Patient arrived with multiple dental concerns and desire to have teeth fixed. Due to multiple factors, a fixed prosthesis was treatment planned in the maxillary anterior and a RPD in the maxillary posterior.
I was given permission by our director to provide comprehensive care for the patient under the supervision of a prosthodontics faculty member.
At the same time, before even beginning this case, we worked on patient hygiene and really motivated the patient to improve to cater maintenance of the future prosthesis. And the patient has been very receptive to these efforts.
Wax-up of maxillary anterior made to assess occlusion and create temporaries during treatment visits.
Picture after visits to complete preparations on teeth #5, 6, 8, 9, 11.
Models prepared and dies made to send to the lab.
FPDs and crowns received from the laboratory.
Here is how the initial try-in looked in the patient's mouth. The facial bony defects of the pontic areas #7 and #10 appear masked by the symmetry provided in the prosthesis. That was one of the esthetic concerns I had in the beginning this case.
Unfortunately, one small portion of one of the abutment teeth, the DL of #6, did not seat completely and we decided to retake an impression and try again.
After discussing all the areas where this error could have occurred with my attending, the most logical cause of this deviation could have been the way the die for tooth #6 was made. For that reason, I used loupes and made the next set of dies with even more care.
Here is the final result of the maxillary anterior prosthesis after the second try-in visit. These FPDs adapted nicely with the margins of all abutment teeth, and were delivered after patient approval.
One of the toughest parts of this case for me has been learning to manage occlusion in a patient with positive occlusal sense where small changes in tooth contacts can cause discomfort.
At the same time, delivering surveyed abutments and providing anterior esthetics via FPDs has been a new experience. These restorations together will serve as rest seats for the maxillary RPD
Already, a huge difference can be seen from where I started this case.
