Prosthodontics & Occlusion · patient case question
After removal, what is the appropriate definitive treatment?
Patient case: Loose anterior bridge with an open margin
Patient: 58-year-old woman.
Chief complaint: My bridge is loose and I can see metal at the gumline.
History: Bridge placed roughly ten years ago spanning the maxillary right canine to the maxillary left lateral incisor.
Findings: Visible open margin with exposed metal on the canine retainer, described as an over-contoured and poorly finished preparation margin. Caries at the canine margin. The prosthesis moves under load.
Show answer and explanation
Correct answer: B. Restore the caries, re-prepare the margin on the canine, and fabricate a NEW bridge
- A. Re-preparing the tooth changes the preparation geometry, so the old casting cannot fit it. This is the essential concept in the item.
- B. CORRECT. Caries control and foundation restoration come first, with endodontic assessment if the excavation runs deep. Then the abutments are re-prepared to a sound, properly finished margin, a provisional is placed, and a NEW prosthesis is made. The original casting was generated from a preparation that no longer exists.
- C. Discarding restorable abutments in favour of implants is unnecessarily destructive.
- D. A prosthesis with a demonstrated marginal misfit will not seal on recementation regardless of caries removal.
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