Dr.Manoj Kumar.S MDS-Prosthodontics, DABOI/ID, Fellow AAID, Board Certified Dentist-Canada

Case 13: Attachment supported Cast Partial Dentures Precision Attachments in the field of Prosthodontics is an exceptional option in replacing missing teeth when the remaining dentition is healthy. Here we see a Kennedy's class 1 edentulous site in the maxillary arch with Canine to Canine been endodontically treated due to caries, while the mandibular arch is a completely edentulous arch requiring a complete denture. The treatment plan involved the fabrication of crowns for the endodontically treated maxillary canine to canine. Considering the choice for replacing the posterior teeth in maxillary arch along with the need for a Fixed prosthesis, the choice of precision attachments came into the light. I decided to go ahead with Rhein-83 attachments. A total of 4 attachments was attached to the frame behind the 6 unit splinted FPD mainly considering the posterior spread of the prosthesis. The lower arch was treated with a conventional complete denture. Initially a D...

Publication 4: Custom anatomic healing abutments  Gowda VS, Anand D, Sundar MK, Reveredo AM, Shetty S. Custom anatomic healing abutments. J Indian Prosthodont Soc 2016;16:386-9. Dental implants with their increasing success rates and predictability of final outcome are fast becoming the treatment of choice for replacing missing teeth. Considering the success of immediate implant placement in reducing tissue loss and achieving good esthetic results, is making it a more popular treatment modality in implant dentistry. Understanding the management of gingival tissues in relation to implants to obtain maximum esthetics is of utmost importance. The use of provisional abutments and immediate temporization has a proven track record of their ability to produce optimal esthetics and to guide the tissue response during the healing phase. With careful patient selection and execution, customized healing abutments can provide an effective method to enhance the esthetic and emergence profi...

Case 12: Surgical and Prosthetic Phase- Single implant restoration 2.5 Here we can see a simple case of implant restoration starting from placement till restoration with a cement-screw retained PFM crown for tooth 2.5 The edentulous site of 2.5 was adequate enough for a standard platform implant( 3.8 mm dia implant of Biohorizon in this case). An infiltration anesthesia was given to anesthetise the site and a local muco-periosteal flap with a crestal incision was elevated. The implant had an ideal primary stability and was decided to be loaded after 4-5 months. After 4-5 months when the patient walked in for the definitive implant crown a radiograph was taken to assess the radiographic status of the implant in 2.5. The site was ready for an implant crown to be done and the prosthetic phase starts by uncovering the implant site and placement of a healing collar.  The choice of the healing collar depends on the soft-tissue thickness, site of restoration, depth of t...

Case 11: Surgical Phase- Stage 1 Implant surgery - Extraction and Immediate placement. Dental implants are a viable option in replacing teeth. However, careful case selection and ideal prosthetic driven planning is important. To achieve success an ideal planning involving CBCT analysis and atraumatic surgical procedure is a prime necessity. This case had a hopeless teeth in 1.2 and 2.1 which were endodontically treated and were retainers for a three unit FPD. The patient was medically fit and was classified under ASA Class 1. After careful prostheitc planning and CBCT analysis it was decided for extractions and immediate placement of dental implants in the extraction sockets. The use of Periotomes play a vital role in atraumatic extraction of the remaining root stumps. The entire procedure of extraction, implant placement along with synthetic bone fillers for jumping distance and resorbable collagen membrane was carried out under local anesthesia. Considerin...

Case 10: Indirect restorative techniques- Emax Inlay for a posterior tooth Gone are the days when Amalgam restorations were by default the choice for most of the restorations. With the advent of more esthetic indirect restorative techniques there is a paradigm shift in choice of restorative techniques. Here is a simple restoration of a wide cavity in tooth 4.6 which was an ideal indication for an inlay. With the advent of technology and various esthetic materials I decided to go ahead restoring this tooth with an E-max Cad Inlay. By going through these ten odd cases, you might wonder and will be clear that Emax is one of my favourite restorative material. Yes! It is indeed an awesome material. Its Esthetic Maximum and thus its name. But the most important thing with Lithium DIsilicate ceramics is the need for a proper isolation. Ideal rubberdamology is one of the pre-requisite for an excellent bonding and better longevity of the restoration. This case was done by m...

Case 9: Veneer- "Sometimes we need to respect patient's choice" There was this situation when I had a request from one of my patients that they do not want a composite filling! Yes, the patient was irritated with the frequent fracture of his old composite class 4 incisal edge restoration which was done somewhere else. I did insist on going ahead with another composite restoration and I even suggested that it needs to be done with ideal isolation techniques. But, his previous dental history and frequent fracture of his old composite in tooth 1.1 made him choose against it.  Eventually, I had to do an emax-Cad Veneer on 1.1. The sequence of steps here in this visual display involves an incisal butt joint type 1 veneer prep (refer Pascal Magne's Book on insights) and an MT blank was used for milling the veneer. The other steps involving the provisionalisation was carried out with a spot-etch and no-bond temporaries with Luxatemp DMG. Definitive luting was carrie...

Case 8: Another case on Fibre post and core with a Zirconia esthetic crown Yet another simple case on Zirconia crown in the anterior zone. This case was a straight forward one for a fibre post and composite core followed by a simple full coverage zirconia esthetic restoration. Although it might sound simple, the characterisation and achieving the esthetics is always tricky. My suggestion is to take a lateral angle photograph with the light falling from the labial direction which is at 90 degrees from the orientation of the lens. Such an image captures the ridges, valleys, contours, depressions, horizontal striae, crack lines and all rough surfaces. And, I normally add and mark the necessary points in the photograph and mail it to my ceramist for him to understand the features more clearly. Additionally, a monochromatic image will help us determine the value of the shade obtained. This case was done by me at Parasu Dental Hospital, Chennai.

Publication 3: A comprehensive Prosthodontic Management of subtotal Maxillectomy. ABSTRACT  Patient: A 21-year-old female patient was diagnosed with intraosseous mucoepidermoid carcinoma on the left side of maxilla, which was planned for subtotal maxillectomy involving the left maxillary sinus. Discussion: Prosthodontic rehabilitation of patients with maxillectomy is a challenge as it involves restoring speech, deglutition, mastication and respiration. This clinical report describes a comprehensive prosthodontic management of a young girl treated for a subtotal maxillectomy due to intraosseous mucoepidermoid carcinoma. The prosthodontic management that was carried out right from the surgical obturator to a definitive prosthesis with a two-piece closed hollow bulb, magnet-retained obturator shows the ease and simplicity in the management of a case with subtotal maxillectomy. Conclusion: Subtotal maxillectomy defects represent a complex challenge for the maxillofacial prostho...

Case 7: Immediate FPD- the best option in achieving the emergence by creating ovate pontics in provisionals Periodontially compromised situations requiring esthetic correcting is challenging. The proclination is accentuated to a greater extent and the periodontal status makes it a contra-indication for orthodontic alignment. Instead a diagnostic mock up was done to achieve retroclination for esthetic correction. A diagnostic mock-up is done with ivory wax and considered an excellent method to discuss the details and the outcome of the treatment with the patient and the lab technician or the ceramist. Once finalised a putty index is made for the use and fabrication of provisionals post- extraction. The sequence involves the preparation of tooth to receive the retainer of the FPD. In this case, I decided to fabricate 6-unit FPDs for maxillary and mandibular anteriors involving extraction of centrals and laterals in the lower and centrals in the maxillary arch. Firstly, we...

Case 6: Salvaging a fractured tooth with Cast post and core followed by PFM crowns Due to economical constraint, not always do we come across patients choosing an all ceramic or a Zirconia variant in achieving esthetics. In such situations, salvaging a fractured tooth requires a cast post and core followed by a PFM crown. here is a situation where tooth 2.2 is an old endodontically treated tooth with a recent fracture at the crown level. On examining, we decided to salvage the tooth based on the fact that the ferrule structure available was adequate. In this situation, a cast post and core followed by a Porcelain Fused to Metal crown. Recording the post space can be done either by a direct technique or an indirect technique. Here I have used a direct technique with Pattern resin. pattern resins are very accurate in recording and maintaining the details until invested and casted for a Co-Cr cast metal post. Esthetics can be achieved with PFM too. This...