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A clinical case of occlusal reconstruction using a maxillary cross-arch bridge for a patient with severe periodontal disease
Abstract
Patient: The patient, a 55-year-old woman, complained of bleeding and pus discharge from the maxillary anterior gingiva. The patient was diagnosed as having severe generalized periodontitis with a defective prosthesis. Periodontal therapy and occlusal improvement using provisional prostheses were performed together. As the final prostheses, a cross-arch bridge in the maxilla and bridges in the mandible were placed. Thereafter, she has remained satisfied without the previous complaints.
Discussions: Accurate transfer of the crown shape from the provisional prostheses to the final ones and subsequent maintenance accounted for the good prognosis.
Conclusion: Appropriate periodontal and occlusal therapy for this periodontally compromised patient has led to a good course for more than 5 years since the final restoration.
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Severe periodontal disease often leads to tooth loss, necessitating prosthetic rehabilitation to restore function and aesthetics. The concept of perio-prosthetic treatment using extensive bridges of cross-arch design was introduced approximately 30 years ago. Long term follow-up studies have shown that teeth with reduced periodontal support can be used as abutments for extensive fixed prostheses, provided periodontal disease has been treated successfully, and an effective recall programme has been instituted to prevent periodontal disease recurrence. Low complication rates have been reported with these extensive constructions.
To review the clinical literature on fixed partial denture (FPD) and removable partial denture (RPD)treatment for periodontally compromised patients with partial dentate. In addition, prosthodontic management in periodontitis-susceptible subjects was evaluated from the results of Part 1 and Part 2.
Clinical studies that documented survival rates of FPD in periodontally compromised patients were selected and reviewed.
There was no RPD study that fulfilled the criteria of this review paper. On the other hand, 8 reports that were reviewed in this study showed good survival rate of FPD in long-term clinical results.
Since the number of reports on RPD is very few, it was difficult to evaluate the RPD treatment for periodontally compromised patients. From the results of some long-term follow-up retrospective studies, however, it was suggested that FPD of high-risk design showed excellent results. Regarding management in periodontits- susceptible subjects, it should be discussed whether positive prosthodontic treatment is necessary. Strict plaque control by both doctors and patients before/after treatment is indispensable for prosthodontic management in periodontally compromised patients.