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ProsthodonSid

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23.01.2022 As much as we like to treatment plan right from the beginning, sometimes we start in the middle. Guy walks in with 8 implants on the maxillary arch with a horse-shoe denture that is retained with a ton of denture adhesive. Implant positions are favourable, the implants had integrated well, periimplant tissues looked reasonably healthy. Pretty straighforward, until he tells us about his gagging issues. Even a mouth mirror or a toothbrush usually set off a pretty severe gag re...flex. The lower arch had very mobile teeth splinted together. But thats another story in progress. We talked about a removable solution initially to make hygiene maintenance a bit easier but expectations could only be managed with a fixed prosthesis. So we decided to make a temporary prosthesis to see if he coped with it well. We evaluated the aesthetics, phonetics and oral hygiene maintenance over a period of time and finally settled on a fixed implant supported bridge. Surprisingly, his gagging issues improved significantly the more time he spent in the chair. We used all the tricks in the book to make the impressions and try ins as comfortable as possible (Salt, timing the appointments when the gag reflex was reduced, fitted custom trays to control the volume of material, etc) One of the most common prosthetic complications of maxillary fixed acrylic bridges is the denture teeth pinging off as the wear on the acrylic teeth starts reducing the vertical dimension. My preferred design for resin bridges is a titanium framework layered with composite. I worked closely with Nicola Redase who has developed his own technique for pressing heated composite onto titanium frameworks with a complete wraparound. When adequate space for the resin is available, this tends to work well. Laboratory work and photos by Nicola Redase. More descriptions on the photos.

19.01.2022 Following on from my last post on Bonded Bridges. Here is another one done with a very similar workflow. Patient presented with a missing lateral and wasnt ready for implant therapy for various reasons. The clinical protocol is pretty straightforward but the ceramic work was challenging due to the quirky texture on the patients natural teeth. So full credits to ceramist Nicola Redase. In this case we didnt have the luxury of using a separate prosthesis to sculpt her pont...ic site so I modified her existing hawleys retainer to sculpt the gums. Also we were working on a short schedule so we let the tissues mature for about a month before final impressions. Traditional impressions here with VPS to capture the textures accurately. A bit about how we approach these missing laterals with bonded bridges: 1. Occlusal control : I routinely build up small ridges of composite resin to shift the guidance away from the lateral pontics. These buildups are often on the centrals, canines or the first premolars. The occlusion needs to be routinely monitored to make sure the guidance hasnt re-established on the pontic. 2. We prefer a single retainer on the centrals in most cases due to the better surface area and longer connector length possible. 3. Orthodontic retainers or Occlusal splints are made with a labial window at the pontic site so the retainer doesnt yank on the pontic everytime they are removed.