cone beam CE

cone beam1_2012 I case study_fixed partial denture 22 I Fig. 1b_As observed in this clinical intraoral image, all four mandibular incisor teeth are missing. Note the knife-edge shape of the gingival tissue in the area of the missing teeth. Fig. 2a_Three-dimensional CBCT based cross-sectional slices revealed the edentulous anterior section of the mandible from an entirely different perspective. Note the knife-edge shape of the alveolar crest. Fig. 2b_A closer look at the 3-D CBCT based cross-sectional slice revealed a very slim knife-edge shape, measuring infinitesimal bucco-lingually in the gingival region of the alveolar crest. Fig. 2c_The 3-D CBCT based cross-sectional slices also revealed anatomical variances in the lingual aspect of the anterior region of the mandible. andlong-termprognosis,andnottomentiontheas- sociated future clinical consequences, the ultimate treatment options will be discussed. _Treatment options CaseNo.1 Aremovablepartialdenturewithcastframework. Thisoptionisconsideredamongstthemostconserv- ative and reasonable options with the least amount ofriskstothepatientand/orwiththeleastamountof long-term associated clinical consequences. As described in a recent publication in the British Dental Journal,1 when defining the need for a RPD, dentists focused on the anatomical and physical properties whereas patients focused on cost and so- cial sense. The article concludes with the notion that furtherresearchontherelationshipbetweendenture use and social identity could be beneficial. Nevertheless, considering the age of the patient andtheassociatedsocialsense,plusthefactthatthe price tag in this case was irrelevant, other options were considered. CaseNo.2 A fixed partial denture extending from tooth #22 totooth#27.Again,historicallyspeakingthisoption was considered less conservative than a RPD and much more expensive. Furthermore, the long-term prognosis and the associated clinical consequences were substantially different. As recent as 2008, Dr. Gordon J. Christensen2 re- portedthatpatientsareinterestedtoknowhowlong a FPD is expected to last. According to Christensen, while studies’ estimates for service longevity vary fromafewyearsto20years,recurrentcarieswasthe most reported reason for failure. Now,thatplusthefactthataFPDextendingfrom tooth #22 to tooth #27 is considered a long span bridge, further compromises the long-term prog- nosis and the potential for associated future clinical consequences. CaseNo.3 Implants-supportedfixedpartialdentureextend- ing from tooth #21 to tooth #26. In this option the specific anatomical complexity and condition is very relevant. As can be seen in the 3-D CBCT-based cross- sectional slices in Figure 2a, the edentulous section of the alveolar crest in the anterior region of the mandible had a sharp knife-edge shaped ridge. Interestingly,the3-DCBCTbasedcross-sectional slices also revealed anatomical variances in the lin- Fig. 1b Fig. 2a Fig. 2b Fig. 2c