Management of long span partially edentulous maxilla with fixed removable denture prosthesis
A 55-year-old male patient reported to the department of prosthodontics, Tagore Dental College and Hospital, Chennai, complaining of missing mandibular anterior teeth and unesthetic appearance of maxillary anterior teeth. Clinical examination [] revealed missing 13, 31, 41 and 42, grossly decayed 27, mesially tilted 21 and 43, gingival recession with furcation involvement in 36, generalized plaque and calculus and mobile 32.\nRadiographic examination [] revealed a maxillary radiolucency extending from 15 to 24, involving an impacted 13. The Orthopantomogram also revealed generalized interdental bone loss, grossly decayed 27 and periapical radiolucency in relation to 36.\nThe patient was diagnosed with the following problems.\nImpacted 13 with Odontogenic Kerato Cyst (OKC) Dental caries with chronic pulpits and gross destruction in 27 Generalized chronic gingivitis with localized chronic Periodontitis in relation to 32, 36. Partially edentulous mandibular arch.\nThe following teeth were extracted along with the OKC-13, 15, 14, 13, 12, 11, 21, 22, 23, and 27. A tooth supported fixed partial denture was fabricated for replacement of the missing mandibular anterior teeth using 33, 44, and 45 as abutments after extraction of 32.\nTreatment options presented for replacement of missing maxillary teeth were a removable cast partial denture and an implant supported fixed dental prosthesis. The patient did not favour a removable cast partial denture and could not afford the cost of an implant supported fixed dental prosthesis. A tooth supported conventional fixed partial denture could not be used in this situation because of the unfavourable long-term prognosis of a long span tooth supported fixed partial denture.\nAs an alternative, we suggested a fixed removable dental prosthesis using cement retention for the fixed bar framework and ball retention for the metal fused to ceramic removable partial denture. This treatment option was favourable to the patient.\nDiagnostic impression of the maxillary and mandibular arches was made using irreversible hydrocolloid (Zelgan, Dentsply, India). Casts were poured using model plaster (Orthocal, Kalabhai Karson, India) and articulated (Hanau, Whipmix, Fort Collins, USA).\nA wax pattern with acrylic teeth replacing the missing teeth was fabricated and patient approval was obtained.\nA putty index of this pattern was made using addition silicone putty material (Aquasil, Dentsply, India).\n16 and 23 were prepared to receive metal retainers and a putty, light body impression, was made and poured in die stone (Ultrarock, Kalabhai Karson, India).\nA wax pattern (Yeti, Gmbh, Germany) was fabricated for metal copings on 16 and 23 with a custom bar in between using the putty index. Ball attachment patterns (Rhein 83, USA) were attached on the wax bar in the position of 15, 13, and 33 [].\nThis pattern was cast using Ni-Cr alloy (Auriloy N.P. Aurium, USA). The metal framework was finished and evaluated in the patient's mouth. Ceramic (Vita VMK Master, Vita Zahnfabrik, Germany) was built up on the metal coping of 16 and 23 and evaluated in the patient's mouth [].\nThis framework was picked up using putty-light body addition silicone impression material and the cast poured using die stone.\nA wax pattern was fabricated for the metal copings of 15 to 22 on the metal bar substructure and cast using Ni–Cr alloy.\nAfter the metal framework was finished and evaluated in the patient's mouth, ceramic was built up on the superstructure framework for 15 to 22 and silicone housings (Rhein 83, USA) were incorporated in this removable PFM prosthesis.\nThe bar framework was cemented on to the abutment teeth using glass ionomer cement (GC Luting and lining cement, GC Corporation, Japan) and the removable PFM framework was attached to the fixed substructure framework using the ball attachment [].