In the mandible, teeth Nos. 22 to 28 were all saved. Tooth No. 22 needed a crown, and an Equipoise precision C-rest crown was chosen (Figure 14) because it is highly aesthetic and capable of acting as a freestanding crown to support a free-end Tooth No. 28 needed a composite restoration. A mesial-occlusal composite using Z100 (3M ESPE) was done (Figure 15). A light-cured composite, to act as a space maintainer, was placed in the area prepared for the guide plane between appointments (Figure 14). This prevents potential drifting of the adjacent teeth into this space. Due to the location of this tooth in the mouth, a conventional Equipoise clasp design (mesial plate, mesial-occlusal spoon-shaped rest, and distal E-Clasp) was used (Figure 16). Due to the minimal amount of metal in the interproximal plate, the patient was assured that this would be aesthetic.
All rest preparations and frameworks were designed with built-in permanence in mind. Each rest, guide plane, and retentive mechanism was placed so that if any teeth are lost over time the partial denture would be easily repairable and still function properly.
Once all tissues were healthy and the design finalized, crown preparations were done and impressions were taken (Extrude [Kerr]). Bite registration and vertical were established. Then, copings were tried in to check fit (Figures 12 and 14). A rigid pick-up impression of the copings and simultaneous impression of soft tissues was taken next (Extrude), so the upper and lower Equi-poise frameworks could be cast (Figures 17 and 18). Care was taken to incorporate retromolar pads on the mandible and the tuberosities on the maxilla.
At the next visit, the frameworks were tried in with the crown copings to check for fit and stability.
Bite and vertical were reconfirmed and a shade match was taken, along with the instructions for denture tooth morphology (mold guide for anterior teeth; occlusal plane for posteriors).
At the following visit, tooth set-up and shade match were confirmed. Any necessary refinements were made, and the case was sent back to the dental laboratory for denture processing and por-celain glazing.
At the insertion phase, crowns were cemented with temporary cement (Temp-Bond), and the RPDs were inserted (Figures 13 and 16). The patient was instructed in the insertion and removal of the prostheses. Proper oral hygiene was reviewed, and the patient was directed to reschedule in 48 hours. At that time no adjustments were necessary, and the crowns were cemented with permanent cement (Vitremer [3M ESPE]).
The patient was seen every 3 months for follow-up visits, including examinations and dental prophylaxis. A 5-year follow-up revealed no breakdown of abutment teeth from either decay or periodontal disease. The patient’s oral condition was improved and stabilized (Figure 19).