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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 11  |  Issue : 4  |  Page : 229-231

Esthetic treatment option for rehabilitation of anterior defect using andrew's bridge system


1 Prosthodontic Consultant, Navi Mumbai, Maharashtra, India
2 Department of Prosthodontics, Dayananda Sagar College of Dental Sciences, Bengaluru, Karnataka, India
3 Department of Prosthodontics, ITS Dental College and Hospital, Greater Noida, Uttar Pradesh, India

Date of Submission25-Jul-2019
Date of Decision16-Sep-2019
Date of Acceptance16-Sep-2019
Date of Web Publication1-Oct-2019

Correspondence Address:
Joel Koshy Joseph
B-27, Row House Kwality Complex, New Panvel, Navi Mumbai - 410 206, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJDS.IJDS_84_19

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  Abstract 


With high incidence of ridge deformity following extraction, the choice of treatment or the treatment option chosen plays a vital role in the longevity and success of the treatment. This study describes a particular case where the patient losses her lower anterior teeth because of periodontal reasons and has other confounding factors which made the obvious choice of treatment of fixed partial denture, implant-retained prosthesis, and conventional removable partial denture unsuitable.

Keywords: Andrew's bridge, fixed removable partial denture, Seibert's class III


How to cite this article:
Joseph JK, Sharan S, Rao SJ, Bhat P. Esthetic treatment option for rehabilitation of anterior defect using andrew's bridge system. Indian J Dent Sci 2019;11:229-31

How to cite this URL:
Joseph JK, Sharan S, Rao SJ, Bhat P. Esthetic treatment option for rehabilitation of anterior defect using andrew's bridge system. Indian J Dent Sci [serial online] 2019 [cited 2019 Nov 15];11:229-31. Available from: http://www.ijds.in/text.asp?2019/11/4/229/268425




  Introduction Top


In an event of loss of teeth, in anterior esthetic regions of oral cavity for a young patient, conventional fixed partial dentures or implant-supported prosthesis can successfully rehabilitate the defect and restore the patient's lost esthetics and function.

However, these treatments may not be of choice if the patient has extensive defect involving the alveolar bone or has excessive proclination or is associated with open bite. Fixed prosthesis in such cases would also be contraindicated because of unfavorable position of existing abutment teeth; nevertheless, removable prosthetics is always an option. However, esthetic and adaptability of removable prosthesis for young patients is always an issue.

This study describes a case report of a similar situation where a young patient who has lost her lower anterior teeth and has open bite, bimaxillary protrusion, and Seibert's Class III ridge defect.


  Case Report Top


A 27-year-old female patient reported with a chief complaint of missing lower anterior teeth. On clinical examination, she had missing 31 and 41 which were extracted because of poor periodontal condition. She had bimaxillary protrusion and labially tilted 32 and 42. She had Grade I recession and mobility with 32 and 42. She had canine-guided occlusion on both sides and anterior open bite. She had undergone extraction 5 months back because of periodontal reasons, following that her apicocoronal height and buccolingual width of the residual alveolar ridge were considerably reduced in size and shape [Figure 1].
Figure 1: Preoperative view

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The proposed treatment plan was extraction of 32 and 42 as it was periodontally compromised followed by removable prosthesis with 32, 31, 41, and 42. Fixed prosthesis and implant rehabilitation was not suggested to her because of contradicting factors such as periodontally compromised implant site along with unfavorable position of teeth because of bimaxillary protrusion and open bite.

However, the patient was not satisfied with esthetics and adaptability “clause” involved with removable partial denture was an issue.

Such compromised situation necessitated the use of a fixed removable prosthesis. That is the Andrew's bridge system, in which 43 and 33 would be used as primary abutment and 44 and 34 as secondary abutment for additional support, followed by removable prosthesis with 32, 31, 41, and 42, which is retained by bar and sleeve assembly. 33 and 42 were in an unfavorable position; hence, they were intentionally root canalled, followed by tooth preparation was done in such a way that the teeth was bought within lower arch [Figure 2].
Figure 2: Intentional root canal with 33 and 43 followed by tooth preparations

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Elastomer-based impression was made, facebow transfer was done, and die cut models were articulated in a semiadjustable articulator [Figure 3].
Figure 3: Die cut models prepared

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Metal coping was fabricated with an Andrew's bar soldered to the primary retainer's coping [Figure 4].
Figure 4: Metal coping with Andrew 's bar soldered

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Bisque trail was done [Figure 5], followed by fabrication of removable prosthesis with 31, 32, 41, and 42 such that the pink acrylic part would mask the gingival defect and hence maintain the adequate length of artificial teeth and crowns [Figure 6].
Figure 5: Bisque trial

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Figure 6: Removable prosthesis with 32, 31, 42, and 41

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Soft retentive tags were positioned in the inner surface of the removable prosthesis such that it snugly fits and engages on to the sleeves of the Andrew's bar [Figure 7].
Figure 7: Soft retentive tags positioned

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With Andrew's system, open bite was corrected and also the teeth were bought within the arch. The final result was appreciated by the patient herself and was very satisfied [Figure 8].
Figure 8: Pre- and post-operative

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  Discussion Top


There is always a high incidence (91%) of residual ridge deformity following anterior tooth loss, and majority of these are Class III defects.[1] Patients with Class II and Class III defects are often dissatisfied with the esthetic of their fixed partial dentures and hence preprosthetic surgery like residual ridge augmentation must be carefully considered.[2] Esthetic surgical replacement is difficult and unpredictable, particularly when papilla in the esthetic zone needs to be restored.[3] The bar, joins and splints both the abutment teeth on either side of the edentulous area.[4] About 3–4 mm occlusogingival height is necessary for an Andrew's bridge.[5] A minimum of 2mm vertical height of the bar is maintained, for adequate strength and retention of the removable portion of the restoration.[6]

The advantage of Andrew's bar system is that the ridge defect was esthetically masked with acrylic denture and also the patient was able to maintain better hygiene.[7] Furthermore, it is economically better option than ridge augmentation following implant placement.

However, there are disadvantages such as high wear and fracture incidence of acrylic partial denture which necessitated its periodic replacement and maintenance.[8]


  Conclusion Top


The art and science of prosthodontics involves the replacement and restoration of teeth by artificial substitutes. The primary focus is to restore function, esthetics, and comfort. Andrew's bar and sleeve system is designed to meet the requirements for esthetics, comfort, phonetics, hygiene, and favorable stress distribution to the abutments and soft tissues.[4]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rosenstiel Contemporary Fixed Prosthodontics, 4th Edition, Ch. 20., St. Louis, Missouri: Mosby Elsevier; 2006. p. 619-21.  Back to cited text no. 1
    
2.
Seibert JS, Cohen DW. Periodontal considerations in preparation for fixed and removable prosthodontics. Dent Clin North Am 1987;31:529-55.  Back to cited text no. 2
    
3.
van den Bergh JP, ten Bruggenkate CM, Tuinzing DB. Preimplant surgery of the bony tissues. J Prosthet Dent 1998;80:175-83.  Back to cited text no. 3
    
4.
Andrews JA, Biggs WF. The Andrews bar-and-sleeve-retained bridge: A clinical report. Dent Today 1999;18:94-6, 98-9.  Back to cited text no. 4
    
5.
Bolliger W. Precision attachments in dentistry. TIC 1984;43:5-7.  Back to cited text no. 5
    
6.
Everhart RJ, Cavazos E Jr., Evaluation of a fixed removable partial denture: Andrews bridge system. J Prosthet Dent 1983;50:180-4.  Back to cited text no. 6
    
7.
Gubrellay P, Gubrellay P, Vyas R. Andrews bridge system – A literature review. Int J Res Dent 2014;4:59-62.  Back to cited text no. 7
    
8.
Douglas D. Pontic design. In: Rosenstiel SF, editor. Contemporary Fixed Prosthodontics. 4th ed. New Delhi: Elsevier Publishers; 2014. p. 619-21.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]



 

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Abstract
Introduction
Case Report
Discussion
Conclusion
References
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