Treatment Options for Fractured Bridge

intercession Options for Fractured Bridge reference Study Discuss the give-and-take options of a case that you have manipulation planned as cave in of your ICEi clinical portfolio. enduring complaint Had a nosepiece in fastness left argona which had fractured and wanted to marvel about the possibility of graft interference to supersede the odontiasis and remnant the gap .History of pre direct condition Patient had a bridge for years for his one front missing tooth , and had recently fractured the bridge .No pain sensation or discomfort from the broken tooth and has left the gap as much(prenominal)(prenominal) .Patient also had tried 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 alveolar consonant institutes. Patient not in any discomfort, and did not report any other dental problems.Patients expectation from the discussion is to replace front tee th, so that they look, function and receive like his own teeth and can give him confidence to make a face as before .Social History Patient rarely consumes inebriant and is a non-smokerLow sugar intake in diet checkup History High blood pressureMedications Ramipril, Cardioplen (Felodipine) / SimvastatinExtra vocal examination No abnormality detectedIntra oral examination loopy Tissue The soft tissues intra-orally were in good health.Periodontal condition haemorrhage on probing at some areas and calculus in get down front teeth. Grade 1 mobility with LR1, LL1 teeth but the pocketing depth was at heart normal range. Patient had average oral hygiene.Teeth Teeth and animate restitutions and pourboires were generally in good condition.Generalised mild attrition was noted. wanting(p) teeth UR8 UR7 UR6 UR5UL3 UL6 UL7 UL8LR7 LR6 LR5LL5 LL6 LL7Crowned teeth (PBC) UR4 UR3 UR2 UR1 UL2Restored teeth UL5 LR8 LR4 LL8 restored with amalgam riposteLR8 LL8 drifted medianly.UL4 tooth wa s fractured which was an abutment for medial cantilever bridge(UL3-pontic, UL4- retainer crown), No caries, minimal coronal tooth anatomical structure presentOcclusionUpper cockeyed Kennedys Class 1, passing 1, considering missing UL3. put down arch Kennedys Class 3, Modification 1 blood was present.Due to missing posterior teeth in both upper and lower arch, patient had an edge to edge biteNo unadorned canine guidance or group function on squint movements.Lip / Smile contestationLip and smile lines were positioned in such a way that when smiling broadly some of the gum 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 beat mar on palpation.UL4 tooth was having good hard tissue height and width cod to the presence of the tooth.Diagnostic testsRadiographs takenDPT x-ray was done to assess the alveolar off-white levelsPeriapical X-ray UL34 was done to assess the quality and quantity of ram available for the implant fixture.PhotographsFront view (close up) to record the lip lineIntraoral view of UL3, UL4 areaBone stain pictureDiagnosisFailed preliminary cantilever bridge (UL3 pontic, UL4 retainer)UL4 fracture tooth (no caries minimal tooth to restore)Upper and Lower partially edentulous arches.Generalised chronic mild gingivitisPatient wishes Patient prefers a fixed option for the gap in the front. interference planning, objectives and considerations sermon 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, specialised objectives of the treatment should be to restore missingUL3 tooth and UL4 tooth with a fixed option.The deck up around the fractured tooth (UL4) is adequate, and there is sufficient bone height and width to brook the restoration of implant fixture. However, the bo ne around the missing tooth (UL3) was inadequate with wasted defect and would need bone grafting to aid the long-term perceptual constancy of the fixture. This can also further help to improve aesthetic results after implant treatment. insecurity factors / limitationsFracture of buccal bone can top during extraction of UL4.UL3 has been noted to have less adequate bone, the implant restoration may have a higher restoration margin than the natural teeth, and tooth might appear to emerge higher up the gum than the beside teeth.No posterior support present in the present compromised occlusion and risk of excessive load on implants and hence failure of implants over repayable to biomechanical reason and occlusion overloading(Kim, Oh et al. 2).Lack of primary stability of implants and embed failure.(Chrcanovic, Chrcanovic et al. 6). intervention 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 supported crown and UL3 Implant supported crown withbone grafting in UL3 (Al-Khaldi, Sleeman et al. 2011).Advantages and Disadvantages of unlike treatment options 1. Leave, accept gap / Leave alone fractured UL4AdvantagesNo treatment neededNo surgeryAccept gap, no addressDisadvantagesUnaesthetic drift / Tilting of adjacent teethFunction and phonetic compromisedContinuous bone overtaking, devising restoring site more challenging at later date.Development of occlusal interferences seek of caries developing UL4 put on the line of acute pain / swelling and transmittance UL42. Partial denturesAdvantagesNo surgeryLow costFew visits for treatmentsDisadvantages may be unstableFood s olicitationDoes not prevent bone lossTolerance can be difficult3. Bridge break (Not advised / feasible in this case)AdvantagesNo surgeryLow costFew visits for treatmentsTeeth are fixedDisadvantagesHealthy teeth alert 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 define .Implant optionsa) UL4 implant and mesial cantilever bridge with UL3 UL4 (Implant supported bridge)Advantages slight cost as one implant to be placedNo bone grafting needed, one functional visit would be less.Treatment completion would be early as no bone augmentation needed. mulish 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 deuce implants as planned as the next option and hence further cost. oral exam hygiene needs to be maintained.b) UL4 implant 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 divided on dickens 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 percentage 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 lengthen treatment time.Risk of implant fixtures failure to ossteointegrate.The success of implant treatment will mainly depend on the ability to maintain a very high level of oral hygiene and plaque jibe measures in the long term.Need to attend dentist at 3-6 periodical intervals to ensure good periodontal (gum) condition is maintained around your implant fixture and standing natural teeth. provisionary restoration optionsNo Provisional restoration or DenturePatient 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 see 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 made of unreal materials.Patient had no reservation for xenograft and hence xenograft Bio-oss was hold 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 do shield and polishExtract the UL4 tooth and Bone Graft UL3 areaPlace two implant UL3 and UL4Fabricate new upper and lower partial dentures nourishment instruction and regular 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. perceptual constancy 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 contend 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. favored 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 issue Ltd.KIM, P., IforefrontOVSKI, 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 biome chanical 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 distressed 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. Comparison 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 optical estimation. American Journal of Orthodontics and Dentofacial Orthopedics, 139(2), pp. 174-180.