July 2006

Zirconia ceramic bridge

R.Sathyanarayanan

preop1

 

 

This patient reported with a loose bridge that was cemented about 15 years back. On examination, there was a bridge extending from 14 to 16 with secondary caries underneath the gingival margin of 15.

 

 

preop2xray

 

 

 

 

 

Radiographic examination revealed RC treated 14, 15, and 16 and the obturations were not satisfactory. Crowns for 14,15 and 16 were present in single unit. Retreatment was not planned since the canals of 16 were not traceable radiographically, the posts in 15 were floating in the roots and the obturation in 14 was comparatively satisfactory. Initial treatment plan involved removal the bridge and assess for caries and the gingival status to plan the treatment further.

 

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preop5xray

 

 

 

 

 

After removal of the bridge, it was seen from the radiograph that only the palatal canal of the first molar was obturated and the other canals were not traceable, the post in 15 was removed and the obturation in 14 was satisfactory. Glass Fibre post and core in 15, repair resin composite restorations in 14 and 16 for secondary caries and zirconia crowns in 14,15 and 16 in single unit was planned. The decision to fabricate the crowns in single unit was taken since the longevity of 15 was questionable. In case, if 15 fails in near future, the same single unit crowns can be used as bridge. Gingival tissue was managed by gingivectomy with electrocautery and the margins and the granulation tissue were exposed. Post space was prepared in 15 for a fibre post .

 

operative1

 

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operative3xray

 

 

 

 

 

 

These images show the core build up after gingival tissue management and secondary caries removal. A glass fibre post was placed in 15 and a core was built with core composite in 15 and the margins were satisfactory in spite of the initial gingival condition.

 

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These are the post operative images showing the ceramic bridge in place with a good occlusal morphology and proper margins. The margins in 14 and 15 were placed sub gingivally and in 16, supragingivally. The marginal adaptation is precise for Zirconia ceramic bridge and the follow up of the same will be published at a later date.