Case Report

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Full mouth rerestoration of partially

edentulous dentition: Aperiodontic,
endodontic, orthodontic and prosthodontic
interrelationship2year followup
Santhosh Kumar, G. Subraya Bhat, K. Mahalinga Bhat
Department of Periodontics, MCODS, Manipal University, Manipal, Udupi, Karnataka, India

Address for correspondence: Dr.Santhosh Kumar, Email:drsanthoshkumar@gmail.com

ABSTRACT
An interdisciplinary approach towards full mouth rerestoration of severely compromised dentition requires; complete
understanding of the patients problem through history and examination of the dentition. The treatment approach should begin
with an appropriate diagnosis and predictable prognosis sequencing it with specialty treatment to obtain a successful result.
This clinical case report describes the implementation of a diagnostically based treatment plan for treating the maxillary arch
with flap surgery and intrusion, partially edentulous mandibular arch treated by extracting the hopeless teeth and replacing
the missing with an overdenture. During follow-up esthetic management of the gingival recession with respect to upper right
central incisor was done using a subepithelial connective tissue graft procedure and paramount importance was placed on
supportive periodontal therapy during the followup period of 2years.

CLINICAL RELEVANCE TO INTERDISCIPLINARY DENTISTRY

The article describes an interdisciplinary approach for a successful implementation of interdisciplinary treatment to
resolve dental problems for an individual requiring full-mouth re-restoration.

Describes an unique way of restoring lost aesthetics and function.

Key words: Connective tissue, edentulous, graft, intrusion, recession

INTRODUCTION

he demands for treatment with fixed partial

prosthesis are increasing and it is essential
to replace the missing teeth as well as create a
biological balance between conjunct prosthesis and
prosthetic field. When the forces, which maintain
the tooth in position is changed trauma can occur.
Hence, it is necessary to create an occlusal field with
dentoperiosteal tolerance by realigning the migrated
teeth.
Pathological migration is defined as presence of a
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DOI:
10.4103/2229-5194.113265

developing diastema in the upper anterior sextant,

which was not present in the past or already existed
but increased.[1] The degree of migration will differ
from tooth to tooth, according to the periodontal
destruction and can also produce extrusion of the
teeth.[2] This can be treated by orthodontic intrusion.
There is histological evidence of new cementum and
collagen attachment formation following orthodontic
intrusion if good oral hygiene is maintained.[3]
In many partially edentulous situations implant
assisted prosthesis has become a modern treatment
of choice. But the combination of implant and fixed
restoration is difficult to implement.[4] Moreover, there
is a paucity of studies concerning the combination of
implants and removable partial dentures.

CASE REPORT
A 38yearold systemically healthy female patient visited

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Kumar, etal.: A multidisciplinary treatment for full mouth rerestoration

the dental clinic with a chief complaint of extruded upper

front teeth and missing lowerposterior teeth.
On intraoral hard tissue examination: Upper anterior teeth
and upperposterior teeth were extruded beyond the
line of occlusion with grade2 mobility.[5] The fixed partial
denture replacing the lower anterior was impinging the
labial marginal gingiva and the missing posteriors except
the 2ndmolars was replaced by an interim denture.

On completion of intrusion the lower fixed partial

denture[Figures4 and 5] was removed and the extractions
of the abutment teeth(32),(33),(42) and mobile left
first premolar(34) was done, remaining canine(43) and
the molars(37) and(47) were prepared for receiving
coping[Figure6]. Later partially edentulous arch was
replaced with an overdenture[Figure7].

Softtissue examination showed: Generalized bleeding

on probing. Upper anterior tooth (11) showed compound
pocket probing depth of 78mm. Millers ClassIII gingival
recession[6] of 23mm was noticed with respect to(16)
and(26)[Figures1 and 2].
Based on the examination the following treatment plan
was implemented:
Phase I therapy included supra gingival, sub gingival
scaling and root planning, local drug therapy, reevaluation
to be done after 15days. In the Phase II therapyopen
flap debridement for the pocket reduction in relation
to(11) and(21); extraction of the mobile lower anterior
and premolar after removal of the fixed partial denture.

Figure1: Preoperative anterior view

Root coverage with respect to(11), reevaluation of the

patient to be done after 15days, Maintenance phase
included recall and reevaluation in 3months. In the Phase
III therapyintrusion of the upper anterior and posteriors,
replacement of the lower with an overdenture and occlusal
bite equilibration, reevaluation was advised after every
month. Phase IV therapy included maintenance of the
dentition by recall and reevaluation after every 3months.

CLINICAL PROCEDURE
The patient was advised to take orthopantomogram
and intraoral periapical radiographs. Supragingival and
sub gingival scaling and root planning was completed.
Recall period was scheduled and local drug delivery
using tetracycline fiber(periodontal plusAB, Chennai,
Tamil Nadu, India) was planned after 1520days. After
3months of the initial therapy open flap debridement was
done due to the persistent pocket depth and BioGraft HT
(Betatricalcium phosphate)(IFGL Bioceramics, Kolkata,
West Bengal, India) was placed into the site.

Figure2: Intraoral periapical radiograph of 11 and 21

The patient was referred to the department of orthodontics

for intrusion of the upper teeth after a maintenance period
of 34months[Figure3]. The intrusion was done using
a fixed appliance with a Niti wire for arch alignment.
Stainless steel wire was used for the final adjustment. Slots
of 0.016 by 0.002 for the wire was used to stabilize the
tooth and for realigning the tooth to the arch.

Figure3: Orthodontic intrusion

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Kumar, etal.: A multidisciplinary treatment for full mouth rerestoration

During the recall visit after 23months the patient showed

a persistent sinus tract with respect to the upper(11).
Hence, the tooth underwent root canal therapy and
rescheduled for treatment of the recession. The recession

dimension was found out to be 5mm2.5mm. Classified

to be a Millers ClassIII recession. [6] Sub epithelial
connective tissue graft was harvested using a trap door
technique from the palatal donor site and transferred
into a pouch created at the recipient site.[Figure8].
Healing was uneventful. After 23weeks recall, 23mm
of attachment gain was noted.

Figure4: Intraoral periapical post orthodontic intrusion showing

radioopacity surrounding tooth suggestive of bone fill
Figure5: Preoperative partially edentulous lower arch

Figure6: After placement of the coping

Figure7: Post overdenture placement

Figure8: Connective tissue graft sutures at the recipient site

Figure9: Postoperative recall after 2years

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Kumar, etal.: A multidisciplinary treatment for full mouth rerestoration

an excellent treatment option for maintaining the

integrity of the alveolar ridge in an edentulous
patient.[10] Oral prophylaxis was performed at an interval
of 34weeks during the orthodontic treatment and at
an intervalof34months after the definitive prosthetic
replacement.

CONCLUSION

Figure10: Intraoral periapical after 2years showing improvement

in bone support

Two years followup after the procedure showed

acceptable change in the hardtissue and the softtissue
components. There was about 12.1% foreshortening of
the root of incisor which was within the acceptable range.
The patient was satisfied with the treatment done and
was extremely pleased with the overall appearance of the
dentition and its function[Figures9 and 10].

DISCUSSION
Patient with periodontitis or history of periodontitis
demonstrate a greater incidence of tooth migration
than teeth without bone loss due to reduced osseous
support.[1] Periodontal therapy is usually initiated(whether
nonsurgical or surgical) before repositioning the teeth
orthodontically.[3] Following the orthodontic therapy the
gingival recession persisted but the overall bone gain and
tooth contact improved.
The gingival recession on the incisor following the
intrusion was tr eated using Langer and Langer
technique. The subepithelial connective tissue graft, as
described by Langer and Langer predictably increased
root coverage of Miller ClassI and II recessions to more
than 90%.[7] The gingival esthetic treatment was done
only after the orthodontic procedures. In this study,
the association of the procedures can be suggested as
safe, predictable, and the final result was consistent with
scientific literature.[8,9]
Replacement of the missing teeth with an overdenture
overcomes the har mful consequences of wearing
conventional complete dentures. Due to its various
advantages, the tooth supported overdenture is

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A long range planning is required for periodontal

treatment. Its value to the patient is measured in years
of healthy functioning of the entire dentition. The health
of the dentition should not be compromised by a heroic
attempt to retain questionable teeth. Removal, retention
or temporary(interim) retention of one or more teeth is a
hugely crucial part of the overall treatment plan. Supportive
periodontal care is of paramount importance and it should
consist of examination, treatment including instructions in
oral hygiene and scheduling next procedure.

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How to cite this article: Kumar S, Bhat GS, Bhat KM. Full mouth
re-restoration of partially edentulous dentition: A periodontic, endodontic,
orthodontic and prosthodontic interrelationship-2 year follow-up. J Interdiscip
Dentistry 2012;2:211-4.
Source of Support: Nil, Conflict of Interest: None declared.

Journal of Interdisciplinary Dentistry / Sep-Dec 2012 / Vol-2 / Issue-3