Cast removable partial denture improving appearance and masticatory function-A case report

Dentists are disappointed after delivery of cast removable partial dentures because their patient refuses or is unable to wear the denture and the treatment is therefore deemed unsuccessful. When so many patients do not comply with treatment, it is instructive to reflect on why and how the treatment is performed. Appropriate, comprehensive treatment planning should precede and eliciting the patient's chief complaint, as well as his or her expectations of treatment before treatment planning. The case presentation provides for the practitioner to discuss the patient's expectations and to outline both favourable and unfavourable short and long term outcomes. By providing this information, the practitioner ensures that the patient is fully informed before giving consent and that he or she understands the associated benefits and risks. Introduction Removable partial denture is utilized to improve the aesthetic and masticatory function. It fulfils the necessary requirement of patient. Masticatory performanceand bite force as the objective measurement in evaluating masticatory function. Denture patient were reported handicapped and have less masticatory performance1-10. The demand for replacement of missing teeth is strongly related to the position of the missing teeth. Replacement of missing posterior teeth and cosmetic dental treatment in general, depends on the perception *Address of Correspondence: Dr. Ali Afzal Khan Asst. Professor Dept of Prosthodontics Update Dental College & Hospital. Aichi Nagor, JBCS Sarani, Turag, Dhaka-1711. Telephone: +8801912-331254 E-mail: dr.afzal14@yahoo.com of the patient. Even in countries with highly developed dental care systems, open spaces in the premolar and molar regions are well accepted by people of all ages.12 However where anterior teeth are missing, the importance of restoring the spaces is self evident and reinforced by the large impact on satisfaction with esthetics where there are any unrestored spaces.13 Even when the patient considers the prosthesis unsatisfactory, he or she is more likely to wear the device if it replaces missing anterior teeth.14 Update Dent. Coll. J 2011: 1(1): 14-17


Introduction
Removable partial denture is utilized to improve the aesthetic and masticatory function.It fulfils the necessary requirement of patient.Masticatory performanceand bite force as the objective measurement in evaluating masticatory function.Denture patient were reported handicapped and have less masticatory performance 1-10 .The demand for replacement of missing teeth is strongly related to the position of the missing teeth.Replacement of missing posterior teeth and cosmetic dental treatment in general, depends on the perception of the patient.Even in countries with highly developed dental care systems, open spaces in the premolar and molar regions are well accepted by people of all ages.12 However where anterior teeth are missing, the importance of restoring the spaces is self evident and reinforced by the large impact on satisfaction with esthetics where there are any unrestored spaces.13 Even when the patient considers the prosthesis unsatisfactory, he or she is more likely to wear the device if it replaces missing anterior teeth. 14he prospect of a good esthetic result frequently motivates the patient to wear a new denture15and esthetics can be more important than function for many individuals. 11,16desire to enhance chewing ability is the second most frequent reason given for seeking dental treatment. 17Masticatory efficiency of the dentition can be determined by an objective and repeatable laboratory test 18 that measures the amount of grinding for a predetermined number of strokes.Masticatory ability is the subjective assessment of chewing capacity, as determined by questionnaire or interview. 19The act of mastication is one of the most important physiological determinants governing food intake.If people feel they can chew efficiently, then their food intake is not restricted by texture or hardness.An intact masticatory apparatus can exert a positive effect on nutrition by permitting a wide selection of food items, whereas compromised dentition can have a detrimental effect by promoting adverse shifts in food ingestion patterns. 20

Case Report
A male patient aged 56 years reported to the department of Prosthodontics, Bangabandhu shekh mujib medical university, Dhaka, for the treatment of his missing teeth for four month.The patient was mixed diet consumer and demanded a restoration which improves the appearance and masticatory efficiency.On clinical examination and analysis of the mounted diagnostic models, the patient exhibit with missing both central incisors, lateral incisors, canines, right first premolars, right first and second molars and left second molar.The intra oral picture and mounted diagnosed casts showed maximum space between the edentulous space and the opposing remaining natural teeth.Diagnostic models were analyzed and were surveyed.resins are better than the non metallic acrylic denture.Krall and others were investigate to state that the presence of removable partial denture is an important for nutritional intake and the replacement of missing teeth could help people maintain a healthy diet.Other investigators have reported that partial tooth loss results in altered food acceptability, just as edentulism is associated with poor diet and compromised nutrition and tooth loss may cause dietary change . 21Moynihan and others suggested that the probable reason for failure of prosthetic rehabilitation to improve diet is that chewing ability is only one component of food choice.In the absence of dietary intervention, patients may be unaware of the need to change their diet, and those requiring dental prostheses should therefore receive dietary advice that accounts for all the factors influencing individual food choice. 22

Conclusion
The restoration of the partially edentulous exhibits a challenging decision making in planning the treatment without compromising the patient's needs.The technique followed in the treatment of this patient is a simple but yet effective treatment plan for providing an optimum treatment for an individual.Mockup mouth preparations were done on the diagnostic models and the desired preparations were executed on the teeth intraorally in the patient's mouth.Final mouth preparations were made in the patients mouth and final impressions were made using polyether elastomeric impression material.Master cast fabricated using high strength stone.Master cast surveying procedure was carried out to block the under cuts and refractory casts were made using phosphate bonded investment material.Wax pattern were contoured using preformed was patterns.All the surface were contoured in the anato-mical form.
The refractory model with the wax pattern was invested and casting procedure was carried out.The casted cast partial denture was finished and polished in the conventional manner.The metal framework was tried in the patients' mouth for proper seating.The occlusal rim was made and proper alignment was done and tried again.After curing the satisfactory consent was obtained from the patient and the cast partial denture was delivered to the patient.One year follow-up, the patient had provided evidence of better face profile and he reported superior masticatory efficiency.

Discussion
The procedure explained in the rehabilitation of this patient is an innovative way of restoration of partially edentulous arches with increased masticatory efficiency and apearance.The cast partial denture fabrication metal framework will be trained in the patient's mouth and will be subjected to acrylization.The impact strength, compressive strength of the alloys with acrylic

Fig 4 .
Fig 4. Insertion of the prostheses after curing.