Periodontics · patient case question
What can be done to protect the abutment carrying the connector?
Patient case: Intracoronal attachment prosthesis in a patient on denosumab
Patient: Female, 72 years old
Chief complaint: “Something feels loose on this side and the tooth has changed colour.”
History: Osteoporosis treated with denosumab, six-monthly injections for the past four years. No other systemic disease.
Findings: Intracoronal (precision) attachment retaining a removable partial denture. The abutment tooth shows extensive vertical bone loss, greater than the radiograph shown suggests. The tooth does not respond to pulp testing.
Show answer and explanation
Correct answer: A. Splint it to adjacent teeth
- A. CORRECT. SPLINTING joins a mobile abutment to adjacent teeth so that occlusal load is distributed across a larger combined root surface area and periodontal support. In a patient where extraction is being actively avoided, splinting is the mechanical intervention that keeps a periodontally compromised abutment functional. It is an adjunct to periodontal therapy, not a substitute for it.
- B. Removing the attachment without addressing the tooth abandons both the prosthesis and the abutment.
- C. Fluoride varnish protects the root surface from caries — worthwhile in its own right, but irrelevant to mechanical stabilisation of a mobile abutment.
- D. Increasing occlusal load on a tooth with severe attachment loss accelerates mobility and bone loss. Occlusal forces on a compromised abutment should be REDUCED, by adjustment and by redistributing the prosthesis design.