The Construction of a Removable Combined Precision Denture for a PATIENT WITH MARGINAL GINGIVITiS In partial fulfilment of BTech: Dental Technology, Department of Dental Sciences, CPUT, 2008 by Nicolea Jacobs

OVERVIEW Patient History Definition Clinical Treatment Possible Treatment Options Chosen Treatment Option Advantages and Disadvantages Laboratory Procedures Problems Experienced Future Treatment Options References Acknowledgements

PATIENT HISTORY A 36 year-old female Complained of tooth ache, gingival erythema, swelling, and bleeding1 Referred to the Tygerberg Hospital UWC Dentistry Faculty Inflammation on the margins of the gingiva, and caries on certain teeth (Fig. 1)1,2

PATIENT HISTORY (cont.) Fig. 1: Marginal gingivitis1

DEFINITION Mild inflammation of gingival tissue3 Exists around teeth3 Amona – a human ailment4 Irritating effects caused by bacterial plaque4

CLINICAL TREATMENT Received mouth wash for plaque formation and sensitivity of the gum tissue2,5 Teeth with caries were extracted Most teeth with inflammation were extracted Maxillary 2∙1, 2∙8, and 1∙7 were prepared for single crowns Remaining standing teeth were the 1∙1, 1∙8 and 2∙5

POSSIBLE TREATMENT OPTIONS MAXILLA MANDIBLE Removable acrylic partial denture6 Fixed partial prosthesis7 Metallic removable partial denture7 Combined precision attachment denture8,9 Conventional acrylic denture8,9,10 Implant-retained overdenture10,11 14 unit bridge prosthesis10,11

CHOSEN TREATMENT OPTION Combined precision attachment denture 2∙1 metal-ceramic crown 2∙8 and 1∙7 milled gold crowns Metallic removable partial denture MAXILLA Conventional acrylic denture with labial gum tinting MANDIBLE

ADVANTAGES OF POSSIBLE TREATMENT OPTIONS MAXILLA Conventional removable partial denture6,12 Fixed partial prosthesis6 Metallic removable partial denture6,9,12 Combined precision attachment denture12,14 Less expensive than all options6,12 Good aesthetics6,12 Excellent retention- retentive arms6,9,12 Excellent retention and stability - combination12

ADVANTAGES OF POSSIBLE TREATMENT OPTIONS MANDIBLE Least expensive of all the choices6,14 Excellent stability and retention Good aesthetics Conventional acrylic denture6,12 Implant - retained overdenture11,13 14 unit bridge prosthesis14

DISADVANTAGES OF POSSIBLE TREATMENT OPTIONS Conventional removable partial denture6,12,14 Fixed partial prosthesis10,11,15 Metallic removable partial denture6,12,14 Combined precision attachment denture7,8,9,11,15 MAXILLA Insufficient stability and retention11,14,15 Most expensive option Lack of aesthetics – clasp arms Bone resorption

DISADVANTAGES OF POSSIBLE TREATMENT OPTIONS MANDIBLE Conventional acrylic denture14 Implant - retained overdenture15 14 unit bridge prosthesis15 Less stability and aesthetics14,15 Most expensive treatment option Too expensive compared to a conventional denture

LABORATORY PROCEDURES FIRST PHASE: Poured final model Fabricated record block for bite registration (Fig. 2) Articulate case Fig. 2: Bite registration F. Goetze

LABORATORY PROCEDURES (cont.) SECOND PHASE: Prepared model for 2∙1 metal-ceramic crown Waxed coping with metal collar Cast coping Fabricated metal-ceramic crown (Fig. 3) Fig. 3: Metal-ceramic crown F. Goetze

LABORATORY PROCEDURES (cont.) THIRD PHASE: Wax crowns on 1∙7 and 2∙8 Milled wax crowns Cast gold crowns Milled cast gold crowns (Fig. 4) Polished 1∙7 and 2∙8 gold crowns Precision attachments offers controlled wear, less wear, and have standard interchangeable parts9,10

LABORATORY PROCEDURES (cont.) F. Goetze Fig. 4: Milling of gold crowns

LABORATORY PROCEDURES (cont.) FOURTH PHASE: Preparing Co-Cr framework Wax-up Co-Cr (Fig. 5) Final Co-Cr framework (Fig. 6) F. Goetze Fig. 5: Wax-up Co-Cr framework F. Goetze Fig. 6: Final Co-Cr framework

LABORATORY PROCEDURES (cont.) FIFTH PHASE: Set-up on Co-Cr framework Crowns and framework attachment (Fig. 7) Poured and polished Co-Cr denture (Fig. 8) Y. Chen Fig. 7: Attachment Y. Chen Fig. 8: Final Co-Cr denture

LABORATORY PROCEDURES (cont.) Set-up edentulous mandible Labial gum tinting (Fig. 9) Final mandibular denture (Fig. 10) Y. Chen Fig. 9: Labial gum tinting Y. Chen Fig. 10: Final mandibular denture

LABORATORY PROCEDURES (cont.) Y. Chen Fig. 11: Final case

PROBLEMS EXPERIENCED Open margins on gold crowns after casting Limited space on the buccal area of the coping for ceramic material Finished chrome did not seat as desired Porosity in mandibular denture

FUTURE TREATMENT OPTIONS Maxilla Fixed bridge prosthesis Mandible Soft lining denture - tissue sensitivity 14 unit bridge prosthesis

REFERENCES Scully C. Handbook of Oral Disease. London: Martin Dunits.1999: 280-281. Scully C, Flint SR, Porter SR. Oral Disease, 2nd ed. Singapore: Crispian Scully and Stephen Flint. 1989: 182. Sweet Haven Publishing. Fundamentals of Dental Technology (1985). Available: http://www.waybuilder.net. 7 August 2008. Roberts G. What is Marginal Gingivitis? Available: http://www.2hub.com. 7 August 2008. Enrique B, Needleman HL, Karimbax N, Van Dyke TE. Periodontal and Gingival Health and Diseases. Singapore: Martin Dunits Ltd. 2001: 31-32.

REFERENCES (cont.) Rosentiel SF, Land MF, Fujimoto S. Contemporary Fixed Prosthodontics, 4th ed. Missouri: Mosby Inc. 2006: 273. Soltner HM. Dental Labor National: Anchoring – band Attachments. Berlin: Dental Labor International. 2008; 4; 42. Wulfes H. Precision Milling and Partial Denture Construction, 1st ed. Bremen: Academia Dental. 2004: 149. Martin P. Attachments for Prosthetic Dentistry. Berlin: Quintessence Publishing Co Ltd. 1994: 11-12. Ney JM. Crown and Bridge Manual. Hartford: JM Ney Company. 1972: 105-112, 125-128.

REFERENCES (cont.) Preiskel HW. Precision Attachments in Prosthodontics: The Applications of Intracoronal and Extra Coronal Attachments, Volume 1. Chicago: Quintessence Publishing Co. 1984: 85-99. Stewart KL, Rudd KD, Kuebker WA. Clinical Removable Prtial Prosthodontics. Missouri: C.V. Mosby Company. 1983: 125-128. Smith BGN. Planning and Making Crowns and Bridges, 3rd ed. Bremen: Martin Dunitz. 1998: 3-100. Morrow RM, Rudd KD, Rhoads JE. Dental Laboratory Procedures - Complete Dentures, 2nd ed. St. Louis: C.V. Mosby Company. 1986: 545-550. Naylor WP. Introduction to Metal Ceramic Technology. London: Quintessence Publishing Co. 1992: 36; 136-153.

ACKNOWLEDGEMENTS Dr. Wright Mr. L Steyn Miss M Kruger Mr. Latief Mr. M Mazema

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