What to do if the dentist has completed the work with multiple fixed bridges, but his patient returns for a visit? All the efforts look good at every recall, but the bridge has cracked.
It is crucial to find out the reason of the crack. Maybe the patient bit a spare rib, a chicken bone or a hard nut? Did he accidentally hit the bridge with a table-ware? Did he wear the nightguard?
A reasonably strong reliable repair decision would be a porcelain repair. First of all, the occlusion should be carefully observed in every position. If the crack is at the biting edge of the patient’s front tooth, than a composite resin-to porcelain fix may become a challenge. The client should receive some pieces of advice on what to avoid eating/biting.
What to do if the same patient turns back in several weeks and again after the second fix?
HISTORICAL BACKGROUND MATTERS
Let us examine the problem on one separate example. The patient with a fractured bridge asked for help. When he was a teen, he had the porcelain veneering procedure done on his teeth Nos. 6 to 11. When the patient turned 41, he thought it would be good to do the whole rehabilitation.
It is important to observe the patient’s jaw in different positions for better image of each separate situation. As the patient from the example stood while completing his work, it was crucial to examine his mouth cavity in this position. One of his movements inside the oral cavity differed from all the previous ones greatly. The client was “playing” with his teeth because of the constant pressure at work. His father and uncle were grinding their teeth what motivated the man to wear the nightguard regularly. Though, at daytime, the nightguard is not being worn, so such “playing” can be the cause of the fracturing.
There are sleep and awake kinds of bruxism. Awake bruxism is associated with stress and is semivoluntary. The patient from the example was hyperactive and very anxious. He even had a habit of shaking his leg. He might be a genetically programmed neurologic grinder.
HOW TO DEAL WITH BRUXISM AND AVOID FRACTURING
A comprehensive exam (periodontal probing, radiographs, oral cancer screening exam etc.) is recommended if a patient has bruxism. Diagnostic model impressions should be obtained with the help of single use trays. Creation of diagnostic casts and fabrication of lower and upper wax-ups are the next steps.
This special patient had his tooth No. 9 removed as it suffered from a crossover motion during many years of daytime bruxism. Core build-ups were placed during the healing of the removed tooth’s area. Then teeth No. 22 to 27 received porcelain veneers, lithium disilicate crowns were manufactured and bonded with the help of resin cement. After that the practitioner cemented the zirconia fixed bridge. After full recovery of the removed tooth’s tissue, a fixed bridge was cemented. The specialist applied a universal cleaning paste for 20 seconds before cementing. Then the professional completed a full occlusal evaluation.
Zirconia was a perfect choice as it is strong, fully polished and properly adjusted. Besides, it would be gentler during the awake bruxing. Monolithic zirconia would not look aesthetic, so the technician designed a windowed zirconia frame covering the palatals.
The patient needs to have his porcelain surfaces polished and receive in-office fluoride care during special visits. His bridge is functioning successfully for 2 years. Deep search for the possible reasons of dental problems brings excellent results for both the work of a dentist and the health of a patient.