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A conservative approach in restoration with combination fixed partial

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 E-ISSN :0975-8437 P-ISSN: 2231-2285

CASE REPORT
A conservative approach in restoration with combination fixed partial denture: case report
Mansoor Shariff, Mohammed M Al-Moaleem, Syed Sadatullah, Abdorahman Aseri

ABSTRACT
Treatment of multiple partial edentulous spaces is always a challenge for dentists. This article reports the manange-
ment of a 45 yr old patient with multiple missing teeth with an inlay retained fixed partial denture combined with a full
crown preparation opposing a cast partial denture. A conventional cast partial denture was fabricated for the maxillary
arch and bilateral inlay retained fixed partial denture were considered for the mandibular arch. The prosthetic treatment
with fixed partial denture and cast partial denture improved subjective perception of facial aesthetics, psychological
status and social relations of the patient.
Key Words: Cast Partial Denture; Combined Bridge; Fiber Post; Inlay Retained Bridge

Introduction at College of Dentistry, King Khalid University, seeking arti-

ficial replacement of missing teeth. After a detailed history
Full mouth rehabilitation always demands careful attention

I N T E R N AT I O N A L J O U R N A L O F D E N TA L C L I N I C S
and screening of the case with intra oral examination and full
and meticulous treatment planning. It becomes more chal-
mouth radiograph, the patient was referred to the prosthetic
lenging with partial edentulism where bilateral segment is
department. The treatment started with extra-oral examina-
found missing. Successful restoration of partial edentulism
tion and intra oral charting, interpretation of periapical and
can be done with plenty of contemporary and conventional
panoramic radiographs (Figure 1). There were remaining roots
treatment modalities.1,2 This includes patients who have lost
in relation to 14, 15, 16, 24, 25, 26 and 38. Grossly destructed
either upper or lower posterior teeth, unilaterally or bilater-
35 had periapical radiolucency. Both the lower second molars
ally. In recent times implant prosthodontics has become the
were mesially inclined and had occlusal caries. Tooth number
choice of replacement of missing natural teeth. Implant thera-
36 and 46 were found missing. Maxillary and mandibular pri-
py has its limitation in relation to case selection and econom-
mary impressions were made for preparation of study casts.
ics. Conventional method of fabrication of removable partial
At this stage scaling, root planning and polishing were per-
denture continues to be an essential prosthetic consideration
formed and oral hygiene instructions given.
in these oral reconstructions, especially when implant therapy
is not a possibility.3 Subsequently extraction of remaining roots of teeth number
14, 15, 16, 24, 25 and 26 and 38 were done. In the following
For many years, the only prosthetic application used to deal
appointment teeth number 17 and 27 were restored with
with cases for single missing tooth was a fixed partial denture,
composite. The restored teeth served as abutments for a cast
however, the preparation of two teeth required for correcting
partial denture. The next phase was mouth preparation and
a single tooth deficiency causes unnecessary dental tissue
maxillary final impression using double mixing technique for
loss.4 Full-coverage metal–ceramic fixed partial dentures are
the cast partial denture. The metal frame work try-in, inter-oc-
still viewed as a standard for tooth replacement, event though
clusal registration with occlusal rims and teeth shade selection
they exhibit relative disadvantages like decreased capacity of
were done in the same visit. A try in of the cast partial denture
retention, associated soft-tissue pigmentation and an opaque-
was done. After acrylization the processed cast partial denture
to-darkish discoloration in the cervical area of the abutment
was delivered with post-insertion instructions (Figure 2,3).

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teeth.5 Minimal preparations bridges are a good alternative to

2014 Volume 6 Issue 1

conventional types because they are less expensive and allow
greater preservation of tooth structure with easy periodontal
assessment.6
Inlay retained fixed partial dentures are indicated in the pres-
ence of amalgam restoration or caries in abutment teeth adja-
cent to edentulous space with opposing artificial teeth.7 They
are also indicated when there is slight drifting of abutment
teeth with absence of heavy forces from opposing arch.8 A
Combination type of fixed partial denture prosthesis includes
a minimal or inlay bonded retainer in one of the abutment
teeth and a conventional cast preparation on the other.9,10 This
article presents a two year clinical performance of an inlay re-
tained fixed partial denture combined with a full crown prepa-
ration opposing a cast partial denture.
Case report
A 45-year-old male patient reported to the Dental Hospital
The mandibular arch was restored in the following manner.
The first step involved endodontic treatment of tooth num-
ber 35 (Figure 4). Following root canal treatment the tooth
received fiber post and composite build up. Surgical crown
lengthening and gingival re-contouring was also performed
to improve esthetics.
Tooth number 35 was used as an abutment for a fixed partial
denture, which received a full porcelain fused to metal crown.
Tooth number 37 was used as the second abutment. Occlusal
caries were excavated and a cavity was prepared to receive an
inlay.A combination fixed partial denture with a full porcelain
fused metal crown for 35 and inlay for 37 was planned to re-
place the missing 36. After the preparation of abutments, final
impressions were made. Provisional crown for 35 and tempo-
rary restoration for 37 were cemented. Metal try-in was done
followed by tooth shade selection using the digital shade

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Shariff et al

cellent alternative to conventional retained full-coverage fixed

partial denture.6,7 In the same way inlay retained bridges with
adhesive cement performed proved to be an effective resto-
ration solution in missing posterior teeth. The single biggest
advantage of this treatment option was the preservation of
natural tooth structure.

Figure 1. Pre-operative Panoramic view, Figure 2. Cast Partial Den-

ture, Figure 3. Master cast after processing, Figure 4. Periapical radio-
graph post endodontic treatment 35, Figure 5. A combination bridge
in third quadrant- Metal try-in, Figure 6. Post cementation, Figure 7.
Inlay retained bridge in fourth quadrant - Frame work in master cast,
Figure 8. Metal try-in, Figure 9. Post cementation, Figure 10. Post-op-
erative Prosthesis, Figure 11. Post-operative panoramic radiograph.
guide VITA System 3D-Master. Porcelain build-up and try-in
allowing adjustment of occlusion, during centric and eccen-
2014 Volume 6 Issue 1
Inlay retained bridges are considered good alternative to con-
ventional bridges, as they are less expensive, less destructive
to abutment teeth and allow easier periodontal health assess-
ment. The concept of maximum conservation of tooth struc-
ture involving box-shape proximal preparation to the abut-
ment was chosen for this patient. The walls of the cavity were
flared between 50 to 150 with rounded internal angles. The de-
cision to restore the teeth with inlay fixed partial denture was
primarily influenced by size of the carious defect.11 Pre-exist-

tric movements was carefully done. Finally the glazed bridge

ing fillings minimize the need to remove tooth structure and
was cemented with resin cement following the manufacturer
promote retention of the inlay-retained fixed partial denture
instructions (Figure 5,6).
and reduce the heavy forces from opposing teeth.7,8
The fourth step of the treatment involved the preparation of
The case was followed up for two years for maintenance. Pa-
inlays for fixed partial denture in the mandibular quadrant.
tient’s cooperation in following oral hygiene instruction and
Both the abutments in this quadrant had occlusal caries with
keeping up with the appointments was satisfactory. Post-op-
minimal drifting. The caries were excavated and cavities were
erative sensitivity, de-bonding of the inlay retainers and signs
prepared to receive inlays which to be the retainers for the
of secondary caries were evaluated during the follow up vis-
pontic. This was followed by final impressions and temporary
its. Marked improvement of oral hygiene, function along with
restorations. After routine metal try-in and remaining steps of
self perceived satisfaction and positive psychological status
bridge construction the inlay retained fixed partial denture
were reported. This was similar to the observations made by
was cemented (Figure 7-9). Post-operative panoramic radio-
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Cenci et al,12 and Jevremovic et al.13 Prosthodontic treatment

graphic was taken after complete oral rehabilitation of the
I N T E R N AT I O N A L J O U R N A L O F D E N TA L C L I N I C S

is known to improve the oral and psychological health of the

patient. The patient was then followed-up for maintenance
appointments at 36, 12 and 24 months (Figure 10,11).
Discussion
When the needs of the patient have been identified and ap-
propriate corrective measures determined, a logical sequence
of treatment steps must be decided on. The steps should ad-
dress the symptoms, stabilization of deteriorating condition,
definitive therapy and a program of follow-up.10 Careful plan-
ning is considered crucial, especially when a combination of
cast partial denture, and fixed partial denture are planned in
opposing arches. In this case, after carefully recording patients’
complain the possible treatment options were discussed. The
number of patient visits, laboratory steps involved and the
overall time required for completing the oral rehabilitation
process was clearly explained after studying mounted study
casts and radiographic interpretation of oral structures.
Starting the treatment with periodontal therapy was preferred
prior to extraction of remaining roots. A trial maxillary den-
ture is normally fabricated with a mandibular fixed prosthesis
prior to replacing it with a cast partial denture. This facilitates
effective intercuspation of upper and lower teeth and a well
aligned occlusal plane.10 The fabrication of cast partial denture
alongside the endodontic treatment of the abutment resulted
in maintaining the vertical dimension.
When abutment teeth have previously been restored, inlay re-
tained prosthesis based on an adhesive approach offer an ex-
patient.14
Conclusion
In this case report we reiterate that bilateral inlay retained
fixed partial dentures are an excellent conservative choice of
treatment in the presence of occlusal caries or restorations on
both abutment teeth. However, a combination of full crown
and inlay retained fixed partial denture should be considered
as a good option if one of the abutments is endodontically
treated. It can be safely conveyed that both inlay retained and
combination of full crown and inlay retained fixed partial den-
tures are suitable in the presence of an opposing cast partial
denture.
Author Affiliations
1. Mansoor Shariff, Assistant Professor, Prosthetic Department, Col-
lege of Dentistry, King Khalid University, Abha ,Saudi Arabia, 2. Mo-
hammed M Al-Moaleem, BDS, MSc, PhD, Assistant Professor, Pros-
thetic Department, College of Dentistry, Jazan University, Jazan
,Saudi Arabia , 3. Syed Sadatullah, Assistant Professor, Dept. of Max-
illofacial Surgery and Diagnostic Sciences, College of Dentistry, King
Khalid University, Abha, Saudi Arabia, 4. Abdorahman Aseri, Demon-
strator, Department of Preventive Dental Sciences, University of Na-
jran, Najran, Saudi Arabia.
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How cite this article
I N T E R N AT I O N A L J O U R N A L O F D E N TA L C L I N I C S
Shariff M, Al-Moaleem MM, Sadatullah S, Aseri A. A conservative ap-
proach in restoration with combination fixed partial denture: case
report . International Journal of Dental Clinics. 2014;6(1):23-25.
Address fro Correspondence
Dr. Mohammed M Al-Moaleem BDS, MSc, PhD,
Department of Prosthodontics,
College of Dentistry, Jazan University,
Kingdom of Saudia Arabia
Email: drmoaleem2014@gmail.com
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2014 Volume 6 Issue 1
Source of Support: Nil
Conflict of Interest: None Declared
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