DTIN0210

Introduction The success of functional and esthetic restorations in a case requiring full mouth rehabilita- tion is often dependant on our understanding of inter- disciplinaryconcepts.Withevery patient being unique and repre- senting a special blend of age, personality characteristics as well as expectations, our know- ledge of interdisciplinary con- cepts can open a whole range of treatment options and out- comes.1 Today, every dental practitioner must have a thor- ough knowledge of the roles of these disciplines in producing an esthetic makeover, with the most conservative and biolo- gically-sound interdisciplinary treatment plan.2,3 Case Report A 57-year-old female patient reported with the complaint of mobile teeth, spacing in anterior dentition, missing bridge, and desire to restore her smile. During clinical examination, it was noted that the patient had deep periodontal pockets, missing teeth, mobile and mig- rated teeth. Diagnostic periapi- cal radiograph revealed hori- zontal bone loss and missing teeth. Based on the clinical and radiographical evidence, it was diagnosed that the patient was suffering from generalized moderate periodontitis with trauma from occlusion. The treatment plan was made keep- ing in mind the end-result, harmonious with biological and functional aspects. The treatment plan involved: - Periodontal therapy invol- ving subgingival curettage. - Extraction of hopeless teeth. - Crowns and bridges on remaining teeth, along with implant-supported prosthe- sis for missing teeth. Reha- bilitation of occlusion is the crucial phase to ensure long- term oral health. - Intentional root canal treat- ment was performed for remaining teeth in order to alleviate post-periodontal therapy hypersensitivity. - Maintenance and recall. Material options were given to the patient and a metal ceramic prosthesis was chosen. Treatment Sequencing Treatment was carried out in the mandibular arch followed by the maxillary arch in the following phases: Phase 1 Subgingival curettage of the lower arch along with the extraction of lower right (LR) 1 and 2, and lower left (LL) 1, 2, and 7, followed by place- ment of immediate extraction implants (Xive/Frialit by Fria- dent, GmBH) on LR 6(4.5 x 13), 2(3.4 x13) and LL 2(3.4 x 13), 7(5.5 x 8) was done. Prefabri- cated provisional acrylic fixed prostheses were given in the same sitting resting on the remaining natural teeth. Occ- lusal adjustments were made to achieve proper function, comfort, and esthetics. After a week, subgingival curettage of the upper arch along with extraction of upper right (UR) 1, 2, 4, 5, and 6, and Upper left (UL) 1, 2, 4, and 6 followed by immediate extrac- tion implants (Xive/Frialit by Friadent, GmBH) on UR 2 (3.4 x 11), 4(3.8 x 13), 5(3.8 x 11), 6(4.5 x 9.5); UL 1(3.8 x 11), 2(3.4 x 11), 4(3.8 x 13), 6(4.5 x 8) was done. Prefabricated provisional acrylic fixed pros- theses were given after bite adjustment. During the follow- ing visit, intentional root canal treatment was performed in LR 3, 4, 5, 7, and LL 3, 4, 5, 6 teeth. Phase 2 The loading of abutment in the upper and lower arch implants was performed six months after the stage 1 surgery. UL 3 was, also extracted due to persisting mobility, hence, poor long-term prognosis. Intentional root canal treatment was performed in UR 3, 7 and UL 5, 7 to improve their prognosis and prepared to receive crowns. After a week, final impres- sions were made using rubber base impression material, and working casts were prepared to make abutments. The work- ing casts were then mounted on a non-arcon, semi-adjust- able articulator using facebow records. The centric relation and vertical dimension were also transferred to the articu- lator from the patient, using polyvinyl siloxane putty bite. During metal trial, fit of the castings and occlusal clearance were checked. A Bisque trial was, done to confirm fit, shade and occlusal parameters. Later, the final metal ceramic prosthesis was constructed. The final prosthesis, after all occl- usal adjustment, was cemented using Glass Ionomer Cement. Recall appointments were given for cleaning and maintenance of the prostheses at every 6 months. Restorative and Occlusal Consideraions The final occlusion given to the patient was Class II with anterior guidance, which DeNtaltribuNe|april-June, 2010 Clinical 19 Case report:Interdisciplinary full mouth rehabilitation By Dr Ratnadeep Patil, Dr Kripa Shetty, and Dr Kavita Mahesh, India Figs. 1a-d: Pre-operative intra oral view Fig. 1e: Pre-operative smile Fig. 1f : Pre-operative OPG Fig. 2a: Maxillary occlusal view after final preparation Figs. 3b-d: Post-operative intraoral view Fig. 3e: Post-operative smile Fig. 2b: Mandibular occlusal view after final preparation Fig. 2c: Post-loading OPG Fig. 3a:Post-operative intraoral view 1a 1b 1c 1d 1e 1f 2a 2b 2c 3a 3b 3c 3d 3e