LONG-TERM TEMPORARY BRIDGE
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SMILE MAKEOVER
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| BEFORE |
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AFTER |
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| Before (Nov.19/04)
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After (Feb.1/05)
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| Patient was unhappy with a previous removable,
upper partial denture. He came to me requesting that I fix his teeth and
replace the missing ones with something that is not removable. Initially,
I said, “ NO. Your remaining teeth are loose and not sufficient
in number to expect a good long-term result from a fixed (non-removable)
bridge. You should have dental implants placed into the bone. These implants
will then give you the good support for any fixed bridge you want.”
With further discussion, we agreed to make a temporary acrylic bridge
supported by 5 teeth, if the patient would allow me to do periodontal
surgery to reduce uncleansable periodontal pockets where bone loss was
occurring and contributing to the mobility of teeth. The bridge would
provide cross-arch stabilization to reduce mobility of individual teeth.
Root canal treatment would also be needed to eliminate any sensitivity
of exposed roots, and allow me to cut the teeth adequately to fit the
bridge.
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3 teeth were extracted, and
5 teeth were prepared to receive the long-term, temporary bridge. This
preparation included, root canal treatment, periodontal surgery, cast
metal post-core in tooth 1.3, composite resin cores in 1.6, 2.3, 2.5,
& 2.6, and shaping each of the 5 teeth to receive the bridge. Note
how well the gingiva is healing. Temporary acrylic bridge has been removed.
The long-term temporary bridge is about to be cemented. |
| Before
(Nov.19/04) |
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After (Feb.1/05) |
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| Note the calculus and stain on the lower
teeth. Upper right cuspid (1.3) has caries into the pulp, but a long root
with adequate bone support. The position of the upper right central incisor
distant from the midline papilla, and its reduced bone support, made it
an appropriate candidate for extraction. Aesthetically, we will be better
able to position all the new incisors without 1.1 present.
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The dental hygienist cleaned the teeth on
Dec.16/04 and the patient improved his oral hygiene. The lower teeth and
gums look so much better. The upper temporary acrylic bridge is about
to be removed. |
| During
(Jan.13/05) |
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During
(Dec. 22/04) |
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| Cast metal post-core is about
to be cemented into 1.3. On Dec.1/04, in one long appointment, the upper
right was treated. 1.7 was extracted. Periodontal surgery was done for
1.8, 1.6, & 1.3. 1.8 was treated with a deep, occlusal composite resin
restoration. (HealOzone did not become available in my office until Dec.7/04.)
Root canal treatment was done for 1.6 & 1.3. On Dec. 3, root canal
treatment was done for 2.3 & 2.5. On Dec.15, 2.7 was extracted, periodontal
surgery was done for 2.8, 2.6, 2.5, & 2.3, and root canal treatment
was done for 2.6.
On Dec.22, patient was having significant soreness from palatal surgical
sites. Ozone was applied for 40 seconds to each of 3 sites (palatal side
of 2.6, of 2.5, & between 2.5 and 2.3). This produced instant reduction
in soreness, and the sites continued to heal uneventfully.
On Dec. 28, 1.1 was extracted, 5 teeth were shaped, and temporary acrylic
bridge was fitted.
On Dec. 29, composite resin cores were placed in 1.6, 2.3, 2.5, &
2.6.
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Blue block-out resin is temporarily in place
to deliver ozone between and palatal to 2.3 and 2.5. A rubber cup from the
HealOzone handpiece will fit over the circular opening to deliver ozone
for 40 seconds. This was already done today for the more posterior surgical
sites on the left side, with other block-out resin scaffoldings. (This was
my first month of using the HealOzone. Now I would use an impression technique
to apply the ozone to the larger area at one time, and not bother with 3
separate block-out resin applications. |
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| Long-term temporary bridge was made with
non-precious metal, covered with acrylic and denture teeth, at minimal cost.
(The “permanent” bridge would usually be made with precious
metal and custom-made porcelain for each tooth, at a much higher cost.)
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Exposed occlusal metal
supports the occlusion at centric relation position. |
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After (Feb.1/05) |
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Anterior view shows 5 prepared teeth, ready to
receive the long-term, temporary bridge. Upper wisdom teeth 1.8 and 2.8
are still present at the back. |
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After (Feb.1/05) |
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Long-term temporary bridge cemented
On June 17/05, patient was still comfortable and pleased with the bridge |
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Treatment
by Dr. Mel Perlmutter & Talisman Dental Laboratory |
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