case 33: failed bridge

Question 1

Case Summary

Answer 1

40 y/o man with decemented cantilever - wants it recemented or replaced.
- happened 2 years ago, recemented and was fine until yesterday
- UL1 avulsed at 16, UR1 #
- replaced by spring cantilever bridge off crowned UL45
- pt never had UL2
- UR1 post crown RCT
- UL45 crown margins unsound caries, 4mm probing depth

Question 2

What is the prognosis of the bridge? Why?

Answer 2

poor
- not aesthetic
- abutment teeth are carious
- abutments compromised due to caries risk and perio

Question 3

Why might a spring cantilever bridge have been chosen in this instance?

Answer 3

1. allows for diastemas between adjacent crowns (natural appearance for the pt due to missing 2)
2. UR1 not suitable as abutment (RCT, trauma, post crown)

Question 4

What are the potential treatment options for this case?

Answer 4

1. no tx
2. RPD
3. new spring cantilever
4. RBB
5. implant

Question 5

Describe the new spring cantilever option.

Answer 5

Has served the pt well and still suitable design.

HOWEVER
- abutment teeth with require restoration (may no longer be be suitable)
- re-design to incorporate single abutment
- assess OH, occlusal assessment.

Question 6

Describe the RBB option.

Answer 6

• from UL3 (canines make good abutment teeth due to surface area)
• UL1 replaced by cantilevered pontic
• minimal tooth prep needed (but depends on enamel available)
• allows for diastema to be maintained
• carious abutment teeth can be independently restored

Question 7

Describe the single tooth implant option:

Answer 7

• dependent on suitability: available bone, active perio
• allows diastema to be maintained
• enhanced prognosis of carious abutment teeth

adv: long term solution
disadv: involves surgery, cost, provisional restoration needed after implant placement.

Question 8

3 components of an implant:

Answer 8

1. implant that is osseointegrated into the surrounding bone
2. abutment - attached to implant by abutment screw.
3. crown - either porcelain or porcelain bonded to metal.

Question 9

Things to look out for when monitoring implant osseointegration.

Answer 9

1. implant is firm
2. symptomless
3. no PA radiolucency / crater-like bone loss

Question 10

Which 3 factors would indicate implant failure?

Answer 10

1. crater-like bone loss
2. PA radiolucency / infection present (suppuration)
3. mobility