Clinical Case Report: Bridge to Nowhere
providing all her maxillary posterior support that were failing due to being periodontally involved with periapical radiolucent lesions.
Dane C. Risinger, DDS Bonita A. Wynkoop, RDH, DDS, TTS Alba N. Dugarte, DDS, MSD Ben F. Warner, DDS, MD, MS Houston, Texas
Introduction Prosthodontic limitations for patients, whether financial or functional, often guide treatment plans. Patients routinely present with the need for endodontic therapy, full coverage restorations, and extractions. It is the responsibility of the dentist to restore function to patients that present with these needs. In select cases, flexible base partial dentures (Valplast) are indicated to restore edentulous spaces for patients that are not good candidates for standard acrylic removable partial dentures.1 Patient History Ms. R, a 63yr. old female presented to the UTHealth School of Dentistry at Houston (UTSD) for comprehensive treatment. Her chief complaint was restoring a premolar due to previous endodontic therapy. After a review of the initial full mouth series of radiographs, many more dental issues were noted. The patient had a medical history significant for an ischemic stroke over a decade ago, type II diabetes, and hypertension. All of her medical conditions are currently well controlled with medications prescribed by her physician. At the end of her treatment plan, the patient was diagnosed with breast cancer and underwent partial mastectomy surgery. The patient began radiation therapy shortly after her dental treatment was completed.
Figure 1. Maxillary Periapical Radiographs and Bitewing Radiographs
Dental Needs
Ms. R presented to UTSD seeking dental care due to previous negative experiences elsewhere. Unfortunately, the progression of her treatment changed due to COVID-19 restrictions (emergency care only) and patient fears of seeking treatment. The periapical infections around her bridge abutments (Figure 1) worsened and led to excruciating pain which limited her function. During the beginning of COVID, UTSD was restricted to providing emergency care only. Due to pain and infection, Ms. R had the abutment teeth of her maxillary bridges extracted and an immediate interim RPD delivered. Due to quarantine, social distancing, and the mask mandate, Ms. R did not wear the interim partial often.
When the patient presented to UTSD in 2019 she had multiple failing dental restorations including crowns, bridges, direct composites, and endodontic therapy. On her maxillary arch, the patient presented with bilateral fixed bridges
The Importance of Posterior Support Once routine dental care was allowed to resume at UTSD in August of 2021, Ms. R returned for comprehensive care. Before getting her caries under control, her existing ceramic crown on #8
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