bridge from right canine to left second premolar with attachment and attachment prosthesis for maxillary posterior teeth. Mandibular new bridge was also planned.

 

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Images showing progression of mandibular bridge with in bite registration stage 

 

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Completed maxillary crowns in single unit with attachment.

 

 

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Attachment prosthesis in place.

 

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Completed maxillary and mandibular prosthesis. Two year follow up is satisfactory esthetically and functionally. Further follow up will reveal the fate of the treatment plan.