POST-CORE RETAINED TOOTH-SUPPORTED MAXILLARY FIXED DENTAL PROSTHESIS: A CASE REPORT

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1 Original Article POST-CORE RETAINED TOOTH-SUPPORTED MAXILLARY FIXED DENTAL PROSTHESIS: A CASE REPORT SUMMARY 1 MOHAMMED RAFIQUE MOOSA 2 KASHIF IKRAM 3 ZAHID AKHTER A female of 52 years age was complaining about aesthetics, mastication and speech. Clinical examination revealed advanced wear in maxillary anterior teeth. Orthopantomograph showed healthy alveolar bone and ridges. Post-retained fixed prosthesis was provided as method of rehabilitation. This case report describes the details of prosthesis that enhanced the aesthetics and improved mastication. Key Words: Post-retained fixed dental prosthesis, Root canal therapy, Metal-ceramic fixed prosthesis, oral rehabilitation. INTRODUCTION Prosthesis are used for different dental treatments to rehabilitate jaw, chewing ability, to improve aesthetics and speech. A dental prosthesis may be luted, screwed or mechanically attached to natural teeth. 1 A fixed or removable appliance used to replace one or more loose or missing natural teeth. 2 Edentulism is a debilitating and irreversible condition and is described as the final marker of disease burden for oral health. 3,4 Many dental professionals will agree that cement-retained crowns or screw-retained crowns are a necessity for multiple units. 6 Individual philosophy plays a huge role. 7 The goal of dentistry is for patients to keep all of their teeth throughout their lives in health and comfort. 8 It is the dentist s responsibility to help the patient take decisions on the options available, based on their unique situation and circumstances. 9 CASE REPORT Oral examination: Gingiva and ridges were found healthy. In maxilla, eight teeth were present out of sixteen. Upper right central and canine were carious. On same side lateral second premolar and molar had broken down roots. Left central, lateral and canine showed attrition. Left upper 2nd molar was grossly 1 Dr Mohammed Rafique Moosa, BDS, M.Phil, Assistant Professor, Baqai Dental College, Baqai Medical University, Near Toll Plaza, Karachi For Correspondence: SC-28, F-10, Jaffar Arcade-II, Chandi Chowk, Stadium Road, Karachi rafique.moosa@ live.com Cell: Dr Kashif Ikram, BDS, FDSRCS, FFDRCS, Principal Baqai Dental College, Baqai Medical University 3 Dr Zahid Akhter, BDS, MCPS, Associate Professor Received for Publication: February 15, 2017 First Revised: March 15, 2017 Second Revised: March 20, 2017 Approved: March 21, 2017 carious. In lower jaw, 12 teeth were present. The left upper second premolar canal was blocked (pulp stone). The upper right molar had broken down root. In the lower arch, both sides had sound premolars. First molars on both sides were missing. (Fig 1, 2, 3) Treatment plan Patient wanted to save remaining upper and lower teeth. All broken down roots were removed surgically. Those which could serve as abutments were endodonticaly treated. Post selection Prefabricated posts are available in different sizes and shapes: First step was to select the posts that best fitted in the canal. 12 Post system contains at least 6 different thicknesses and 3 different lengths. Moreover, the surface of the posts can be smooth or threaded 13 (in case of metal screw posts). Insertion of screw posts Purpose of the post is the retention of core and support of prosthesis. 14 Selected size of the 3 screw posts were in the canals. Cementation of the Post Composite or Glass Ionomer Type-II Thin mix of cement was coated around threaded portion of post, and also applied in the treated root canal. The post were gently inserted in the canal till the cement was set. Fig 8, 9,

2 Fig 1 Fig 7: Screw Post box Fig 2 Fig 3: OPG X-ray before treatment Fig 8: Posts in place Fig 9: View of core post cementation Fig 4: After Endodontic Treatment Fig 5 Fig 6: OPG of Root Canal Treatment Fig 10: After post cementation View of core 193

3 Fig 15 Fig 16 Fig 11: Alginate impression Fig 17 Fig 18 Fig 19 Fig 12, Fig 13, Fig 14: Metal frame is tried in and verified for fit Fig

4 After post is properly cemented into the root canal space, a core material, normally dental cement, is packed around the cervical post until the material is set. The core restoration replaces lost dentine, and provide internal support and retention for the crown and prosthesis also ensure resistance against cervical tooth fracture. Cementation of fixed bridge After confirmation of the patient s acceptance i.e, occlusion, lip support and teeth form and comfort, bridge fitting was done with care, as it acts as a barrier between microbes and restoration - seals the space between the tooth and restoration. The Bridge was seated by digital pressure and held firmly in place of prepared tooth and occlusion was rechecked. Fig DISCUSSION Esthetic dentistry has made great advancement in last two decades. Various materials and techniques have evolved lately. Advance research in Composite Resins and Ceramics has made the result more predictable. However, basic concepts of esthetics dentistry are often neglected and they compromise the results, jeopardizing the outcome of treatment. This clinical case relied on post and core tooth supported fixed prosthes was to establish vertical dimension of occlusion, in an uncomplicated manner with minimum patient discomfort. Oral hygiene maintenance and regular follow up of patients wearing Fixed Partial Dentures should be highlighted in order to ensure long term success of such prosthesis. 18 For many years, custom cast metal posts were considered the standard. Since many years cast metal posts have been a favorable choice as they require less chair time and were easily handled. It is important to consider the advantages and limitations of the screw-retained versus cemented prosthetic restorations. 19 The Bridge is more esthetic in certain circumstances, as in this case majority of teeth were lost in upper arch and the remaining teeth required strength which could either be provided by a screw post or an implant. The implant was not possible for this patient due to economical, lengthy and painful procedure. 20 The custom cast post and core system is still regarded as the restoration of choice for endodontically treated teeth when there is no coronal dentin. However the use of prefabricated post systems is better because all steps can be completed chair side and fair clinical success can be expected. Therefore using Screw-post retained Tooth supported fixed prosthesis is important in this scenario to influence the longevity of the treatment. 21 Many dentists are focusing on variety of implants but the screw post is easy to insert in root of the tooth, making it a less complicated procedure when compared with implant. It also prevents the stresses on alveolar ridge or saddle. 22 CONCLUSION The purpose of this clinical report was to document the screw post prosthesis approach for rehabilitation of a patient to provide the strength to remaining natural teeth. It has been reported and found previously through clinical research and practice that implants may be painful, costly and most importantly lengthy clinical procedure with more complications when compared with screw retained prosthesis. This case of screw retained prosthesis did not only rehabilitated the function but also improved the esthetic with less cost and time. Therefore without criticizing the importance of implant, it would be emphasized that in a case like this screw retained prosthesis is more advisable. ACKNOWLEDGEMENTS I would like to thank the following for their contributions: Baqai Madical University and Faculty of Baqai Dental College. I would also like to extend my thanks to the Principal of Baqai Dental College, Dr Kashif Ikram and the Head of Department Prosthodontics; Dr Zahid Akhter for their utmost support. A big thanks to Prof Dr Fazal Ghani for his motivation and support. I am extremely thankful to Professor Dr Shakila Nazir Ahmed who was there as a sincere advisor. I am also thankful to Dr Mujtaba Shaikh and Dr Rida Sohail for their contribution and help in editing the article. Lastly I wish to express thanks for the effort of my family in helping me achieve this. REFERENCES 1 Journal of prosthetic dentistry the academy of prosthodontics. Farrar device the fixed dental prosthesis.2005;(1);94: Mosby's Pocket Dictionary of Medicine, Nursing and Health Professions Elsevier Health Sciences Amazon.com. Elsevier/ Mosby; 2012; 7th edition Edward Brant et al. Bad teeth: Partial and denture diagnosis Prevention Treatment. Dental Health Network; 99D David A. Nash.Ethics, Empathy, and the Education of Dentists. Journal of Dental Education 2010;74: Raghavendra Reddy, Dr. Prafulla Thumati.Prosthodontic Rehabilitation of Different Clinical Situation International Journal of Scientific and Research Publications, 2014;4: Cecil Williams1, Manish Kumar2, Manas Bajpai3, Deshant Agarwal Prosthodontic Management of endodontically treated 195

5 teeth; international Journal of clinical preventive dentistry; 2014; 10.1: William Cheung, A review of the management of endodontically treated teeth Post, core and the final restoration. JADA,2005; Goga R1, Purton DG. The use of endodontically treated teeth as abutments for crowns, fixed partial dentures, or removable partial dentures: a literature review. Quintes sence Int. 2007;38(2): Nadia Zafar, Fazal Ghani, Common Post-fitting Complications in Tooth- supported Fixed-Fixed Design Metal-Ceramic Fixed Dental Prostheses;Pakistan Journal of Medical Sciences. (Bi-Monthly). Pak J Med Sci May-Jun; 30(3): Cabello G, González D, and G. Fábrega J. The Edentulous Maxillary Arch: A Novel Approach to Prosthetic Rehabilitation with Dental Implants, Based Upon the Combination of Optimum Mechanical ResourcesCabello et al., Dentistry 2014, 4:4. 11 V Vidyashree Nandini, K Vijay Venkatesh,1 and K Chandrasekharan Nair Alginate impressions: A practical perspective;journal conserv Dent.2008;11(1); S. Jivraj1, W Chee and P Corrado: Treatment planning of the edentulous maxi British Dental Journal:2006;20(01): Jefferson Ricardo Pereira1, Accácio Lins do Valle2, Talita Magro Juvêncio3, Thais Maria Freire Fernandes3, Janaina Salomon Ghizoni4, Marcus Vinícius de Reis Só5Effect of post length on endodontically treated teeth: fracture resistance Braz J Oral Sci, 2010;9(3): DNJ Ricketts, CME Tait and A J Higgins Post and core systems, refinements to tooth preparation and cementation British Dental Journal 2005;198: CONTRIBUTIONS BY AUTHORS 1 Mohammad Rafique Moosa: Principal author 2 Kashif Ikram: Helped in text correction and literature search 3 Zahid Akhter: Helped in overall arrangement 196