I picked up a patient through our preventive dentistry clinic where we do a couple of rotations through each semester. These patients are recall patients who have had dental work done at Temple and come in periodically to maintain their oral health. If the ‘prevdent’ patient happens to have another dental need that needs to be addressed besides a prophy, such as the onset of a new carious lesion, then the student on rotation can add them to their patient pool and address the problem. To make a long story short I picked up a patient from ‘prevdent’ and after addressing his initial problem a new problem was introduced to me.
He called me complaining of the PFM on tooth #21 that had broken off at the gum line. The tooth had been endodontically treated and was brittle. The whole coronal portion of the tooth including a prefabricated post had broken off with the crown. We made an appointment and after reviewing the case clinically and radiographically discussed various treatment plans. The patient decided that he wanted a gold bridge.
The first step was extraction of the retained root of #21. The extraction went smoothly and was allowed to heal for two weeks before our next appointment. The bridge was planned to span from #19 to #22. #19 had mesially drifted into the position of #20 so the bridge would be three units. #19 already had a gold crown so it had to be removed. This tooth was also treated endodontically and a portion of the coronal part of the tooth and a parapost broke off with removal of the crown. The parapost that broke off was not cemented deep enough into the root so a new parapost was placed after increasing the length of the canal with a parapost drill. The post was cemented in the distal canal and two pins were placed in the mesial buccal and mesial lingual portion of the crown. The crown was built up with composite.
The teeth were prepped and provisionalized. Impressions were taken a week later and poured up in jade stone and mounted to the articulator. The wax up began. Here are some photos:
Lingual view
Buccal view
In occlusion
Contrast
I cast the whole thing in one large ring in two pieces. The distal abutment was separate from the mesial abutment and the pontic. It came out beautiful. The next visit was a try in and solder. The bridge was soldered and temporarily cemented in for two weeks. (Normally you wait one week and then check the gingiva for inflamation and make sure the occlusion was good - but Thanksgiving got in the way) After two weeks the gingiva looked great and the occlusion was fine. The crown was removed (with quite a bit of force from an occlusal hammer) and polished to a shining glow. I thought it looked fantastic. Judge for yourself:
Final Cementation
Overall I was very pleased with the way the bridge turned out. I am also grateful for my patient who came in for all the dental school appointments needed to make this possible. It took about 5 appointments (including tx plan and extraction) to get the job done.
I am open to comments and suggestions, please share in the comments below.
12 responses so far ↓
1 Mike // Dec 6, 2008 at 10:25 am
Wow, this is awesome! Good work.
2 R. Watts // Dec 6, 2008 at 10:32 am
How fun! The pictures look nice. I’m curious, what was the rational behind casting the bridge in 2 parts?
At Temple are you required to do the wax up and casting yourself, or do you just like doing that?
3 CheerioKing // Dec 6, 2008 at 10:47 am
Thanks guys. The rational - and I don’t think this is done often in private practice - is to seat both units and make sure they fit individually. When the fit is good they are connected intraorally with duralay. They come out of the mouth then as a ‘three unit’ connected via duralay and are soldered together for a very good fit. Duralay is used because it burns away free of ash or debris.
Another reason is that we do our own lab work - it is required. Because we are students and not professional lab techs it is better to do it this way to ensure a good fit. Does this make sense?
4 R. Watts // Dec 6, 2008 at 1:58 pm
Yes, that makes a lot of sense. It would be pretty devastating if the bridge didn’t fit after all that work. That’s neat that you get to do your own lab work; most of the other schools I’ve been looking at the students do not do their own lab work.
5 brandon // Dec 9, 2008 at 11:36 pm
looks good ben. You finished perhaps the most difficult requirement right out of the chute. Looks like you can ditch those margins like a machine. One of the more valuable skills to learn at temple.
6 Dentistryzone // Dec 12, 2008 at 2:38 pm
Nice work!
7 Kent Newell // Dec 12, 2008 at 8:36 pm
Nice work, only at Temple would you get to do a 3 unit gold bridge that includes a canine. Good job getting the bridge out of the way early.
8 Ben // Dec 12, 2008 at 10:29 pm
Thanks guys. My patient was very cooperative and a really cool guy so it made it a lot easier to do. Hows Alaska Kent?
9 My Singapore Dentist // Dec 15, 2008 at 6:13 am
That’s nicely done!
10 Jae // Jan 13, 2009 at 2:20 pm
beautiful job!
11 Evo // Nov 12, 2009 at 3:05 pm
Hi there,
nice work. I am a dental student in the UK and gold bridges were unheard of for me until I began seeing a patient who had some made in America years and years ago!
I am going to see if I would be allowed to make him some more gold bridges for some other missing teeth.
One question- how did you remove the gold crown from ‘19′ (is that the molar or the canine?!). Was is difficult- my patient has a very solid gold crown on a possible abutment tooth which looks impossible to remove!
12 Ben // Nov 12, 2009 at 5:57 pm
I used a carbide bur with plenty of irrigation and some patience. Start at the margin of the crown mid buccally and slowly work towards the occlusal with the bur, taking it down to the tooth. If the tooth is hit a little it’s ok because you will refine the prep a little to remove old cement and possible decay. Make a cut from the gingival margin up to the occlusal surface and then across the occlusal surface to the lingual and then a little down the lingual side. There is an instrument that you can place into your cut (like a flat head screwdriver) and then twist and pry the crown off. Be careful because the crown can fracture - especially with recurrent caries. His three unit went from his canine to the first molar, but he had been missing one of his premolars for many years and the 1st molar had drifted mesially into this position.
Good luck, and if you can, take some pictures and email them over and I will post them.
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