Year : 2021 Month : June Volume : 10 Issue : 23 Page : 1803-1806

Split It! Let s Break That Stress - A Case Report

Abhijit Patil1, Tanya Sethi2, Mallikarjun H. Doddamani3, Rutvi Shah4, Anandkumar G. Patil5, Ankeet Vora6, Twisha Dave7, Divya Joshi8

1, 3, 4, 5, 8 Department of Prosthodontics and Crown and Bridge, KAHER s KLE Vishwanath Katti Institute of Dental Sciences, Belgaum, Karnataka, India, 2 Department of Prosthodontics, Procure Dental, Bangalore, Karnataka, India.
6 Sabka Dentist Dental Clinic, Ahmadabad, Gujarat, India. 7Clove Dental Clinic, Ahmadabad, Gujarat, India.

CORRESPONDING AUTHOR

Dr. Abhijit Patil, Lecturer, Department of Prosthodontics and Crown and Bridge, KAHER S, KLE Vishwanath Katti Institute of Dental Sciences, Belgaum, Karnataka, India.
Email : dr.abhijitpatil85@gmail.com

INTRODUCTION

Fixed prosthodontics is a zestful and progressing branch because of the numerous advantages that it has over removable prosthesis. The oral cavity for each scenario has its own complications and hence every individual case has its own approach keeping in mind the comfort, function, and aesthetics of the patient. In some cases, we come across an edentulous space on both the sides, creating a lone free-standing tooth. This clinical scenario with a pier abutment needs to be taken into consideration during restoration of the arch as the masticatory forces applied on the abutment teeth at one end of fixed partial denture (FPD) can result in the pier abutment acting as a fulcrum resulting in ultimate failure of the FPD and trauma to the periodontium. To overcome this complication, use of non-rigid connectors is advised. Many innovative clinical designs with modifications to the conventional bridges have been proposed over the years to undertake such a scenario most diligently. Selection of the right type of connector is imperative for the success while undertaking such a case. This era is of digital dentistry; hence, an innovative, time saving, and cost-effective way of fabricating non-rigid connector using Exocad software and 3D printing of split pontic FPD is presented in this case report.

Masticatory forces and occlusal loads applied to a fixed partial denture (FPD) are transmitted to the supporting structures through the pontic connectors, and retainers.1 An FPD with the pontic firmly stable on the retainer will provide stability to the prosthesis along with minimizing the stresses associated with the restoration. However, in case of a pier abutment with edentulous space occurring on both the sides; the physiologic tooth movement, position of the abutment tooth in the arch, and a disparity in the retentive capability of the retainers can make a long span FPD a less than ideal treatment plan.2

The choice of a pontic is considered crucial for abutments, since maximum stresses are concentrated on them under occlusal loading. The selection of the most favourable type of connector is essential for the success of the prosthesis.3,4 Various researchers have given different locations of connectors in FPD. There are many areas of dentistry where digital technology is used today. Each area of digital dentistry has advantage over the conventional techniques. Hence in this case report, Matrix and Patrix system of the connector were fabricated using Exocad software and 3-D printed framework was tried and final prosthesis was fabricated using CAM. It has numerous advantages over conventional techniques.

They are as follows -

  1. Less time consuming
  2. Less technique sensitive
  3. Cost effective as compared to the precision and semi-precision attachments
  4. Accurate fit of the prosthesis

Split pontic has several privileges over conventional connectors like conservative preparation of all abutments, anterior abutment neither requires distal box preparation to accommodate the female attachment, nor does the tilted abutment requires over reduction. The interface between the two pontic halves is constructed away from the tissue and occlusal surface of the pontic, hence obliterating the difficulties like hygiene and occlusion. Increased stability is another added advantage of placing the attachment in the pontic.5

PRESENTATION OF CASE

A 45-year-old male patient presented to the Department of Prosthodontics with a chief complaint of missing teeth, thereby having problems in mastication and aesthetics. Past medical history was insignificant and past dental history revealed that patient had undergone extraction of the grossly carious left maxillary lateral incisor, first premolar and first molar six months back. The prosthodontic diagnosis was Kennedy’s class III with modification II (Pier abutment).

Intraoral examination revealed missing first premolar, left maxillary lateral incisor and maxillary first molar with left maxillary central incisor and maxillary second molar acting as terminal abutments. The canine and second premolar were the pier abutments in this scenario (Fig 1). The radiographic evaluation revealed adequate bone support on the abutment teeth.

DISCUSSION OF MANAGEMENT

Due to financial constraints, dental implants were ruled out. Hence, after discussing all the treatment options, their advantages and limitations, a seven-unit FPD using split pontic technique incorporated with non-rigid connector was planned for the patient. Exocad software was used and final prosthesis was fabricated in all ceramic FPD using computer aided milling. The risks and benefits were discussed with the patient and a written, informed consent was obtained.