1. Oral Rehabilitation of a Patient with Chronic Periodontitis In partial fulfilment of BTech: Dental Technology, Dental Sciences, Tygerberg Campus, CPUT, 2008 Presented by Abduraghmaan Ismail

2. Overview Patient background Treatment options for maxillary arch Treatment of choice for maxillary arch Treatment options for mandibular arch Treatment of choice for mandibular arch Clinical procedures for maxillary arch Clinical procedures for mandibular arch Laboratory procedures for maxillary arch Laboratory procedures for mandibular arch References Acknowledgements

3. Periodontitis Fig.1 Adult periodontitis 1 Fig. 2 Periodontitis after surgery 1

4. Patient Background 45 year-old male Excessive smoker Main complaint is poor aesthetics Patient wants best possible treatment options Middle income group Patient has chronic periodontitis 2,3 Maxillary teeth extracted {1·3, 1·4, 1·5, 1·6, 2·3, 2·4, 2·6, 2·7} All mandibular teeth extracted

5. Periodontitis in Maxillary and Mandibular Arches The patients’ dentition prior to extraction ( Fig.3) A. Allie

6. Periodontitis in Mandibular Arch A. Allie Patient’s dentition prior to extraction (Fig. 4)

7. Treatment Options for Maxillary Arch Extract remaining teeth, replace with acrylic denture Restore teeth with fixed prosthesis, partial denture for edentulous spaces 4 Restore remaining teeth, replace with all- ceramic bridge 5

8. Treatment Option of choice for Maxillary Arch Restore remaining teeth 1·7, 2·1, 2·8 A prosthesis fabricated for prepared teeth 4 A partial prosthesis for edentulous spaces 6

9. Treatment Options for Mandibular Arch A full mandibular acrylic denture 7 Implant retained ceramic bridge 8

10. Treatment Option of choice for Mandibular Arch Mandibular acrylic denture with personalised tinting 7 Most viable option, excellent success rate; and more affordable for patient

11. Clinical Procedures Maxillary Arch Root canal therapy to 1·7, 2·1, 2·8 1·7, 2·1, 2·8 prepared for prostheses 2·2 will be extracted

12. Clinical Procedures for Mandibular Arch Impressions for fabrication of mandibular prosthesis 9,10 Followed by accurate bite registrations 9,10 Wax try-in of mandibular denture 10 Placement of finished denture by dentist 10

13. Laboratory Procedures for Maxillary Arch PFM restoration for 2·1 11,12,13 Full gold crowns with precision milled seats for attachment of RPD on 1·7, 2·8 4,6,14 Co-Cr RPD replaces missing teeth 6,15,16

14. Laboratory Procedures for Mandibular Arch Pouring impressions - primary and final Record block fabrication Set-up and wax-up of try in Finishing and polishing with personalised denture tinting 7,9,12

15. Maxillary Prosthesis Fig. 5 Palatal view of maxillary prosthesis Ismail

16. Mandibular Prosthesis Du Preez Fig.6 Completed mandibular prosthesis

17. Completed Prosthesis Du Preez Fig. 7 Articulated prosthesis

18. References 1. Lindhe J. Clinical Periodontology and Implant Dentistry. 4 th ed. Oxford: Blackwell Publishing Co. 2003: 47-53. 2. MayoClinic.com-Tools for Healthier Lives. Available: http://www.mayoclionic.com/health/periodontitis 26 July 2008 3. Oral Health-Common Problems-All About Periodontitis. Available: http://www.health24.com/medical/condition_centres 26 July 2008. 4. Smith GNB. Planning and Making Crowns and Bridges. 3 rd ed. London: Martin Dunitz Ltd. 1998: 24-25. 5. Van Noort R. Introduction to Dental Materials. 2 nd ed. Edinburgh: Elsevier Science Ltd. 2002: 180, 238, 240. 6. Wulfes H. Precision Milling and Partial Denture Constructions - A Manual. 1 st ed. Bremen: Academia Dental International School BEGO Germany. 2004: 57-59; 138; 195.

19. References cont. 7. Muraoka H. A Colour Atlas of Complete Denture Fabrication. Chicago: Quitessence Publishing Company. 1989: 41-43. 8. Babbush CA. Dental Implants - The Art and Science. Philadelphia: W B Saunders Company. 2001: 3-19. 9. Morrow RM, Rudd KD, Rhoads JE. Dental Laboratory Procedures-Complete Dentures. Volume 1. St. Louis: The CV Mosby Company. 1986: 223-240, 312-320. 10. Basker RM, Davenport JC. Prosthetic Treatment of the Edentulous Patient. 4 th ed. Oxford: Blackwell Publishing co. 2002: 146-241. 11. Roberts DH. Fixed Bridge Prostheses. 2 nd ed. London: John Wright and Sons Ltd. 1980: 129-130, 139-140, 166.

20. References cont. 12. Mclean JW. The Science and Art of Dental Ceramics. Volume 1 - The Nature of Dental Ceramics and their Clinical use. Chicago: Quintessence Publishing Co. 1979: 23-28, 37-39. 13. Dykema RW. Johnston’s Modern Practice in Fixed Prosthodontics. 4 th ed. Philadelphia: W.B Saunders Company. 1986: 8-16, 22-25, 60-63. 14. Jenkins G. Precision Attachments- A Link to Successful Restorative Treatment. London: Quintessence Publishing Co. Ltd. 1999: 33-40. 15. Stewart KL. Clinical Removable Partial Prosthodontics. St. Louis: The CV Mosby Company. 1983: 18-20; 56-60. 16. Anusavice KJ. Phillips’ Science of Dental Materials. 10 th ed. Philadelphia: WB Saunders Company. 1996: 237.

21. Acknowledgements Dr. A. Allie, UWC Ziyaad Williams, UWC Gerhard Du Preez, CPUT Timothy Peterson, CPUT

22. Thank You