Loop connectors in dentogenic diastema
Identifieur interne : 000175 ( Pmc/Corpus ); précédent : 000174; suivant : 000176Loop connectors in dentogenic diastema
Auteurs : Sanjna Nayar ; Raghevendra Jayesh ; V. DinakarsamySource :
- Journal of Pharmacy & Bioallied Sciences [ 0976-4879 ] ; 2015.
Abstract
Patients with a missing tooth along with diastema have limited treatment options to restore the edentulous space. The use of a conventional fixed partial denture (FPD) to replace the missing tooth may result in too wide anterior teeth leading to poor esthetics. Loss of anterior teeth with existing diastema may result in excess space available for pontic. This condition presents great esthetic challenge for prosthodontist. If implant supported prosthesis is not possible because of inadequate bone support, FPD along with loop connector may be a treatment option to maintain the diastema and provide optimal esthetic restoration. Here, we report a clinical case where FPD along with loop connector was used to achieve esthetic rehabilitation in maxillary anterior region in which midline diastema has been maintained.
Url:
DOI: 10.4103/0975-7406.155956
PubMed: 26015732
PubMed Central: 4439692
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Loop connectors in dentogenic diastema</title><author><name sortKey="Nayar, Sanjna" sort="Nayar, Sanjna" uniqKey="Nayar S" first="Sanjna" last="Nayar">Sanjna Nayar</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, Sree Balaji Dental College and Hospital, Chennai, Tamil Nadu, India</nlm:aff></affiliation></author><author><name sortKey="Jayesh, Raghevendra" sort="Jayesh, Raghevendra" uniqKey="Jayesh R" first="Raghevendra" last="Jayesh">Raghevendra Jayesh</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, Sree Balaji Dental College and Hospital, Chennai, Tamil Nadu, India</nlm:aff></affiliation></author><author><name sortKey="Dinakarsamy, V" sort="Dinakarsamy, V" uniqKey="Dinakarsamy V" first="V." last="Dinakarsamy">V. Dinakarsamy</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, Sree Balaji Dental College and Hospital, Chennai, Tamil Nadu, India</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26015732</idno><idno type="pmc">4439692</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439692</idno><idno type="RBID">PMC:4439692</idno><idno type="doi">10.4103/0975-7406.155956</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000175</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000175</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Loop connectors in dentogenic diastema</title><author><name sortKey="Nayar, Sanjna" sort="Nayar, Sanjna" uniqKey="Nayar S" first="Sanjna" last="Nayar">Sanjna Nayar</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, Sree Balaji Dental College and Hospital, Chennai, Tamil Nadu, India</nlm:aff></affiliation></author><author><name sortKey="Jayesh, Raghevendra" sort="Jayesh, Raghevendra" uniqKey="Jayesh R" first="Raghevendra" last="Jayesh">Raghevendra Jayesh</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, Sree Balaji Dental College and Hospital, Chennai, Tamil Nadu, India</nlm:aff></affiliation></author><author><name sortKey="Dinakarsamy, V" sort="Dinakarsamy, V" uniqKey="Dinakarsamy V" first="V." last="Dinakarsamy">V. Dinakarsamy</name><affiliation><nlm:aff id="aff1">Department of Prosthodontics, Sree Balaji Dental College and Hospital, Chennai, Tamil Nadu, India</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Pharmacy & Bioallied Sciences</title><idno type="ISSN">0976-4879</idno><idno type="eISSN">0975-7406</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Patients with a missing tooth along with diastema have limited treatment options to restore the edentulous space. The use of a conventional fixed partial denture (FPD) to replace the missing tooth may result in too wide anterior teeth leading to poor esthetics. Loss of anterior teeth with existing diastema may result in excess space available for pontic. This condition presents great esthetic challenge for prosthodontist. If implant supported prosthesis is not possible because of inadequate bone support, FPD along with loop connector may be a treatment option to maintain the diastema and provide optimal esthetic restoration. Here, we report a clinical case where FPD along with loop connector was used to achieve esthetic rehabilitation in maxillary anterior region in which midline diastema has been maintained.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Kalra, A" uniqKey="Kalra A">A Kalra</name></author><author><name sortKey="Gowda, Me" uniqKey="Gowda M">ME Gowda</name></author><author><name sortKey="Verma, K" uniqKey="Verma K">K Verma</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dr Ravikumar, Akulwar" uniqKey="Dr Ravikumar A">Akulwar Dr. Ravikumar</name></author><author><name sortKey="Dr Susheen, Gajare" uniqKey="Dr Susheen G">Gajare Dr. Susheen</name></author><author><name sortKey="Dr Shivkumar, Mule" uniqKey="Dr Shivkumar M">Mule DR. Shivkumar</name></author><author><name sortKey="Dr Ashwin, Kodgi" uniqKey="Dr Ashwin K">Kodgi DR. Ashwin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rosensteil, Sf" uniqKey="Rosensteil S">SF Rosensteil</name></author><author><name sortKey="Land, Mf" uniqKey="Land M">MF Land</name></author><author><name sortKey="Fujimoto, J" uniqKey="Fujimoto J">J Fujimoto</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bhadari, U" uniqKey="Bhadari U">U Bhadari</name></author><author><name sortKey="Bakshi, S" uniqKey="Bakshi S">S Bakshi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Levin, Ei" uniqKey="Levin E">EI Levin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Balkaya, Mc" uniqKey="Balkaya M">MC Balkaya</name></author><author><name sortKey="Gur, H" uniqKey="Gur H">H Gur</name></author><author><name sortKey="Pamuk, S" uniqKey="Pamuk S">S Pamuk</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Menezes, N" uniqKey="Menezes N">N Menezes</name></author><author><name sortKey="Chitre, V" uniqKey="Chitre V">V Chitre</name></author><author><name sortKey="Singh, Rk" uniqKey="Singh R">RK Singh</name></author><author><name sortKey="Aras, M" uniqKey="Aras M">M Aras</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Plengsombut, K" uniqKey="Plengsombut K">K Plengsombut</name></author><author><name sortKey="Brewer, Jd" uniqKey="Brewer J">JD Brewer</name></author><author><name sortKey="Monaco, Ea" uniqKey="Monaco E">EA Monaco</name></author><author><name sortKey="Davis, El" uniqKey="Davis E">EL Davis</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Pharm Bioallied Sci</journal-id><journal-id journal-id-type="iso-abbrev">J Pharm Bioallied Sci</journal-id><journal-id journal-id-type="publisher-id">JPBS</journal-id><journal-title-group><journal-title>Journal of Pharmacy & Bioallied Sciences</journal-title></journal-title-group><issn pub-type="ppub">0976-4879</issn><issn pub-type="epub">0975-7406</issn><publisher><publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26015732</article-id><article-id pub-id-type="pmc">4439692</article-id><article-id pub-id-type="publisher-id">JPBS-7-279</article-id><article-id pub-id-type="doi">10.4103/0975-7406.155956</article-id><article-categories><subj-group subj-group-type="heading"><subject>Dental Science - Case Report</subject></subj-group></article-categories><title-group><article-title>Loop connectors in dentogenic diastema</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Nayar</surname><given-names>Sanjna</given-names></name><xref ref-type="aff" rid="aff1"></xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Jayesh</surname><given-names>Raghevendra</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Venkateshwaran</surname><given-names></given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Dinakarsamy</surname><given-names>V.</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib></contrib-group><aff id="aff1">Department of Prosthodontics, Sree Balaji Dental College and Hospital, Chennai, Tamil Nadu, India</aff><author-notes><corresp id="cor1"><bold>Address for correspondence:</bold> Prof. Dr. Sanjna Nayar, E-mail: <email xlink:href="Sanjna101@yahoo.com">Sanjna101@yahoo.com</email></corresp></author-notes><pub-date pub-type="ppub"><month>4</month><year>2015</year></pub-date><volume>7</volume><issue>Suppl 1</issue><fpage>S279</fpage><lpage>S281</lpage><history><date date-type="received"><day>31</day><month>10</month><year>2014</year></date><date date-type="rev-recd"><day>31</day><month>10</month><year>2014</year></date><date date-type="accepted"><day>09</day><month>11</month><year>2014</year></date></history><permissions><copyright-statement>Copyright: © Journal of Pharmacy and Bioallied Sciences</copyright-statement><copyright-year>2015</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>Patients with a missing tooth along with diastema have limited treatment options to restore the edentulous space. The use of a conventional fixed partial denture (FPD) to replace the missing tooth may result in too wide anterior teeth leading to poor esthetics. Loss of anterior teeth with existing diastema may result in excess space available for pontic. This condition presents great esthetic challenge for prosthodontist. If implant supported prosthesis is not possible because of inadequate bone support, FPD along with loop connector may be a treatment option to maintain the diastema and provide optimal esthetic restoration. Here, we report a clinical case where FPD along with loop connector was used to achieve esthetic rehabilitation in maxillary anterior region in which midline diastema has been maintained.</p></abstract><kwd-group><title>KEY WORDS</title><kwd>Diastema</kwd><kwd>esthetic</kwd><kwd>fixed partial denture</kwd><kwd>loop connector</kwd></kwd-group></article-meta></front><body><p>Replacing a single tooth in esthetic region has been considered as a challenge for the clinician. Loss of the anterior tooth with existing diastema may result in excess space available for pontic. Various treatment options are available for replacement of single anterior tooth that includes an implant supported prosthesis or conventional fixed partial denture (FPD). This leaves a challenge for prosthodontist whether to close the space or to maintain the space with restoration for a natural appearance. If diastema has to be maintained in restoration and implant is not as treatment option, FPD along with loop connector is the best treatment option. The modified FPD with loop connectors enhance the natural appearance of the restoration; maintain the diastema and proper emergence profile. This clinical report describes a technique to fabricate a three unit porcelin fused to metal FPD with modified palatal loop connector to achieve an optimal esthetic and functional correction for patient with missing maxillary central incisor along with spacing in the maxillary anterior region.[<xref rid="ref1" ref-type="bibr">1</xref><xref rid="ref2" ref-type="bibr">2</xref>]</p><sec id="sec1-1"><title>Case Report</title><p>A 48-year-old male patient reported to the Department of Prosthodontics with a chief complaint of replacement of missing right maxillary central incisor [<xref ref-type="fig" rid="F1">Figure 1</xref>]. The edentulous area was wide mesiodistally, and there was spacing between existing anterior teeth [<xref ref-type="fig" rid="F2">Figure 2</xref>]. Radiographic examination reveals the less amount of bone available in right maxillary central incisor area. The treatment options include implant supported prosthesis or FPD with the aid of loop connector and resin bonded FPD. Considering his availability of bone and esthetic requirement of maintaining space between maxillary anterior teeth, the treatment option of three unit of porcelin fused to metal FPD from right maxillary lateral incisor to left maxillary centeral incisor with intermittent loop connector was considered.</p><fig id="F1" position="float"><label>Figure 1</label><caption><p>Teeth preparation with right maxillay lateral incisor and left maxillary central incisor</p></caption><graphic xlink:href="JPBS-7-279-g001"></graphic></fig><fig id="F2" position="float"><label>Figure 2</label><caption><p>Loop connectors between maxillary central and lateral incisor</p></caption><graphic xlink:href="JPBS-7-279-g002"></graphic></fig></sec><sec id="sec1-2"><title>Clinical Procedure</title><p>The proposed treatment plan was discussed with patient and following clinical procedure were carried out for his oral rehabilitation, teeth preparation for porcelain fused to metal prosthesis was carried out on right maxillary lateral incisor and left maxillary central incisor with equigingival margins and shoulder finish line in order to enhance the esthetics [<xref ref-type="fig" rid="F1">Figure 1</xref>]. The gingival retraction was carried out with gingival retraction cord, and final impressions were made using elastomeric impression material with two stage double mix technique. An interocclusal record was made using bite registration material. Provisional restorations were fabricated with a tooth colored auto polymerizing acrylic resin and cemented with noneugenol temporary cement. The impression was poured in type IV dental stone. Wax patterns were fabricated using blue inlay wax. Wax spacer was adapted on the palate and hence that adequate space will be given in the area of loop connectors for the maintenance of oral hygiene. The wax patterns were invested with phosphate-bonded investment material and cast in base metal alloy [<xref ref-type="fig" rid="F2">Figure 2</xref>]. After confirming the metal try in [<xref ref-type="fig" rid="F3">Figure 3</xref>], the ceramic build-up was done [<xref ref-type="fig" rid="F4">Figure 4</xref>]. Bisque trial was done. Loop connectors were highly polished to the high shine [<xref ref-type="fig" rid="F4">Figure 4</xref>]. Final fixed dental prosthesis with loop connectors was luted using glass ionomer cement [<xref ref-type="fig" rid="F5">Figure 5</xref>], [<xref ref-type="fig" rid="F6">Figure 6</xref>]. The patient was instructed to maintain proper oral hygiene. Use of dental floss and interdental brush were recommended. The patient was evaluated after 1-week to assess the oral hygiene status.</p><fig id="F3" position="float"><label>Figure 3</label><caption><p>Metal try in</p></caption><graphic xlink:href="JPBS-7-279-g003"></graphic></fig><fig id="F4" position="float"><label>Figure 4</label><caption><p>Ceramic build up</p></caption><graphic xlink:href="JPBS-7-279-g004"></graphic></fig><fig id="F5" position="float"><label>Figure 5</label><caption><p>Final prosthesis after cementation</p></caption><graphic xlink:href="JPBS-7-279-g005"></graphic></fig><fig id="F6" position="float"><label>Figure 6</label><caption><p>Final prosthesis in occlusion</p></caption><graphic xlink:href="JPBS-7-279-g006"></graphic></fig></sec><sec sec-type="discussion" id="sec1-3"><title>Discussion</title><p>Connectors are the part of FPD that connect between retainer and pontic. They may be either rigid or nonrigid. Conventional FPD connectors are more rigid as compared to loop connectors.[<xref rid="ref3" ref-type="bibr">3</xref>] Loop connectors become more flexible, and its flexibility depends upon its lengths, diameter and its cross Indications for loop connector:</p><p><list list-type="bullet"><list-item><p>Patient wishes to maintain the diastema</p></list-item><list-item><p>Presence of the excessive pontic space</p></list-item><list-item><p>Multiple joined prosthetic restorations in clinical situations with presence of localized or generalized spacing between abutments</p></list-item><list-item><p>Prosthetic restorations for pathologically migrated and peridontally weak teeth.[<xref rid="ref4" ref-type="bibr">4</xref>]</p></list-item></list></p><p>Patient with missing central incisor along with diastema have limited treatment option. Closing the space (diastema) with conventional FPD without considering golden proportion would fail to create an esthetically pleasing appearance and detrimental effects on the periodontium.[<xref rid="ref5" ref-type="bibr">5</xref><xref rid="ref6" ref-type="bibr">6</xref>] The modified FPD with loop connectors enhances the natural appearance of the restoration, maintain the diastema, proper emergence profile and preserve the remaining tooth structure of abutment teeth.[<xref rid="ref7" ref-type="bibr">7</xref>]</p><p>Disadvantages of loop connectors include additional laboratory procedures, difficult to maintain oral hygiene, interference in tongue movement and discomfort in speech. However keeping the connectors round and small in size will not affect the phonetics.[<xref rid="ref8" ref-type="bibr">8</xref>]</p></sec><sec sec-type="conclusion" id="sec1-4"><title>Conclusion</title><p>Treatment planning is crucial to the success when considering any form of tooth replacement. Whichever treatment modality is finally selected, it should suit the needs of the patient. This clinical report describes the use of loop connector for replacing missing central incisor with existing diastema. Loop connectors maintain proper emergence profile and enhance esthetic.</p></sec></body><back><fn-group><fn fn-type="supported-by"><p><bold>Source of Support:</bold> Nil</p></fn><fn fn-type="conflict"><p><bold>Conflict of Interest:</bold> None declared.</p></fn></fn-group><ref-list><ref id="ref1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kalra</surname><given-names>A</given-names></name><name><surname>Gowda</surname><given-names>ME</given-names></name><name><surname>Verma</surname><given-names>K</given-names></name></person-group><article-title>Aesthetic rehabilitation with multiple loop connectors</article-title><source>Contemp Clin Dent</source><year>2013</year><volume>4</volume><fpage>112</fpage><lpage>5</lpage><pub-id pub-id-type="pmid">23853468</pub-id></element-citation></ref><ref id="ref2"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Dr. Ravikumar</surname><given-names>Akulwar</given-names></name><name><surname>Dr. Susheen</surname><given-names>Gajare</given-names></name><name><surname>DR. 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