Management of a patient with loss of posterior support
CASE STORY
A 51-year-old female presents with failing fixed partial dentures. Her chief complaint is “My teeth are breaking and I have nothing to chew on.”
The patient has lost her posterior teeth due to caries, failed endodontic treatment, and periodontal disease. Her previous restorations were placed approximately 11 years ago in the maxilla. The deterioration of her condition started about 1 year ago, when the fixed partial denture in the maxillary right side failed. She had noticed a slight discomfort prior to this event.
Figure 1: Preoperative left side.
Figure 2: Preoperative right side.
Figure 3: Preoperative presentation.
LEARNING GOALS AND OBJECTIVES
- To recognize the consequences of loss of posterior support
- To apply appropriate treatment modalities in a partially edentulous patient
Medical History
- Hypertension
- Hypercholesterolemia
Dental History
- Multiple extractions due to caries, failed endodontic treatment, and periodontal disease
- Fracture and loss of maxillary fixed partial denture 1 year ago
- Last dental visit was approximately 1.5 years ago when she was advised that some of her restorations needed to be replaced due to caries. Patient was not able to follow up with the planned dental work prescribed by her dentist.
Medications and Allergies
- Norvasc—5 mg daily
- Lipitor—20 mg daily
- No known drug allergies
Review of Systems
- Blood pressure and cholesterol levels are well controlled
- Vital signs:
- Blood pressure: 130/88
- Heart rate: 68 beats/minute
- Respiration rate: 16 breaths per minute
Social History
- Alcohol: occasional social use
- Recreational drugs: denies ever using any
Extraoral Examination
- Muscles: slightly tender/sore
- TMJ: Left side clicks; patient experiences tenderness upon closing and opening; relatively normal range of motion; no deviations noted upon opening and closing
Charting
Clinical Findings/Problem List
- Partial edentulism
- Failing existing restorations
- I nadequate oral hygiene
- Poor masticatory function
- Loss of posterior support
Radiographic Findings
- (See Figs. 5, 6, and 7.)
Diagnosis
- Loss of posterior support
- Generalized mild periodontitis
- Caries
- Multiple root fractures
- Reduced salivary flow
Clinical Decision-Making Determining Factors
- The loss of posterior teeth may result in compromised function and aesthetics. Establishment of a stable posterior occlusion is thought to be o/>
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