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Dental Tribune Middle East & Africa Edition | 2/2017 RESTORATIVE 27 ◊Page 26 Figure 33: Upper arch completed Figure 34: Lower arch completed Figure 35: Inter-cuspal position Figure 36: Final smile ments with the three cantilever units on the upper left hand side, and one cantilever on the upper right hand side (Fig. 33). In the lower jaw the bridge consisted of a 12 unit bridge on 7 mobile lower teeth with one cantilever each side (Fig 34). The final result can be seen in Figs. 35, and 36. Acknowledgements I would like to thank the following for help with this series of articles: • Dr Ibrahim Hussain, BDS, M.Med. Sci.Implantology – Implant Surgeon • Dr Andrew Watson, BDS, MSc, Spe- cialist in Endodontics • Dr Amit Patel, BDS, MSc, MClin- Dent, MFDS, RCSEd , MRD, RCSEng Specialist in Periodontics • Mr John Wilbberley- Dental Techni- cian- Waterside Dental Laboratory Lancashire Professor Paul Tipton BDS, MSc, DGDP RCS (UK) DENTAL SURGEON Visiting Professor of Restorative and Cosmetic Dentistry, City of London Dental School | www.colds.co.uk SPECIALIST IN PROSTHODONTICS | www.drpaultipton.co.uk T Clinic @ Manchester , London | www.tclinic.co.uk TIPTON TRAINING Ltd | www.tiptontraining.co.uk www.bard.uk.com President of the British Academy of Restorative Dentistry (BARD) in 26 out of the 332 bridges. These failures appeared as (1) loss of reten- tion of retainer crowns from abut- ment teeth in 11 bridges, (2) fracture of bridgework in seven bridges, and (3) fracture of abutment teeth in 8 bridges. All of these potential failures could be reduced by further adapta- tion of the bridge design and con- struction techniques. Case Study This lady was referred to me by her GDP from Birmingham with severe mobility of her remaining teeth, an inability to wear a partial denture, aversion to dental implants and a re- quest to fix her teeth (Figs. 1-4). On examination it was noted that there was grade 1 - 2+ on all of the teeth with a reduced periodontal support. After an initial phase of per- iodontal treatment including visits with both hygienist and periodontist she was declared sound and healthy but with increased mobility of her teeth. Her response to periodontal therapy indicated a likely success for a peri- odontal prosthesis type of bridge- work. Initial diagnostic work includ- ed full mouth diagnostic waxing and prototypes (Figs. 5-8). This was followed by initial tooth prepara- tions and fitting of the prototypes to try out the new aesthetics and func- tion. At a later stage further tooth preparations were completed and impressions taken using a polyvinyl siloxane material in a stock plastic tray (Figs. 9,10). As was indicated in the last article it is exceedingly difficult to take ac- curate impressions of mobile teeth. Hence the impressions were silver plated and silver dies prepared of the preparations in both the upper and lower jaws, and duralay bonnets fab- ricated (Figs. 11-14). At a second visit further impressions were completed by first placing the duralay bonnets on the teeth and then splinting them together with further duralay and coat-hanger wire using the “bead on technique” and then taking an over- all impregum location impression in a custom made tray (Figs. 15-18). Following this the silver dies were placed back into the impressions and further stone models poured to produce the highly accurate master models (Figs. 19,20). Occlusal records were taken by using a facebow, measuring the inter-con- dylar distance and a cadiax record- ing (Figs. 21-23) so as to programme the fully adjustable articulator (Figs 24, 25). Metal substrucures were then cast and tried in the mouth and the fit and accuracy verified (Fig. 26) Composite restorative material was veneered onto the metal subframes to produce the final definitive res- torations (Fig. 27, 28). Using the fully adjustable articulator a balanced form of occlusion was achieved by placing non working side interfenc- es. In Right Lateral exclusion this was achieved by guiding contacts on UL4, LL4 on the balancing side (Fig. 29), and with contacts on UR12345 and LR12345 on the working side (Fig. 30). Whilst moving into a left lateral excursion the balancing side guiding contacts were achieved on UR4 and LR5 (Fig. 31) and on the working side between UL123 and LL123 (Fig. 32). The restoration in the upper jaw was a 12 unit bridge on 6 mobile abut-