The fabrication of a maxillary and a mandibular prosthesis to restore the natural dentition of a patient Elwin Burger In Partial fulfilment of BTech: Dental Technology Department of Dental Sciences CPUT 2008

Overview  Patient history  Comparative study  Clinical procedures  Treatment options  Treatment options: Advantages and disadvantages  Treatment of choice  Technical laboratory procedures  Problems experienced  Future treatment options  Conclusion  Acknowledgements  References

Patient history  Gender: Male  Age: 55  Middle class income group  History of severe periodontitis  Loss of some maxillary teeth  Loss of all mandibular teeth Fig 1. Gingiva and gum resorption 1

Clinical Procedures  Cleaning and scaling  Periodontal surgery  Extractions  Tooth preparations for crowns Fig 4. Example of Periodontitis 3

Comparative study Fig 2. Boys vs Girls 1 Fig 3. Age groups vs Oral hygiene 1

Treatment Options Implant-retained bridge Dentures Upper acrylic RPD Upper CoCr RPD Implant-retained overdenture Maxilla and mandible

Clinical option 1 Implant retained bridge R Advantages Improve aesthetics 1 Tooth-saving 1 Improve patient confidence 1 Reliable 2 Long life expectancy 2 Disadvantages Expensive 2 Time consuming 2 Discomfort or pain 2 Bruising and minor swelling 2 Crown replacement in years 2 Fig 5. 11

Clinical option 2 Advantages Improve natural appearance. 4 Made from durable materials 4 Last between five to ten years 4 Correction of masticatory and related problems 5 Disadvantages Take time to get use to 4 Speech problems Mouth irritation or sores 4 Replacement after time 4 Masticatory deficiencies 4 Bulky Fig 6. 7 Dentures R 1313

Clinical option 3 Partial acrylic RPD R 587 Advantages Replace missing teeth 3 Improve mastication and oral health 3 Preserving natural teeth 3 Improve aesthetics Comfourtable 4 Disadvantages Tooth Damage caused by moving clasps 4 Traps food Loss of fit 4 Tipping can occur 4 Speech difficulty Fig 7. 15

Clinical option 4 Partial CoCr RPD R1977 Advantages Biocompatible and hypoallergenic 2 Provide added strength 2 Natural feeling 2 Weight may contribute to additional denture stability 6 Disadvantages Oral hygiene is essential 2 May feel bulky 2 Frequent maintenance and examinations necessary 4 More expensive than acrylic RPD Fig 8.

Clinical option 5 IR overdenture R Advantages Can be removed easilly. 4 Excellent stability 4 Lower cost Good hygienic properties 6 Good aesthetics Disadvantages Increased cost 6 Discomfort Implant takes time to heal 4 Fig 9. 7

Treatment of Choice: Maxilla Add Your Title PFM Crown on 2.1 Gold Crowns on 1.7, 2.8 with precision milled shoulder attachments Cobalt Chrome RPD Fig 10. Kennedy classification 3 mod 2

Treatment of choice: Mandible Full acrylic denture with selective labial gum tinting Fig 11. Tinted mandibular denture F Goetzer

Technical Laboratory Procedures Fabrication of PFM Crown 3.Wax up and precision mill of posterior crowns in wax stage 4.Cast gold crowns, trim and precision mill 5.Duplicate and pour refractory model 6.Wax up and Sprue of CoCr RPD 1.Standard model preparation

Technical Laboratory Procedures cont Invest and elimination of wax 8.Cast, trim and finish of Cobalt Chrome RPD 9.Set up of artificial teeth

Technical laboratory procedure cont. Fig 12. Milling of wax crowns Fig 13. PFM and milled gold crowns Fig 14. Wax Design Fig 15. Cast, trimmed and high shined E. Burger

Problems Experienced Milling difficulties Porosity Incomplete Casting Poor fitting around Gold Crowns

Future treatment options  14 Unit upper and lower implant-retained bridge (Full oral rehabilitation)  Dental Implants  Full upper and lower dentures  Implant-retained overdentures

Conclusion Dentist Patient Technologist Final prosthesis Fig 15 Complete prosthesis F. Goetzer

Acknowledgements  Mr. M Mazeema  Mr. A Latief  Mr. LA Steyn  Dr. J Wright  Mrs. A De la Crouse

References 1. Lindhe J. Clinical Periodontology and Implant Dentistry. 4th ed. Oxford: Publishing Co. 2003: MayoClinic.com-Tools for Healthier Lives. Available: 26 July Oral Health-Common Problems- All About Periodontitis. Available: 26 July Smith GNB. Planning and Making Crowns and Bridges. 3rd ed. London: Martin Dunitz Ltd. 1998: Van Noort R. Introduction to Dental Materials. 2nd ed. Edinburgh: Elsevier Science Ltd. 2002: 180, 238, Wulfes H. Precision Milling and Partial Denture Constructions-A Manual. 1st ed. Bremen: Academia Dental International School BEGO Germany. 2004: 57-59; 138; Muraoka H. A Colour Atlas of Complete Denture Fabrication. Chicago: Quitessence Publishing Company. 1989: Babbush CA. Dental Implants- The Art and Science. Philadelphia: W B Saunders Company. 2001: 3-19.

References cont. 9. Morrow RM, Rudd KD, Rhoads JE. Dental Laboratory Procedures- Complete Dentures. Volume 1. St. Louis: The CV Mosby Company. 1986: , Basker RM, Davenport JC. Prosthetic Treatment of the Edentulous Patient. 4th ed. Oxford: Blackwell Publishing co. 2002: Roberts DH. Fixed Bridge Prostheses. 2nd ed. England: John Wright and Sons Ltd. 1980: , , Mclean JW. The Science and Art of Dental Ceramics. Volume 1- The Nature of Dental Ceramics and their Clinical use. Chicago: Quintessence Publishing Co. 1979: 23-28, Dykema RW. Johnston’s Modern Practice in Fixed Prosthodontics. 4th ed. Philadelphia: W.B Saunders Company. 1986: 8-16, 22-25, Jenkins G. Precision Attachments- A Link to Successful Restorative Treatment. London: Quintessence Publishing Co. Ltd. 1999: Stewart KL. Clinical Removable Partial Prosthodontics. St. Louis: The C V Mosby Company. 1983: 18-20;