CHIEF COMPLAINT:
Patient was not satisfied with his superior prosthesis, complained it was "very loose and worn”.
DIAGNOSIS:
Male patient, 61 years old, non-smoker. Carrying a superior acrylic partial prosthesis, presenting teeth 1.3 and 2.3 with endodontic treatment. Teeth 1.8.1.7 and 2.7 with extensive cavities. Molars were missing in the lower jaw, and the lower-anterior teeth had cervical caries and infiltrated restorations. Tooth 3.3 with endodontic treatment. The patient didn’t carry a lower prosthesis, had a reduced vertical dimension of occlusion, and minimal oral hygiene.
TREATMENT PLAN:
After clinical and imaging analysis, the patient was offered a recovery of the vertical dimension of occlusion with the confection of two removable skeletal prostheses. The superior skeletal prosthesis would be retained by two fused post-core posts with ball socket Nardy’s, cemented on the roots of teeth 1.3 and 2.3. The teeth 1.8,.1.7 and 2.7 would be used for posterior retention. In the lower jaw, after treatment of the remaining teeth, an inferior skeletal prosthesis would be placed.
TREATMENT NOTES:
Once the diagnosis was made and the decision was taken regarding the treatment to be performed, a pre-impression was made from the removable prosthesis the patient used, to make the addition for tooth 1.3. Teeth 1.3 and 2.3 were prepared for the Nardy's confection. To achieve a supra-gingival margin, a gingivectomy was performed with an electric scalpel. The gutta persha was removed from the root canals, and these were enlarged to create space for the posts. After placement of the gingival retraction cord, a plastic pin was prepared for impression of the intra-root canal. The root canal was washed, dried and carefully vaselined prior to the impression. I used the wash technique impression with double viscosity. In the laboratory, on the working model cast, two fused post-cores with "nardy`s" ball inserts were made. At the same time, waxes with base stabilized acrylic, and a top individual tray were made. The post-core fused spikes were cemented in the mouth, and then the intermaxillary registration was collected, with articulation waxes and bite registration silicone. The acrylic removable prothesis was adapted to ball inserts, with soft denture reline material. The functional impression of the upper jaw was made with fluid silicone, placed in the superior individual tray. In the laboratory, a skeletal prosthesis was made, with female fittings for the nardy's and posterior hooks. The skeletal test was done in the mouth, with teeth mounted on wax. The prosthesis was aesthetically and functionally validated. A new intermaxillary registration was performed, for validation of the previous one. After acrylization of the work in the laboratory, its definitive placement in the mouth was made. After two weeks, an inferior skeletal prosthesis was started, as well as the treatment of cervical caries on the antero-inferior teeth. Oral rehabilitation was accompanied by recovery of the vertical dimension of occlusion.