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Abstract:
A desire to look attractive is no longer taken as a sign of vanity. Since the face is the most exposed part of the body, and the mouth a prominent feature, teeth are getting a greater share of attention. In the past 25 years, the focus in dentistry has gradually changed from routine dental treatment to various restorative materials like CAD CAM, etc but living in an economic country porcelain fused to metal prosthesis is still the most desirable option. A patient, 24yrs old, reported to the Department of Prosthodontics, Institute of Dental Sciences, Bareilly, Uttar Pradesh with the chief complaint of discolored and decayed lower front teeth for a long time who was treated with RCT followed by post and core and crowns.

Introduction: The formerly independent disciplines of orthodontics, periodontics, restorative dentistry, and maxillofacial surgery must often join together to satisfy the public’s desire to look better.
Starting the treatment planning process with esthetics proceeding to functional, structural, and finally biological aspects of dental problem. The purpose is not to sacrifice function but to use it as the foundation of esthetics.
Full mouth rehabilitation cases are one of the most difficult cases to manage in dental practice. This is because such cases involve not only replacement of the lost tooth structure but also restoring the lost vertical dimensions besides imparting both the esthetics and function. Full mouth reconstruction is basically a set of procedures that are aimed at correcting an improper bite position as well as restoring chipped or worn out teeth.

Case report:
A patient named 24yrs old, reported to the Department of Prosthodontics, Institute of Dental Sciences, Bareilly, Uttar Pradesh with the chief complaint of discolored and decayed lower front teeth for a long time. On complete examination, including both the clinical and radiographic revealed grossly carious mandibular anterior teeth along with pulpal involvement, missing maxillary left central incisor, lateral incisor, canine, mandibular first molar and root stump of right maxillary first molar. (fig.1)

• Diagnostic impressions of both the arches were made and the casts were poured which were mounted with face – bow transfer.
• The OPG and periapical radiographs showed grossly carious teeth and various isolated periapical lesions. (fig.2)
• The panoramic radiograph revealed teeth Nos. 11, 12, 13, 46 were missing.


Clinical Procedure:-

• As the patient was not interested in extraction because of her young age, we planned for a multidisciplinary approach involving the periodontal, endodontic and prosthodontic procedures.
• Due to the pulpal involvement, teeth no.- 21, 22, 23, 31, 32, 33, 34, 41, 42, 43, 44 were treated with root canal treatment ( fig 2)
• As crown length of mandibular anteriors and first premolars was small, the biologic width of each tooth was calculated and crown lengthening procedure was carried out followed by Coe-pak application.(fig3)
• After a healing period of 15-20 days impressions were made and casts were prepared mounted by face bow transfer.
• As the patient was young no attrition was present and the vertical dimension was found to be normal.


RESTORATION OF MANDIBULAR ARCH:-

• Due to the loss of a large part of tooth structure post and core treatment was done for teeth no.- 31, 32, 33, 34, 41, 42, 43, 44 followed by tooth preparation (fig 4).
• Temporary crowns were cemented on the prepared teeth with non- eugenol temporary cement as the core was of composite.
• All interferences were removed which were present on a semi-adjustable articulator.
• Now this lower cast was articulated in the previous articulation by using same recoded bite which was taken earlier as there were no changes in posterior teeth.
• Wax patterns were fabricated and porcelain fused to metal crowns were made.


RESTORATION OF MAXILLARY ARCH:-
• Teeth no.- 14, 21, 22, 23 were prepared so as to get the ferrule effect followed by post and core treatment for teeth no.- 22, 23 followed by tooth preparation .
• Temporary bridge for 14, 13, 12, 11, 21, 22 and temporary crown for 23 were cemented Now this lower cast was articulated in the previous articulation by using same recorded bite which was taken earlier as there were no changes in posterior teeth.
• After taking the coping trials complete porcelain fused to metal crown and bridge were fabricated which were cemented with resin cement. (fig.5)
• Patient was recalled after 1 month, 4 months, 6 months for the follow up of the treatment

Discussion:
As the patient was young, the main aim of the whole treatment was to achieve better esthetics along. The treatment plan was framed according to the clinical and radiographic findings which includes root canal treatments, post and cores, crown lengthening procedure, crowns and bridges but no extraction at all (except the root stumps). Conclusion:
The completed treatment was subjectively and objectively very successful, with the patient continuing to do well 2 years after completion of treatment
The treatment began with esthetics, it was correlated to function, it took into consideration the remaining tooth structure, and it was facilitated by recognition of the biologic needs of the patient.
Hence the esthetics of the patient was restored along with complete functional, structural, and biologic rehabilitation

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Figure 1: Preoperative view Figure 2: OPG



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Fig-3 COE pack application after crown lengthening. Fig-4 Tooth preparations



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Fig-5 Postoperative view



Refrences:
1. Sorensen JA, Engelman MJ. Ferrule design and fracture resistance of endodontically treated teeth. J Prosthet Dent 1990;63:529–36.
2. Hemmings KW, King PA, Setchell DJ. Resistance to torsional forces of various post and core designs. J Prosthet Dent 1991;66:325–9.
3. McMullen AF, Himmel VT, Sarkar NK. An in vitro study of the effect endodontic access preparation has upon the retention of porcelain fused to metal crowns of maxillary central incisors. J Endodont 1989;15:4.
4. T. K. Binkley, C. J. Binkley, A practical approach to full mouth rehabilitation The Journal of Prosthetic Dentistry Volume 57, Issue 3, March 1987, Pages 261-266

Biographical sketch.

Dr. Dinker goel passed out his mds in 2007 from College Of Dental Sciences ,Davangere .Since then he is working as an assistant professor in Institute of Dental Sciences , Bareilly.(UP). In his MDS tenure he has presented several posters out of which he was awarded the Best poster award in IPS conference held at Pondicherry in 2006 for Ocular prosthesis – an Overview of Various Impression Techniques. During his job he has been an active member of ida and is currently designated as CDE chairman. He has been called as a guest speaker by Agra Ida for talk on Nanodentistry.

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    DINKER GOEL*, HIMADRI GOEL**
    *Sr lecturer, Department of Prosthodontics
    Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
    ** B.D.S.

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