1. The Construction of a Removable Combined Precision Denture for a PATIENT WITH MARGINAL GINGIVITiS
In partial fulfilment of BTech: Dental Technology,
Department of Dental Sciences, CPUT, 2008
by Nicolea Jacobs

2. OVERVIEW Patient History Definition Clinical Treatment
Possible Treatment Options
Chosen Treatment Option
Advantages and Disadvantages
Laboratory Procedures
Problems Experienced
Future Treatment Options
References
Acknowledgements

3. PATIENT HISTORY A 36 year-old female
Complained of tooth ache, gingival erythema, swelling, and bleeding1
Referred to the Tygerberg Hospital UWC Dentistry Faculty
Inflammation on the margins of the gingiva, and caries on certain teeth (Fig. 1)1,2

4. PATIENT HISTORY (cont.)
Fig. 1: Marginal gingivitis1

5. DEFINITION Mild inflammation of gingival tissue3 Exists around teeth3
Amona – a human ailment4
Irritating effects caused by bacterial plaque4

6. CLINICAL TREATMENT
Received mouth wash for plaque formation and sensitivity of the gum tissue2,5
Teeth with caries were extracted
Most teeth with inflammation were extracted
Maxillary 2∙1, 2∙8, and 1∙7 were prepared for single crowns
Remaining standing teeth were the 1∙1, 1∙8 and 2∙5

7. POSSIBLE TREATMENT OPTIONS
MAXILLA
MANDIBLE
Removable acrylic partial denture6
Fixed partial prosthesis7
Metallic removable partial denture7
Combined precision attachment denture8,9
Conventional acrylic denture8,9,10
Implant-retained overdenture10,11
14 unit bridge prosthesis10,11

8. CHOSEN TREATMENT OPTION
Combined precision attachment denture
2∙1 metal-ceramic crown
2∙8 and 1∙7 milled gold crowns
Metallic removable partial denture
MAXILLA
Conventional acrylic denture with labial gum tinting
MANDIBLE

9. ADVANTAGES OF POSSIBLE TREATMENT OPTIONS
MAXILLA
Conventional removable partial denture6,12
Fixed partial prosthesis6
Metallic removable partial denture6,9,12
Combined precision attachment denture12,14
Less expensive than all options6,12
Good aesthetics6,12
Excellent retention- retentive arms6,9,12
Excellent retention and stability - combination12

10. ADVANTAGES OF POSSIBLE TREATMENT OPTIONS
MANDIBLE
Least expensive of all the choices6,14
Excellent stability and retention
Good aesthetics
Conventional acrylic denture6,12
Implant - retained overdenture11,13
14 unit bridge prosthesis14

11. DISADVANTAGES OF POSSIBLE TREATMENT OPTIONS
Conventional removable partial denture6,12,14
Fixed partial prosthesis10,11,15
Metallic removable partial denture6,12,14
Combined precision attachment denture7,8,9,11,15
MAXILLA
Insufficient stability and
retention11,14,15
Most expensive option
Lack of aesthetics – clasp arms
Bone resorption

12. DISADVANTAGES OF POSSIBLE TREATMENT OPTIONS
MANDIBLE
Conventional acrylic denture14
Implant - retained overdenture15
14 unit bridge prosthesis15
Less stability and aesthetics14,15
Most expensive treatment option
Too expensive compared to a conventional denture

13. LABORATORY PROCEDURES
FIRST PHASE:
Poured final model
Fabricated record block for bite registration (Fig. 2)
Articulate case
Fig. 2: Bite registration
F. Goetze

14. LABORATORY PROCEDURES (cont.)
SECOND PHASE:
Prepared model for 2∙1 metal-ceramic crown
Waxed coping with metal collar
Cast coping
Fabricated metal-ceramic crown (Fig. 3)
Fig. 3: Metal-ceramic crown
F. Goetze

15. LABORATORY PROCEDURES (cont.)
THIRD PHASE:
Wax crowns on 1∙7 and 2∙8
Milled wax crowns
Cast gold crowns
Milled cast gold crowns (Fig. 4)
Polished 1∙7 and 2∙8 gold crowns
Precision attachments offers controlled wear, less wear, and have standard interchangeable parts9,10

16. LABORATORY PROCEDURES (cont.)
F. Goetze
Fig. 4: Milling of gold crowns

17. LABORATORY PROCEDURES (cont.)
FOURTH PHASE:
Preparing Co-Cr framework
Wax-up Co-Cr (Fig. 5)
Final Co-Cr framework (Fig. 6)
F. Goetze
Fig. 5: Wax-up Co-Cr
framework
F. Goetze
Fig. 6: Final Co-Cr framework

18. LABORATORY PROCEDURES (cont.)
FIFTH PHASE:
Set-up on Co-Cr framework
Crowns and framework attachment (Fig. 7)
Poured and polished Co-Cr denture (Fig. 8)
Y. Chen
Fig. 7: Attachment
Y. Chen
Fig. 8: Final Co-Cr denture

19. LABORATORY PROCEDURES (cont.)
Set-up edentulous mandible
Labial gum tinting (Fig. 9)
Final mandibular denture (Fig. 10)
Y. Chen
Fig. 9: Labial gum tinting
Y. Chen
Fig. 10: Final mandibular denture

20. LABORATORY PROCEDURES (cont.)
Y. Chen
Fig. 11: Final case

21. PROBLEMS EXPERIENCED Open margins on gold crowns after casting
Limited space on the buccal area of the coping for ceramic material
Finished chrome did not seat as desired
Porosity in mandibular denture

22. FUTURE TREATMENT OPTIONS
Maxilla
Fixed bridge prosthesis
Mandible
Soft lining denture - tissue sensitivity
14 unit bridge prosthesis

23. REFERENCES
Scully C. Handbook of Oral Disease. London: Martin Dunits.1999:
Scully C, Flint SR, Porter SR. Oral Disease, 2nd ed Singapore: Crispian Scully and Stephen Flint. 1989: 182.
Sweet Haven Publishing. Fundamentals of Dental Technology (1985). Available: August 2008.
Roberts G. What is Marginal Gingivitis? Available: 7 August 2008.
Enrique B, Needleman HL, Karimbax N, Van Dyke TE. Periodontal and Gingival Health and Diseases. Singapore: Martin Dunits Ltd. 2001:

24. REFERENCES (cont.)
Rosentiel SF, Land MF, Fujimoto S. Contemporary Fixed Prosthodontics, 4th ed. Missouri: Mosby Inc. 2006: 273.
Soltner HM. Dental Labor National: Anchoring – band Attachments. Berlin: Dental Labor International. 2008; 4; 42.
Wulfes H. Precision Milling and Partial Denture Construction, 1st ed. Bremen: Academia Dental. 2004: 149.
Martin P. Attachments for Prosthetic Dentistry. Berlin: Quintessence Publishing Co Ltd. 1994:
Ney JM. Crown and Bridge Manual. Hartford: JM Ney Company. 1972: ,

25. REFERENCES (cont.)
Preiskel HW. Precision Attachments in Prosthodontics: The Applications of Intracoronal and Extra Coronal Attachments, Volume 1. Chicago: Quintessence Publishing Co. 1984:
Stewart KL, Rudd KD, Kuebker WA. Clinical Removable Prtial Prosthodontics. Missouri: C.V. Mosby Company. 1983:
Smith BGN. Planning and Making Crowns and Bridges, 3rd ed. Bremen: Martin Dunitz. 1998:
Morrow RM, Rudd KD, Rhoads JE. Dental Laboratory Procedures - Complete Dentures, 2nd ed. St. Louis: C.V. Mosby Company. 1986:
Naylor WP. Introduction to Metal Ceramic Technology. London: Quintessence Publishing Co. 1992: 36;

26. ACKNOWLEDGEMENTS Dr. Wright Mr. L Steyn Miss M Kruger Mr. Latief
Mr. M Mazema

27. THANK YOU