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Table of Contents
CASE REPORT
Year : 2021  |  Volume : 8  |  Issue : 3  |  Page : 85-87

Anterior esthetic rehabilitation using a casted palatal loop connector


1 Post Graduate Student, Department of Prosthodontics, Government Dental College and Hospital, Nagpur, Maharashtra, India
2 Professor and Head, Department of Prosthodontics, Government Dental College and Hospital, Nagpur, Maharashtra, India
3 Associate Professor, Department of Prosthodontics, Government Dental College and Hospital, Nagpur, Maharashtra, India

Date of Submission18-May-2021
Date of Acceptance04-Jun-2021
Date of Web Publication27-Jul-2021

Correspondence Address:
Dr. Pronoy Mukhopadhyay
Department of Prosthodontics, Government Dental College and Hospital, Medical Square, Nagpur - 440 003, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpcdr.ijpcdr_18_21

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  Abstract 


This article aims to demonstrate an esthetic rehabilitation of the anterior teeth region with increased prosthetic space with a fixed prosthesis without compromising esthetic proportions. In cases where excess pontic space is present, the use of a conventional prosthesis would jeopardize the esthetic proportions to maintain the integrity of the prosthesis. A loop connector, which is usually a spring cantilever connector system, can be advocated in such cases to re-establish form without obliterating preexisting spaces or diastema. This case report demonstrates prosthetic rehabilitation of a missing anterior tooth in a 37-year-old female patient with an increased pontic space using a loop connector system that takes bilateral support to better support the prosthesis functionally from the abutments and the palatal tissues that it is rested upon in close adaptation with. In situations that pose constraints in placing an isolated implant-supported prosthesis, a loop connector fixed prosthesis is warranted, to maintain spaces around the pontic that would not compromise with the esthetics and even mechanically sustain well.

Keywords: Esthetics, fixed dental prosthesis, loop connector


How to cite this article:
Mukhopadhyay P, Khalikar A, Wankhade S, Deogade S. Anterior esthetic rehabilitation using a casted palatal loop connector. Int J Prev Clin Dent Res 2021;8:85-7

How to cite this URL:
Mukhopadhyay P, Khalikar A, Wankhade S, Deogade S. Anterior esthetic rehabilitation using a casted palatal loop connector. Int J Prev Clin Dent Res [serial online] 2021 [cited 2021 Nov 29];8:85-7. Available from: https://www.ijpcdr.org/text.asp?2021/8/3/85/322478




  Introduction Top


The oral cavity is a dynamic environment where the absence of a tooth is usually followed by migratory movements of the adjacent and opposing teeth to fill in for the space lost. These movements over a long term may create functional issues of the stomatognathic system as a whole and thus warrant replacement.[1] The choice of prosthetic options is multitude and specific situations ask for specific treatment strategies.

When there is a widespread loss of teeth and subjacent hard and soft tissue, the use of removable prosthetics is indicated that takes better support from the underlying mucosa rather than the adjacent teeth.[2] For fixed prosthetic replacement, the condition of the abutments in question must be thoroughly evaluated under three very specific criteria, namely crown: root ratio, pericemental area of the abutments involved, and the root configuration.[1] A situation further complicated by an excess pontic space requires considerations of the esthetic proportions while rehabilitating in the anterior region, and warrants the use of a specialized connector system that would both rehabilitate the prosthetic space proportionally and maintain the mechanical integrity of the prosthesis for long-term use.[3] This case report specifically utilizes the palatal loop connector system for the esthetic rehabilitation of the anterior region and brings about the utilization and specific indication of such specialized strategies opted for fixed prosthetic treatment.


  Case Report Top


A 37-year-old female patient was referred to the department of prosthodontics for the esthetic rehabilitation of her anterior tooth region. The patient's chief complaint was a poor facial appearance due to a missing front tooth that she lost in a road traffic accident 3 months prior. On examination, it was reported that she had a missing maxillary right central incisor, a fractured maxillary right lateral incisor and a discolored maxillary left central incisor, both of which were root canal treated, and an Ellis Class II fracture in the maxillary left lateral incisor which was evaluated endodontically to be vital with no signs of pulp hyperemia or concussion [Figure 1]. On further investigation, it was found that before the accident, she had a full complement of teeth with spacings in the front tooth region which she wished to be restored exactly like before she lost her tooth. The patient explained all possible treatment strategies with the mechanical and economic benefits weighed in. The patient insisted on a fixed prosthetic strategy but was not willing to opt for dental implant therapy due to economic constraints. With all possible considerations kept in mind, a 3-unit fixed dental prosthesis with a palatally oriented loop connector was planned.
Figure 1: Pre-Operative View (a) Frontal View (b) Occlusal view

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  Treatment Strategy Top


The abutments were first radiographically evaluated for adequate endodontic treatment, crestal bone levels, and root configurations. The maxillary right lateral incisor required a post endodontic restoration for which post space preparation was done with sequential use of Peeso reamers to a depth that provided a 4-mm apical seal. The post space was thoroughly cleaned and rinsed off any excess sealer, followed by etching using 37% phosphoric acid and application of bonding agent and its subsequent light curing. A fiber post was treated with bonding agent and then luted into the post space using dual-cure resin cement which was then light cured [Figure 2]a. This was followed by core buildup and tooth preparation of the maxillary right central incisor as well, to receive a porcelain-fused-to-metal retainer with equigingival shoulder margins [Figure 2]b. A gingival retraction cord was packed and impression made using polyvinyl siloxane impression material using the “one-stage putty-wash” technique. Removable dies were made from the poured impression and a pattern fabricated using inlay wax over the retainers and pontic which were connected with palatal loops using 14-gauge round inlay sticks. The loops were designed away from the rugae to prevent any speech impediments and closely adapted to the soft tissues for additional framework support. The pattern was casted conventionally, and a metal trial done intraorally to check for the framework fit and palatal adaptation of the loops [Figure 3]. This was followed by appropriate shade selection in available natural light, and ceramic sintering over the metal framework. A bisque trial was done for esthetic and occlusal evaluation followed by glazing of the sintered porcelain. The finished final prosthesis was cemented using Type I glass-ionomer cement. The left lateral incisor was then restored in proportion to the prosthetically restored right lateral incisor with shade-matched composite resin using the lingual index technique [Figure 4] for final anterior rehabilitation].
Figure 2: (a) Post and core buildup done, (b) Tooth preparation done

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Figure 3: (a)Metaltrialcheckedoverworkingcast,(b)Metaltrialdoneintraorally

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Figure 4: FinalProsthesisCementeda)Frontalview,b)OcclusalView

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  Discussion Top


Restoring anterior teeth warrants the proper contouring of the prosthesis, so they are esthetically proportionate and in harmonious relation with the adjacent soft and hard tissues.[4] A connector is defined as the component that joins the pontic to the retainer.[5] A palatal loop connector is classified as a form of spring cantilever connector system that takes its support from the palatal tissues that it rests upon. It is indicated in cases with an excess pontic space, to prosthetically restore with a diastema or spacing intact.[3] The removable prosthetic option was dropped since the patient was not comfortable with the idea of one and the implant prosthetic option was ruled out on account of financial and temporal constraints. Designing the loop connector involves fabricating a pattern using sprue wax of a circular cross-section or from a platinum–gold–palladium alloy wire adapted and soldered to metal copings.[6] The strength and longevity depend on the thickness and length of the connector. Interferences to the tongue can be mitigated by designing the connectors away from the rugae while materials with higher yield strength might assist in adding to the rigidity of the connector.[7],[8]


  Conclusion Top


A fixed dental prosthesis with a loop connector provides for esthetics and function, by additionally maintaining the prosthetic space to preserve any preexisting spacings or diastema that either the patient demands or the excess pontic space warrants. They adequately restore the form without compromising the esthetic outcome.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shillingburg HT, Sather DA, Wilson EL, Cain JR, Mitchell DL, Blanco LJ, et al. Fundamentals of Fixed Prosthodontics. 4th ed. Chicago: Quintessence Publishing Co Inc.,; 2012. p. 81-96.  Back to cited text no. 1
    
2.
Rosenstiel S, Land M, Fujimoto J. Contemporary Fixed Prosthodontics. 5th ed. St. Louis, Mo: Mosby; 2016. p. 70-92.  Back to cited text no. 2
    
3.
Nayar S, Jayesh R, Venkateshwaran, Dinakarsamy V. Loop connectors in dentogenic diastema. J Pharm Bioallied Sci 2015;7:S279-81.  Back to cited text no. 3
    
4.
Levin EI. Dental esthetics and the golden proportion. J Prosthet Dent 1978;40:244-52.  Back to cited text no. 4
    
5.
The Glossary of Prosthodontic Terms: Ninth Edition. J Prosthet Dent 2017;117:e1-105.  Back to cited text no. 5
    
6.
Kamalakanth S, Arbaz S. Anterior loop connector fixed partial denture: A simple solution to a complex prosthodontic dilemma. J Indian Prosthodont Soc 2008;8:162-4.  Back to cited text no. 6
    
7.
Taggart JA. Resin bonded spring cantilever bridge. Restorative Dent 1990;6:4-5.  Back to cited text no. 7
    
8.
Plengsombut K, Brewer JD, Monaco EA Jr., Davis EL. Effect of two connector designs on the fracture resistance of all-ceramic core materials for fixed dental prostheses. J Prosthet Dent 2009;101:166-73.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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   Abstract
  Introduction
  Case Report
  Treatment Strategy
  Discussion
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   References
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