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.
