July 2009

Rehabilitation of full mouth

R.Sathyanarayanan

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This patient reported with loose maxillary teeth and wanted replacement of the same. Clinical examination revealed generalized chronic periodontitis. Right maxillary first molar was extracted for the periodontal problem few years back. Left maxillary central incisors was root treated many years back. Both the lateral incisors ,left first premolar and left second molar showed grade 2 mobility.

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Radiograph revealed improper obturation with bone loss till apical third in relation to left maxillary central incisors. Both the lateral incisors and first premolar exhibited bone loss till apical third of the root. Left maxillary second molar showed crown with secondary caries without any root canal therapy and bone loss till apex on distal aspect. As patient did not want any treatment for the mandibular arch, maxillary full arch treatment was planned.

Treatment plan included extraction of right lateral incisors, left central incisors, lateral incisors, first premolar and second molar. Periodontal flap surgery for the remaining maxillary teeth, followed by root canal therapy of all teeth and fixed partial denture was planned. Decision to do root canal therapy for all teeth were made since it would not be possible to achieve the parallelism without compromising the vitality of the pulp. Two bridges, one from right first premolar till right second molar and the other from right canine to left first molar. It was decided not to replace left second molar as it would complicate the treatment and also increase the cost of the treatment.

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These images show tooth preparation following root canal therapy.

 

 

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These are the post operative images after cementation of the bridge.(

 

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These are the post operative radiographs after 2,4,and 5 yrs.Patient was under periodic maintenance with oral prophylaxis procedure and the post operative follow up till five years showed excellent stable condition, both periodontally and endodontically. The patient has left the country and the present status is not known.