Immediate Full Upper Denture with Alveoplasty, Endodontic Treatment, Crown Amputation, Survey Crown, & Lower Partial Denture
Presentation Category
Removable, Endo, Restorative (Direct/Indirect)
Introduction/Context/Diagnosis
The pt presented to the clinic with multiple paruli, sinus tracts, periapical radiolucencies, open margins, cerival caries, iatrogenic periodontal disease due to over-contoured PFMs on every tooth in the mouth, and an ill-fitting lower partial. The patient also presented with prominent buccal bone bilaterally on the maxilla impeding normal ideal seating of a maxillary full denture.
Methods/Treatment Plan
I extracted all remaining maxillary teeth, performed alveoplasty on the buccal aspect of the maxillary alveolar ridge bilaterally using a surgical guide, and delivered an upper immediate full denture. I performed endodontic re-treatment on #22 and initial endodontic treatment on #27. The patient then very unfortunately fractured the crown of #27 during function. I performed a crown amputation on #27, removed a small amount of gutta percha and undercut the preparation circumferentially with a round bur, and filled the access cavity with composite to act as a hard vertical stop for the lower prosthesis. I delivered a survey crown on #22 to accommodate a lingual plate, and then delivered a lower partial denture with a lingual plate extending from #22-#26, a vertical stop on the #27 root, and modified T stress-relieving clasps on the distofacial aspects of #26 and #22.
Results/Outcome
The patient is currently very happy with the upper full denture, although we still await the 6 month Dentical-covered lab fabricated reline. The patient is very happy with the crown on #22. Currently the lower partial denture is still in process though I hope it will be delivered by Excellence Day!
Significance/Conclusions
Poorly designed fixed prosthesis can have a terrible iatrogenic effect on patients who have otherwise excellent home care. Open margins can lead to awful destruction due to caries that sometimes goes un-noticed under PFMs until the point of endodontic infection. This is why regular dental care is important so that we may catch things before they become larger problems. Additionally, anatomic factors like prominent buccal ridges can complicate things like removable appliances indicating pre-prosthetic delivery surgical treatment to ensure a more comfortable and functional end result. Lastly, even with a seemingly devastating crown fracture, an endodontically treated tooth may still serve as a valuable hard tissue vertical support to a prosthesis.
Format
Event
Immediate Full Upper Denture with Alveoplasty, Endodontic Treatment, Crown Amputation, Survey Crown, & Lower Partial Denture
The pt presented to the clinic with multiple paruli, sinus tracts, periapical radiolucencies, open margins, cerival caries, iatrogenic periodontal disease due to over-contoured PFMs on every tooth in the mouth, and an ill-fitting lower partial. The patient also presented with prominent buccal bone bilaterally on the maxilla impeding normal ideal seating of a maxillary full denture.
Comments/Acknowledgements
A big thank you do Dr. Hoover who helped me through this case and has taught me so much!