ORAL IMPLANTOLOGY
Figure 1. C.M. (male, 50):
a, b) radiographic appearance of localized severe periodontitis 11, 42, 41, 31, 32, also apical periodontitis 42, 32;
c) clinical presentation after extraction of hopeless teeth and completing initial therapy;
d) upper and lower interim removable partial dentures for edentulous spaces 11, 42, 41, 31, 32;
e) radiographic appearance after implant placement 11;
f) radiographic appearance after implant placement 42, 32
oral evaluation, photographs, and impressions
for diagnostic casts, the patient was referred to
the Department of Graduate Periodontics at the
UNC School of Dentistry. Following extraction of
hopeless teeth (11, 42, 41, 31, 32) and completion
of the initial therapy the patient returned to
the Prosthodontics Department for restorative
treatment options (Fig 1 c). Interim removable
partial dentures were fabricated (Fig. 1 d) for the
healing phase, while the patient was presented
with several treatment options from removable
prosthodontics to fixed partial dentures and
implant supported restorations. The patient
elected to have a number of posterior crowns with
questionable prognosis being remade. As for the
edentulous spaces, he decided to go for implant
supported crowns/fixed prosthodontics.
The patient returned to the Department of
Periodontics to have implants placed into the
following positions: 11 Straumann tissue level
Regular Neck (internal connection) - (Fig 1 e);
42 and 32 Straumann tissue level Narrow Neck
(external hex connection) – (Fig 1 f).
After implants placement, abutments selection/
fabrication (Fig. 2 a, b), and impressions the patient
abruptly asked to be reassigned to a different
provider within the Department of Graduate
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Prosthodontics. We received the lab work (Fig.2
c, d) and saw the patient at delivery appointment,
when he appeared satisfied with the outcome
and after examining the restorations in the
mirror consented to final cementation (Fig. 2 e).
At that time we delivered a number of posterior
porcelain fused to metal crowns (PFMs) along
with implant supported PFM crown on 11 and
implant supported fixed partial denture (FPD)
from 32 to 42.
In a matter of weeks the patient returned
complaining about the shape of the lower FPD:
“the bridge is off the tract”, the way it is touching
the tongue and the lower lip is not comfortable,
there are “too big gaps between the bridge/crown
and original teeth”, “food scraps are collected
in the spot”, “I cannot talk with someone else at
lunch or dinner”, it does not look natural. It was
immediately clear that the restoration was not
accepted anymore, so we removed it and what
followed was a series of provisional restorations
as we tried different morphologies with more or
less prominent cingulums, various curvatures,
and different bucco-lingual thicknesses, but after
another couple of months in the business, there
was still no acceptance of our designs. During this
time, Mr. CM provided us with several drawings of
STOMA.EDUJ (2014) 1 (2)