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24 RESTORATIVE Dental Tribune Middle East & Africa Edition | 2/2017 Advanced Restorative Techniques And The Full Mouth Reconstruction - The Periodontal Prosthesis. Part 8 By Prof. Paul Tipton, UK Introduction The periodontal prosthesis or as its also commonly known the Lindhe / Nyman bridge is a technique devel- oped by the two leading periodon- tists of the 1970’s, Jan Lindhe and Stu Nyman in Gothenburg. Their technique allows multiple pontic re- placement in fixed bridgework often on severely mobile, compromised and reduced number of abutment teeth. The science is overwhelmingly in favour of this type of bridge in cer- tain situations where conventional dentures and implants are not pos- sible for whatever reasons. The technique relies on good oral hygiene, a reduced but healthy periodontal condition, multiple cantilevers often with three pontics cantilevered off the last remaining abutment, supra gingival margins, acrylic or composite veneering ma- terial on a metal framework and with a balanced form of occlusion (with non-working side interferences de- liberately placed). In effect the bridgework acts as a “living denture” and the balanced occlusion stabilizes the mobile bridgework. This type of bridge has increased but not increasing mobil- ity and excellent long term success rates. Bridge design can vary from end abutment bridges to cantile- vered bridges and often with a 12 unit bridge supported only by two mobile canine abutments. Clinical Studies The clinical studies date back to arti- cles published in the Journal of Perio- dontology in April 1979. The material consisted of 299 individuals (aged 23-72) years, mean age 48.7 years) who during the period 1969 to 1973 were referred to the Department of Periodontology, University of Goth- enburg, for periodontal treatment. The limiting criterion for acceptance of patients for this study was that their dentition had lost 50% or more of the periodontal tissue support. In addition, they had to be (i) willing to accept periodontal treatment includ- ing tooth extractions, periodontal surgery and, if indicated, prosthetic treatment, (ii) capable of maintain- ing optimal plaque control and, (iii) willing to appear for regular appoint- ments for additional maintenance care. Forty-eight of these patients (22 males and 26 females), namely those who still 8 years following initial treatment participated in the controlled oral hygiene program and appeared at the 8-year follow-up reexamination constituted the “non- bridge treatment group” (Group I). played at the initial examination a similar degree of periodontal disease as the patients of Group I but, in ad- dition, the breakdown of the peri- odontal tissues around certain teeth had reached a level where tooth ex- tractions and subsequent prosthetic replacement were required. Out of these 251 individuals, every fifth (in consecutive order according to date of commencement of treatment), i.e. in all 50 patients, were selected to form the “bridge treatment group” (Group II). In these 50 patients, 74 fixed bridges were placed. According to the design of the bridgework “the The remaining 251 patients dis- ÿPage 26 Figure 1: Initial smile Figure 4: Lower arch Figure 2: Inter-cuspal position Figure 3: Upper arch Figure 5: Upper diagnostic wax-up Figure 6: Lower diagnostic wax-up Figure 7: Upper prototypes Figure 8: Lower prototypes Figure 9: Tooth preparations Figure 10: Initial Impressions Figure 11: Upper silver dies Figure 12: Upper silver dies and duralay bonnets Figure 13: Lower silver dies Figure 14: Lower silver dies and duralay bonnets Figure 15: Upper duralay bonnets and coat-hanger wire Figure 16: Upper impregum pick up impression Figure 17: Lower duralay bonnets and coat-hanger wire Figure 18: Lower impregum pick up impression Figure 19: Upper master model Figure 20: Lower master model Figure 21: Facebow Figure 22: Cadiax recording of right lateral Figure 23: Cadiax recording of left lateral Figure 24: Fully adjustable articulator right-view