CHIEF COMPLAINT:
To replace a combined dental prosthesis, in the maxilla, with a fixed dental prosthesis.
DIAGNOSIS:
Female patient, 69 years-old, non-smoker, presents a combined dental prosthesis in the maxilla (bridge 13-21, with pontic on 12; removable partial denture in the posterior areas, with 5 teeth) The retention of the RPD is done through a clasp on tooth 14 and a ‘t-type’ attachment on tooth 21.
TREATMENT PLAN:
Implant-supported fixed partial denture in the 2nd quadrant, to avoid the removable partial denture. The number and location of the dental implants would be decided only after the visualization of a CBCT scan. Patient showed no interest in replacing the anterior bridge in the maxilla.
TREATMENT NOTES:
To achieve the maximum information of the CBCT scan, a radiological guide was done with teeth in barium sulfate. This guide was inserted in the mouth together with reference marks bonded to some teeth, also in barium sulfate. The guide was stabilized with a soft wax. The CBCT scan was then realized with these reference marks. After the CBCT scan, a pick-up dental impression in silicone was done. The dental model was then scanned, and the generated 3D model was superimposed in the CBCT image, allowing an accurate implant planning. Two implants were planned in teeth 23 and 24 avoiding the area of tooth 22 due to the lack of bone available. This 3D study allowed the generation of a surgical guide that guided implant placement. During this osseo-integration period, the patient used a removable denture rebased with a tissue-conditioning material. The surgical guide proved to be also useful in exposing the implants by revealing their location and guiding the incision. The final impression was realized with an open-tray, after eliminating the attachment. In the dental lab, a three-element bridge with a cantilevered 22 was executed. After clinical evaluation and patient’s approval the bridge was cemented. The rehabilitation, although not very long (with tooth 26) proved to be esthetically acceptable and functionally able.