A lady patient in her sixties presented to our clinic with the following complaints and questions:
- Her worn and chipped teeth had become a bit of a nuisance compromising her self-esteem.
- She wanted to have her missing molars and premolars replaced to restore masticatory function
- She wished to have her metal ceramic and metal crowns replaced as these were no longer aesthetic.
- She was looking to have her missing teeth replaced preferably without implants due to financial reasons.
- She desired beautiful uniform teeth so she could feel at ease to smile again
Full restoration of aesthetics and masticatory function
The patient brought along a panoramic radiograph to the first encounter earlier recorded demonstrating that all her upper front teeth needed to be crowned. Fortunately all her remaining teeth and the implants were in a good condition and necessitated no removal. The implants were installed long ago at another clinic. Since our patient was not keen on the placement of new implants we proposed her a combined restoration for the mandible where all molars and premolars had to be replaced. She found this solution appealing and accepted the treatment plan. A fixed solution was therefore conceived for the upper teeth and a combined replacement (i. e. fixed bridge combined with an overdenture) for the lower ones.
First panoramic radiograph presented by the patient (initial condition)
What does combined restoration mean?
Combined restoration is a means of restoration combining two different kinds of replacement. It is generally applied with free-end edentulous spaces where original front teeth are still present but the rear teeth are missing. A fixed metal ceramic bridge is prepared for the natural teeth to which a removable overdenture is attached by means of hidden clasps to replace missing rear teeth.
The old crowns are removed and natural teeth are prepared to accommodate crowns, a precision impression is taken thereof and sent to the dental technician.
When crowning her old implants she decided for every old abutment to be preserved with only the crowns cut off. This is the fastest and least expensive means of crown replacement. In a very lucky scenario the abutment may be preserved when removing the old crown. In this case an impression is taken directly of the abutment as though to prepare a bridge for a tooth stump, with the abutment left in place. No new parts are required, all we need is a screw driver and a ratchet spanner to verify whether the screw securing the abutment sits stable enough. It is advisable to fasten the screw at 35 Ncm torque in case the oscillations in the process of cutting off, and prying off ,the old the bridge have loosened the abutment. If the abutment is stable the abutment only requires sulcus dilation and an impression taken, based on which the dental technician can prepare a new cement-retained crown or bridge. The benefit of such crown replacements is their being fast, inexpensive and simple, but they have the downside that Suba Dentál Clinic is not able to assume warranty on them seeing as the implant was not installed and the abutment was not ordered by our clinic and filed by our dental technician. It is as if a used car was overhauled… nice and good and operable for years, but we cannot provide the same warranty conditions that apply to new tooth replacements. More…
A gnathological treatment determines the correct position of the temporomandibular joints and bite height.
The frame test fitting allows us to verify the accuracy of the impressions and the trueness of the metal frame of the tooth replacement since all tooth replacements must seamlessly fit the master cast.
During tooth test fitting, we once again verify the bite, the length of the frame and the artificial teeth as well as the middle line and smile line. This a trial fitting where the position and shape of the teeth can still be adjusted if required.
At the preliminary test fitting the crowns are almost finished, the ceramic is already sintered onto the frame, the metal plate of the denture is complete, yet the teeth are still embedded in wax to allow for adjustments as required. At this test fitting the patient’s bite (function), the shape and colour of the crowns, the middle line and smile line (aesthetics) can be verified with even better accuracy.
Root canal treatment is performed between the different trial fittings as required.
When bite and aesthetics leave nothing to be desired the crowns are given a glossy finish to sport a natural look. Although several days elapse between the different test fittings, the dental technicians are working at full tilt in the meantime.
Handover/ cementing in place of the artificial teeth is a delicate procedure requiring concentration on the part of the dentist and assistant. On completion of the treatment our patient was content and left the clinic with a broad smile. Her self-confidence was restored and at last she feels again at ease to smile with her new teeth.
On completion of the treatment patients should not forget about regular dental check-ups and professional tartar removal which may shed light on issues at their inception.Regular check-ups and tartar removal are also warranty conditions.
Keywords: metal ceramic crown, metal ceramic bridge, removable tooth replacement, denture, implant, combined restoration, combined denture, tooth test fitting, gnathological treatment, frame trial fitting, precision impression, professional tartar removal