Treatment Options for Fractured Bridge

give-and-take Options for Fractured BridgeCase Study Discuss the manipulation options of a case that you take treatment planned as part of your ICEi clinical portfolio. patient of complaint Had a bridge in upper left orbit which had fractured and wanted to need about the possibility of institute treatment to replace the odontiasis and close the gap .History of present condition Patient had a bridge for historic period for his one confront missing tooth , and had recently fractured the bridge .No pain or discomfort from the broken tooth and has left the gap as such .Patient excessively had move dentures for his other missing teeth but was not able to get used to them. Patient wanted to explore the options to replace his front missing teeth, in particular with dental implants. Patient not in any discomfort, and did not report any other dental problems.Patients expectation from the treatment is to replace front teeth, so that they look, juncture and feel like his own teeth a nd can give him confidence to smile as before .Social History Patient r arly consumes alcohol and is a non-smokerLow sugar intake in dietMedical History High blood pressureMedications Ramipril, Cardioplen (Felodipine) / Simvastatin unneeded oral examination No ab recipeity detectedIntra oral examinationSoft Tissue The soft tissues intra-orally were in near health.Periodontal condition exhaust on probing at some areas and calculus in lower front teeth. Grade 1 mobility with LR1, LL1 teeth but the pocketing depth was within normal range. Patient had average oral hygiene.Teeth Teeth and existing restorations and crowns were generally in good condition. speak mild attrition was noted.Missing teeth UR8 UR7 UR6 UR5UL3 UL6 UL7 UL8LR7 LR6 LR5LL5 LL6 LL7 crown teeth (PBC) UR4 UR3 UR2 UR1 UL2Restored teeth UL5 LR8 LR4 LL8 restored with amalgam restorationLR8 LL8 drifted mesially.UL4 tooth was fractured which was an abutment for mesial cantilever bridge(UL3-pontic, UL4- retainer crown), No caries, minimal coronal tooth structure presentOcclusion top(prenominal) arch Kennedys Class 1, Modification 1, considering missing UL3.Lower arch Kennedys Class 3, Modification 1 relationship was present.Due to missing stinker teeth in both upper and lower arch, patient had an edge to edge biteNo obvious canine guidance or group function on subsequentlyal movements.Lip / Smile toneLip and smile lines were positioned in such a way that when smiling broadly some of the mutter margins of teeth were seen. An average (Moderate) lip line was hence recorded.(Van der Geld, Oosterveld et al. 2011).Bone morphology on palpationUL3 area was noted to have buccal pearl soil on palpation.UL4 tooth was having good hard tissue height and width due to the presence of the tooth.Diagnostic testsRadiographs takenDPT x-ray was done to assess the alveolar fancy up levelsPeriapical X-ray UL34 was done to assess the quality and quantity of bone available for the implant fixture.PhotographsFront v iew (close up) to record the lip lineIntraoral view of UL3, UL4 areaBone defect pictureDiagnosisFailed anterior cantilever bridge (UL3 pontic, UL4 retainer)UL4 fracture tooth (no caries minimal tooth to restore)Upper and Lower fond(p)ly edentulous arches.Generalised chronic mild gingivitisPatient wishes Patient prefers a fixed option for the gap in the front. give-and-take planning, objectives and conditionsTreatment is indicated to restore aesthetics and function and would also benefit the patient psychologically to have confidence in his smile again (Lindsay, And et al. 7).Considering patient desires, specific objectives of the treatment should be to restore missingUL3 tooth and UL4 tooth with a fixed option.The bone around the fractured tooth (UL4) is adequate, and there is sufficient bone height and width to allow the restoration of implant fixture. However, the bone around the missing tooth (UL3) was poor with bony defect and would need bone grafting to aid the long-term st ability of the fixture. This can also advertize help to improve aesthetic results by and by implant treatment.Risk factors / limitationsFracture of buccal bone can occur during extraction of UL4.UL3 has been noted to have less adequate bone, the implant restoration whitethorn have a higher restoration margin than the natural teeth, and tooth might appear to emerge higher up the gum than the adjacent teeth.No posterior support present in the present compromised occlusion and risk of excessive load on implants and hence failure of implants due to biomechanical reason and occlusion overloading(Kim, Oh et al. 2). wish of primary stability of implants and Implant failure.(Chrcanovic, Chrcanovic et al. 6).Treatment options for the replacement of the missing teeth areNo treatment Leave Gap UL3 (Kanno, Carlsson 2006),Leave alone UL4Extraction of UL4 and partial dentures (Davenport, Basker et al. 2000).Bridge (Not advised in this case, considering UL2 heavily restored and not suitable as an abutment). (Anonymous 2007).Implant options UL4 implant and mesial cantilever bridge with UL3 UL4(Implant back up bridge), (Kim, Ivanovski et al. 2).b. UL4 implant support crown and UL3 Implant supported crown withbone grafting in UL3 (Al-Khaldi, Sleeman et al. 2011).Advantages and Disadvantages of different treatment options 1. Leave, accept gap / Leave alone fractured UL4AdvantagesNo treatment requiredNo surgeryAccept gap, no costDisadvantagesUnaestheticDrifting / Tilting of adjacent teethFunction and phonetic compromisedContinuous bone loss, fashioning restoring site more challenging at later date.Development of occlusal interferencesRisk of caries developing UL4Risk of acute pain / swelling and infection UL42. partial denturesAdvantagesNo surgeryLow costFew visits for treatmentsDisadvantagesMay be unstableFood accumulationDoes not prevent bone loss gross profit margin can be difficult3. Bridge get to (Not advised / feasible in this case)AdvantagesNo surgeryLow costFew vis its for treatmentsTeeth are fixedDisadvantagesHealthy teeth prepared for support, Risk of loss of vitality ,may need Root canal treatment or Extraction at later date .Food accumulation as difficult to flossDoes not prevent bone lossHigh costFracture of bridge or any part of it , needs replacing with new bridge as difficult to repair .Implant optionsa) UL4 implant and mesial cantilever bridge with UL3 UL4 (Implant supported bridge)AdvantagesLess cost as one implant to be placedNo bone grafting needed, one surgical visit would be less.Treatment completion would be early as no bone augmentation needed.Fixed prosthesisPrevent bone loss at UL4 siteDisadvantages / LimitationsRisk of implant failure is high due to excessive occlusal load due to missing posterior support.Compromised aesthetic outcome for UL3 due to bone defect present.If bridge work fails, would then plan to put two implants as planned as the next option and hence further cost.Oral hygiene needs to be maintained.b) UL4 impl ant supported single crown and UL3 Implant supported single crown with bone grafting in UL3 area.AdvantagesFixed prosthesisPrevent further bone loss at UL3 UL4 sites.Better aesthetic results.Individual implants, easy to maintain oral hygiene.Risk of failure due to occlusal load decreases as forces dual-lane on two fixtures.If an implant fails, they could be replaced or treated individually.Long term clinical data reveals that the prognosis for implant treatment is very high, in the region of 90-95%. (Pjetursson, Pjetursson et al. 6).Disadvantages / LimitationsMore cost as two implants and bone augmentation required.One surgical appointment added and wait for bone material to mature and hence prolonged treatment time.Risk of implant fixtures failure to ossteointegrate.The success of implant treatment ordain mainly depend on the ability to maintain a very high level of oral hygiene and plaque control measures in the long term.Need to attend dentist at 3-6 monthly intervals to ensur e good periodontal (gum) condition is maintained around your implant fixture and standing natural teeth.Provisional restoration optionsNo Provisional restoration or home platePatient opted for No Provisional restorationType of bone grafting options Dib 2010)An osseous graft can be osteogenic, osteoinductive or osteoconductive agent.Osteogenic graft contains vital cells, which will contribute to new bone growth.Osteoinductive graft stimulates the differentiation of osteoprogenitor cells into osteoblasts due to the bone morphogenetic proteins (BMPs).Osteoconductive graft will serve as a scaffold for new bone formation.Graft materials are also classifies asAutograft bone, obtained from the same individual.Allograft bone, obtained from a different individual, but from the same species(Bone bank)Xenograft bone, obtained from different species (Bovine)Alloplast graft is make of synthetic materials.Patient had no reservation for xenograft and hence xenograft Bio-oss was agreed to be used . Patient information leaflet given on same.Treatment agreed and plannedFrom the options discussed and considering patients wishes , it was agreed to plan two individual implant retained single crowns with bone augmentation at UL3 site and it was proposed to doScale and killExtract the UL4 tooth and Bone Graft UL3 areaPlace two implant UL3 and UL4Fabricate new upper and lower partial denturesMaintenance instruction and unbendable follow upA report was sent to the patient with all the options written after the consultation and attached with a breakdown of the costs for consideration and consent to proceed.Reference list AL-KHALDI, N., SLEEMAN, D. and ALLEN, F., 2011. Stability of dental implants in grafted bone in the anterior maxilla longitudinal study. British Journal of Oral and maxillofacial Surgery, 49(4), pp. 319-323.ANONYMOUS, 2007. Long-term survival of complete crowns, fixed dental prostheses, and cantilever fixed prostheses with posts and cores on root canal-treated teeth . British Dental Journal, 203(9), pp. 523.DAVENPORT, J., BASKER, R., HEATH, J., RALPH, J. and GLANTZ, P., 2000. The removable partial denture equation. British Dental Journal, 189(8), pp. 414-24.DIB, M., 2010. Successful Bone Grafting. Oral Health, 100(4), pp. 106-107,109.KANNO, T. and CARLSSON, G.E., 2006. A review of the shortened dental arch concept focusing on the work by the Kyser/Nijmegen group. England Blackwell Publishing Ltd.KIM, P., IVANOVSKI, S., LATCHAM, N. and MATTHEOS, N., 2. The impact of cantilevers on biological and technical success outcomes of implantsupported fixed partial dentures. A retrospective cohort study. Clinical oral implants research, 25(2), pp. 175 175-184 184.KIM, Y., OH, T., MISCH, C.E. and WANG, H., 2. Occlusal considerations in implant therapy clinical guidelines with biomechanical rationale. Clinical oral implants research, 16(1), pp. 26 26-35 35.LINDSAY, S., AND, K. and JENNINGS, K., 7. The psychological benefits of dental implants in patients di stressed by untolerated dentures. Psychology Health, 15(4), pp. 451 451-466 466.PJETURSSON, B.E., PJETURSSON, B.E., BRGGER, U., LANG, N.P. and ZWAHLEN, M., 6. equality of survival and complication rates of toothsupported fixed dental prostheses (FDPs) and implantsupported FDPs and single crowns (SCs). Clinical oral implants research, 18, pp. 97 97-113 113.VAN DER GELD, P., OOSTERVELD, P., SCHOLS, J. and KUIJPERS-JAGTMAN, A.M., 2011. Smile line assessment comparing quantitative measurement and visual estimation. American Journal of Orthodontics and Dentofacial Orthopedics, 139(2), pp. 174-180.