Callera, Kateleen Phaye E.

2014-64494
Quicio, Candace Noelle S. 2014-19890

DENT142: Removable Partial Denture

RPD Case Written Report (by pair)

I. Chief Complaint
“Nahihirapan akong kumain dahil sa mga bungi ko sa likod at nahihiya
akong ngumiti kasi wala na akong ngipin sa harap.

II. History of Present Illness

According to the patient’s record, extraction of her mandibular first molars
on 2006 when she was only 9 years old resulting to mesial drifting of teeth #37 and
#47. Patient complains about frequent food impaction on the posteriors that
consequently lead to extraction of teeth #35 and #45 on December 2015 followed
by teeth #37, #34 and #44 on January 2016 during a dental mission in their
barangay due to caries. On August 2017, teeth #12, #11, #21, and #22 were
fractured and became mobile due to a bicycle accident. These incisors were
extracted and replaced by a PFM-bridge with the #13 and #23 as abutments.
However, extraction of these abutments were needed as caries developed due to
marginal leakage. Procedure was done on November 2017. The most recent
extraction was done on tooth #14 on March 2018 due to caries.
Due to the loss of several teeth, patient settled for a soft diet because of
difficulty in eating. And the loss of anterior teeth made her conscious that is why
she would cover her mouth every time she smile or talk.

III. Patient Expectation/s

The patient expects that after the dental services rendered, it will restore
her ability to masticate properly and her anteriors will be replaced for esthetic
reasons.

IV. Social/Family History

No history of cigarette smoking and drug use. The patient is an occasional drinker.

V. Medical History
The patient does not have any systemic disease. There is no known
allergies nor other systemic conditions found.

VI. Dental History

Generally, the patient does not do regular dental checkups. Poor oral
hygiene predisposes her to severe caries that led to a series of extraction.

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VII. Clinical Examination
Extraoral examination
i. Gait
The patient’s gait is normal with slightly slouched back.
ii. Facial Asymmetry
No facial asymmetry visible.
iii. Facial Profile
Facial profile is slightly convex
iv. Facial evidence of loss of Vertical Dimension
There is a slight depression on the cheeks and philtrum of the patient
because of the loss of teeth on that area.
v. Auricular and Cervical Lymph Nodes
No visible and palpable swelling of the lymph nodes.
vi. Initial TMJ assessment
No pain or clicking in the TMJ. TMJ is normal.

Intraoral Examination
i. Kennedy Classification
Kennedy Class IV for maxilla and Kennedy Class III, Modification 1 for
mandible.
ii. Hard tissue exam (caries, restorations, abrasions, etc)
Recurrent caries observed on the composite restorations on #16 and #38
and minimal occlusal abrasions on #32, #31, #41, and #42. Malpositioning of
posteriors is also seen with the tilted #38 buccally, #47 mesiolingually and #48
lingually while #18 is infraerupted.
iii. Soft tissue exam (perio assessment, assessment of the residual ridges,
assessment of load bearing areas, presence of tori, exostoses or soft tissue
lesions/mass, etc.)
Functional lingual sulcus depth is within 8-10mm. Residual ridges are found
to of normal thickness and no sign of bone resorption. No ulcerations nor lesions
are found on the soft tissue of the gingival mucosa.
iv. Saliva Consistency
Saliva is watery and the patient does not experience dryness of the mouth.

VIII. Analysis of Pertinent Data

Load Assessment
i. Location and Span of edentulousness
There are edentulous spaces found on the entire span of the anterior teeth
on the maxilla between teeth #15 and #24, and on the posteriors of the mandible
between #38 and #33, and between #47 and #43.

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ii. Nature of support (entirely mucosa-supported, tooth-mucosa supported, or
entirely tooth supported)
The nature of support for both maxilla and mandible is entirely tooth-
supported as they are both tooth bounded cases.
iii. Nature of antagonist
Due to the tilting going buccally, mesiolingually and lingually respectively
for #28, #47, and #48 and the infraeruption of #18, occlusion presents as a
posterior crossbite. There are defective occlusal restorations on the #26 and #38
but will be replaced to make it sound and stable.
iv. Muscle tonicity (which muscles?)
The patient’s oral muscle tonicity is characterized as heavily-toned.
v. Parafunctional Habits
The patient does not have any parafunctional habit.
vi. Diet
The patient is fond of consuming food high in sugar and drinking acidic
liquids such as citrus juices. After losing her anteriors on the maxilla and posteriors
on her mandibular, she switched to a soft diet which mainly composed of semi-
solid foods that are firm but easy to chew and low fiber foods like fish and
vegetables.

Radiographic Findings
i. Radiolucencies/radiopacities seen
No pathologic radiolucency nor radiopacity seen on the teeth and on the
bone.
ii. Level/Height of Alveolar Bone
All teeth were found to have adequate bone support.
iii. Crown-to-root ratio of prospective abutments
The crown-to-root ratio of all abutment teeth were found to have adequate
bone support.
iv. PDL space of prospective abutments
Width of the periodontal ligament space of all abutment teeth were found to
be within the normal width which is around 0.2 mm to 0.4 mm.

Preliminary Survey
The survey lines were obtained using a Ney dental surveyor and a 0.01 inch
undercut gauge.
For the maxilla:
For tooth #17, the survey lines on the buccal area are at the middle third for
the mesial and at the junction of occlusal third and middle third for the distal.

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Meanwhile on the lingual area, the survey lines are at the cervical third
approximating the gingival margin already for both mesial and distal.
For tooth # 15, the survey lines on the buccal area are at the middle third
going to cervical third for the mesial to midbuccal while there is no survey line for
the distal. Meanwhile on the lingual area, the survey line is located at occlusal third
for the mesial going to the cervical third for the distal.
For tooth #24, the survey lines on the buccal area is only at the cervical third
of the midbuccal. Meanwhile on the lingual area, the survey lines are at the junction
of the occlusal third and middle third for the mesial going cervical third for the distal.
For tooth #27, the survey lines on the buccal area is at the middle third for
mesial and at the junction of the occlusal and middle third for distal. Meanwhile at
the lingual area, the survey line is only at the cervical this of the mesial.

For the mandible:

For tooth 38, since the occlusogingival height is inadequate, there were no
survey lines for both buccal and lingual.
For tooth 33, the survey lines on the facial are at the cervical 3rd for both
mesial and distal. The survey lines on the lingual are at the cervical 3rd for the
distal, and at the cervical 3rd for the mesial. The retentive undercut will be on the
mesial of the facial, which is found on the middle 3rd.
For tooth 43, the survey line on the facial are at the junction of cervical and
middle 3rd on the mesial, and at the cervical 3rd on the distal. he survey lines on
the lingual are at the cervical 3rd for the distal, and at the cervical 3rd for the mesial.
The retentive undercut will be on the mesial of the facial surface.
For tooth 47, since the tooth is tilted mesiolingually, there are no survey
lines on the buccal surface. The survey lines on the lingual surface are on the
junction of the middle and occlusal 3rd for both mesial and distal. The retentive
undercut will be on the distal of the lingual surface.

Occlusal analysis/tooth contact relationships

i. Presence of overerupted teeth
There are no supraerupted teeth present.
ii. Maloccluded teeth
Teeth #28 is tilted buccally, while #47 and #48 are tilted lingually so there
are no occlusion with the maxillary antagonists.
iii. Tooth contacts at maximum intercuspation (if any)
At maximum intercuspation, there is no occlusal contact at the posterior
area for all the quadrants because of the malpositioning of the teeth resulting to
posterior crossbite. Occlusion of maxillary anteriors and premolars prior to
extraction could not be determined.

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 iv. Available vertical space for the prosthetic teeth (occlusal clearance, only
applicable if there is an established vertical dimension or occlusal stops)
There is enough vertical space for the placement of the prosthetic teeth at
the posterior considering that there is no occlusion i.e. there is more space than
needed. The anterior area has a 40mm vertical clearance that will adequately fit
the pontics.
v. Available horizontal space for prosthetic teeth (for setting up of pontics)
From the intraoral examination of the soft tissues, no evidence of bone
resorption is concluded thus there is enough horizontal space for the placement of
the prosthetic teeth in the edentulous areas between teeth #15 and #24, between
teeth #38 and #33, and between teeth #43 and #47.

IX. Diagnosis and Treatment Planning

Diagnosis
The patient has poor oral hygiene which predisposed her to caries causing
the extraction of her teeth. The patient was found to be more fit for removable
denture given the number of missing teeth and the failure of fixed prosthetics.
Patient education which focuses on the reinforcement of oral hygiene must
be done prior to the actual procedure.

Pre-prosthetic procedures
Conventional rest seat preparations on the following teeth will be done
using a #3 or #4 round bur:
Occlusal Rest Seats ○ Mesial of 15 and 24
○ Distal of 17 and 27

Incisal Rest Seat ○ Distal of 33 and 43

Occlusal extended rest seat ○ Mesial of 38 and 47

Guide planes will also be prepared on all surfaces of the teeth facing the
edentulous space. The specific surfaces to be prepared are as follows:
● Mesial of 15 and 45
● Mesial of 38 and 47
● Distal of 33 and 43

Enameloplasty to lower the survey line of:

● Mesiolingual of 15 and 24

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Post installation procedure
Instruct the patient to brush every after meal and avoid cleaning the denture
using toothpaste. Remove the prostheses before going to sleep and place them
inside a sealed container with water and a few drops of mouthwash. The patient is
also instructed to go back to do necessary adjustments in cases when there is
excessive pressure or impingement on the soft tissues.

TREATMENT PLAN SUMMARY

1. Oral hygiene instructions and case presentation
2. Scaling and Polishing
3. Repair all defective restorations
4. Pre-prosthetic mouth preparations which are mentioned above
5. Fabrication of maxillary and mandibular RPDs
6. Installation and patient education
7. Post-installation recall