Biology , mechanics then esthetics , these are the 3 pillars of any restorative treatment , many seem still stuck in the second one , in this particular case 4 abutment teeth splinted by a fixed partial bridge , what is the rationale of such treatment option ?
I assume lack of belief & confidence in evidence based practice by the clinician drive the treatment to such options , 4 endodontically treated teeth indicated for crowning , here where the Mechanical Brain kicks in thinking that if they were splinted together they would resist stresses more equally and prolong their stability over time …
From biological aspect , FPD is constructed of individual crowns that are soldered together closing the proximal spaces which is very critical in hygiene maintenance , phonetics & in most cases it results in collapse and damage of inter-proximal papillae .
From Mechanical aspect , functional forces of normal magnitude may induce protrusive migrations of maxillary anterior teeth so stabilization of the front teeth may not be obtained by merely joining them together , the entire front segment may tilt in the frontal direction , stabilization of such front teeth can only be obtained by extending the splinted bridge posteriorly which hasn’t been done in this case .
Reference :
1-Glickman, L, Stein, S., and Smulow, J.: The effect of
increased functional forces upon the periodontium of splinted
and nonsplinted teeth. journal of periodontology .
2-Lemmerman K. Rationale for stabilization. J Periodontol. 1976 Jul;47(7):405-11
3-Nyman SR, Lang NP. Tooth mobility and the biological rationale for splinting teeth. Periodontol 2000. 1994 Feb;4:15-22
1-Faild RCTs with sinus tract.
2-Open margins all around the fixed prosthesis .
3-Discoulored composite restoration .
4-proximal caries lesion.
5-missing premolar.
We started with surgical part , extraction , immediate placement and single stage surgery .
While drilling sinus accidentally perforated , but it's not end of the world !
A collagen membrane placed at the site of perforation followed by bone substitute placement .
Screw retained zirconia crown .
Few months later implant site completely healed and ready to receive the prosthetic part .
APC bonding protocol was followed in this stage .
Meanwhile implant site was healing , anteriors were getting the proper retreatment .
Chaotic palatal anatomy .
just because a tooth is splinted doesn't mean it is immune to occlusal trauma or periodontal damage , Old bridge removed all abutment teeth retreated and restored under isolation .
New separated Lithium Disilicate crowns .
Fitness check .
Confidant smile is a behavior therapy !
simultaneous natural smile .
16 Months follow up .
16 Months follow up .
16 Months follow up .
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