In this series of articles I'll be discussing a specific case as I complete it. This patient is congenitally missing her lower centrals and it's time to replace a 30-year-old bridge. We talked about all of the options, including a block graft to create bone for an implant. After discussing the risks and benefits of doing an implant versus a bridge, she opted for the fixed bridge.

There are several issues here:

  • Loss of attachment on the abutments

  • Abrasive lesions at the cervical of 23 and other teeth in the arch

  • Pathway wear manifested by wear on the facials of the lower anteriors


Pathway wear occurs when there is inadequate overjet and the bite is "locked in." Overjet can be increased several ways:

  • Open VDO

  • Thin the facial of the lower anteriors and the palatal of the upper anteriors

  • Move anterior teeth orthodontically

  • Orthognathic surgery in the instance of skeletal issues


In this case, the entire upper arch is to be restored and it was easy to open the bite to create more overjet. The other pressing issue is the lack of attached tissue on the facial of the laterals.

Planning for the case mandates a diagnostic wax-up. Notice that the gingival levels have been waxed in to the CEJ of the lateral incisors. The treatment sequence will be used to provisionalize the bridge prior to grafting. This will give the periodontist the exact location of the final restorations and allow him to graft to that level.



The provisional includes placing the margin of the pontic at the approximate location of the final restoration as well. In this case, notice the mucosa is almost to the crest of the attached tissue. The surgeon will thicken the facial attached tissue so a well-formed ovate pontic can be fabricated.

 

Learn more about techniques relating to esthetics and treatment planning, as well as, occlusion and wear from the Spear Digital Suite.
View the free lesson: Bite Records in Restorative Dentistry.