This is highly controversial but successful case that I encountered during my practice. It all began 9 years ago, when this patient walked into our office, demanding bridge in his upper jaw. This case was took over by our head of the office- Dr.Velkoski, I was dental technician in that time.While, 9 years after case was lead by me as dentist and dental technician.
Dental Status in Maxillae:
Dental Status in Mandible:
All premolars and molars missing from both sides , except
Condescend byte distance (vertical
Since his birth, patient had progenial jaw correlation. There was inverse over-byte status of his frontal teeth ( lower front teeth overlap the upper front teeth by more than five millimeters when closing mouth..) -this situation cause slight protrusion of lower incisors. During his 30's.patient lost all of his upper incisors.
In this situation , proposed solutions were:
1. Partial denture with metal base ( reduced palatinal surface) or
2. Circular bridgework from one to another end
In both cases , we would rise byte distance, and frontal teeth (of the bridge or denture) will be in slight protrusion in order to reach incisal margins of lower incisors , and to create tooth to tooth ( teete a teete) situation.
Patient wasn`t ready for use of partial denture ( psychological effect) , he was too young for it . He refused circular bridge, due to his fear that his "only functional teeth" ( his left two premolars) will decay under bridge. He was strict in demands for fixed prosthetic restoration, but without left premolars in it . That drove us in very delicate and specific situation.
Regarding patients demands, we came to
only solution that was very controversial: bridgework with three retainers
(one on short abutment) , and two pontics: frontal with 6 components
and posterior with 2 components. Problematic parts of this bridgework
|Duration of the
This bridge was installed in patients mouth in 1993, and succeed to survive until spring 2002 when patient visited our office to check up his bridge. With intra-oral inspection I found out small fissure (narrow opening) on the oclusal part , on the connection between left third canine ( abutment) and frontal pontic. Bridge was still fixed in its base, there wasn`t any movement or extra vibration of the construction.Patient only noticed with his tongue that there is "some discontinuity on the surface of the bridge". I decided that after 9 year this bridge has done his job, and it was time to be pulled out.
For my surprise, parodontal status was excellent! There wasn`t any discolorations or processes in the mucosa of frontal edentulous ridge and those 3 abutments were in excellent shape.
Again , I proposed e new therapy with partial removable denture, but patient , again , like 9 years ago refused, and demanded the same bridge construction. New construction was made, and now all we can do is to wait how long this second bridge will survive :)
e-mail : firstname.lastname@example.org
Note: Digital Camera used for this case: MUSTEK Smartpix. I apologize
for lack of intra-oral images, because this camera was flash-less, and
it was impossible to get intra-oral images.Images also has small resolution
due to capacity of this camera. This camera was my only choice at that
time, so in order to make record of this controversial case , I had to
use this camera.