Aesthetic rehabilitation with multiple loop connectors
A 35-year-old lady reported with chief complaints of missing upper anterior teeth due to trauma. The maxillary laterals incisors and canines on both sides had endodontic treatment post trauma but had good periodontal support. Her past dental history revealed that she was having generalized spacing between her upper anterior teeth and her medical history was non-contributory. Clinical and radiological examination revealed the endodontically treated 12, 13, 22, 23, missing 11, 2, less amount of bone available in upper anterior region and traumatic bite because of supra eruption of lower anterior teeth [Figures and ]. The treatment options included an implant-supported prosthesis, FPD with loop connectors, resin bonded FPD. Considering her availability of bone and esthetic requirement of maintaining the diastema between 12, 11, 22, and 21, the treatment option of 06 units porcelain fused to metal FPD from canine to canine with intermittent loop connectors between 21, 22, 11, 12 was planned.\nThe following clinical and lab procedures were carried out for her oral rehabilitation:\nTeeth preparation for porcelain fused to metal was done on 12, 13, 22 and 23. Maxillary anterior FPD with loop connectors may cause occlusal interferences because of limited interocclusal space. In this patient, enameloplasty of lower anterior teeth was done to regain the interocclusal space and to prevent the interferences. The shoulder finish lines of the preparation were kept equigingival in order to enhance the esthetics as it prevents the color of the metal from showing thorough translucent enamel.[] Final impressions were made with two stage double mix putty light body rubber base impression material (Aquasil, Denstply) [] and poured in Type IV dental stone (Bego stone; BEGO, Bremen, Germany). Master casts were retrieved and die cutting was done. A quick-setting rigid poly vinylsiloxane interocclusal registration material was used to record the maxillomandibular relationship. The provisional FPD was fabricated and cemented using non-eugenol cement []. Casts were mounted on a semi-adjustable articulator (Hanau H2) using a face-bow transfer. A 0.5 mm thick wax sheet was placed on the edentulous ridge to create a space to allow convenient access for oral hygiene. Patterns of the modified FPD with loop connectors were fabricated by using blue inlay wax indirectly on the cast, adjusted for optimal occlusal contacts, and contoured to final shape, and form []. The patterns were invested with a phosphate-bonded investment (Bellawest, BEGO) and cast in a base metal alloy (Wiron 99; BEGO). After confirming the metal try in, the porcelain (Vita, Germany) was fired according to the manufacturer's recommendations. Pontics were contoured with a fine-grained bur maintaining the diastemas and evaluated for esthetics and residual ridge adaptation []. The occlusion was evaluated and adjusted where necessary. After glazing and polishing, the intaglio surface of the retainers was sandblasted using airborne-particle abraded with 50-mm aluminum oxide. Try in was done and interferences if any were removed. The surfaces of abutment teeth were steam cleaned and the restorations were cemented with Glass ionomer cement (GIC) Type I luting cement [Figures and ]. This prosthesis design may decrease access for plaque removal because palatal connectors are over-contoured by design. The patient was instructed to maintain the proper oral hygiene. Use of dental floss (Superfloss; Oral B, UK) and interdental brush (Interdental; Oral B) were recommended. The patient was evaluated after 1 week to assess the oral hygiene status.