Pandey KK et al.

: Cast Partial Denture in Maxillary Anterior Region CASE REPORT

Cast Partial Denture in Maxillary Anterior

Region with Severe Bone Loss: A Case Report
Kaushik Kumar Pandey1, Arun Kumar Tiwari2, Mariyam Ali3, Pratibha Katiyar4, Abhishek Gaur5,
Fauzia Tarannum6
1,6-Assistant Professor, Department of Prosthodontics, Career Post Graduate Institute of
Correspondence to:
Dental Sciences, Lucknow. 2-PG Student, Department of Prosthodon-tics, Career Post Dr. Kaushik Kumar Pandey, Assistant
Graduate Institute of Dental Sciences, Lucknow. 3-Professor & HOD, Department of Professor, Department of Prosthodontics,
Prosthodontics, Career Post Graduate Institute of Dental Sciences, Lucknow. 4-Associate Career Post Graduate Institute of Dental
Professor, Department of Prosthodontics, Career Post Graduate Institute of Dental Sciences, Lucknow
Sciences,Lucknow. 5-Associate Professor, Department of Prosthodontics, Career Post Contact Us: www.ijohmr.com
Graduate Institute of Dental Sciences, Lucknow.

ABSTRACT
Nowadays implant-supported prosthesis is very popular due to various advantages. But every patient is not suitable for
implant-supported prosthesis due to a physical, medical, financial and psychological condition of the patient. In case of
severe bone loss and uncontrolled systemic problems, implant-supported prosthesis is not indicated. In this case report,
treatment planning and steps of cast partial denture are discussed.
KEYWORDS: Removable Partial Denture, Cast Partial Denture, Anterior bone loss, CPD
loss was accidental trauma. Intraoral examination
ASSSAAsasasss
AINTRODUCTION revealed missing 11, 12, 13, 14, and 21 with severe bone
loss in relation to the premaxillary region (Figure 1,2).
According to Glossary of prosthodontics term esthetics
Grossly decayed teeth were 25, 26, and 27. On the basis
can be defined as “pertaining to the study of beauty’ and
the sense of beautiful.” Esthetics plays a major role in the
rehabilitation of complete and partially edentulous
patients. So during planning to rehabilitate a partially
edentulous patient with a prosthesis, esthetics, as well as
function, is to be restored close to natural. This will
enhance patient’s self-confidence.1
In distal extension cases, there are only two options;
implant-supported fixed prosthesis and removable dental
prosthesis. Every patient does not accept implant-
supported fixed prosthesis due to high cost, surgical
interventions and time factor. In case of uncontrolled Figure 1: intraoral view showing missing 11,12,13,21
systemic problems and severe bone loss, implant-
supported prosthesis is also contraindicated. In these
situations, cast partial denture is good treatment options
for the patient with partially edentulous arches.2
In this article, discussed the steps of rehabilitation of
patient having partially edentulous arch and severe bone
loss in a maxillary anterior region with cast partial
denture.

CASE REPORT
A 36-year-old male patient was reported to the
Department of Prosthodontics, of Career Post Graduate
Institute Of Dental Sciences & Hospital Lucknow, with
the chief complaint of difficulty in eating and bad
appearance in relation to the upper front region.
He had no relevant medical history and his occupation
was a farmer. The primary cause of upper anterior teeth
Figure 2: intraoral view showing Severe bone loss in premaxilla
region
of patient’s current condition; two treatment options
could be given to the patient. One implant-supported
fixed dental prosthesis and second is cast partial denture
(removable dental prosthesis). Implant-supported fixed

How to cite this article:

Pandey KK, Tiwari AK, Ali M, Katiyar P, Gaur A, Tarannum F. Cast Partial Denture in Maxillary Anterior Region with Severe Bone Loss: A Case Report.
Int J Oral Health Med Res 2018;5(1):32-34.

International Journal of Oral Health and Medical Research | ISSN 2395-7387 | MAY-JUNE 2018 | VOL 5 | ISSUE 1 32
 Pandey KK et al.: Cast Partial Denture in Maxillary Anterior Region CASE REPORT

dental prosthesis was discarded as there was a severe  With the help of pattern waxes, pattern was made for
bone loss in premaxilla region and patient was not ready cast partial denture framework according to design.
for ridge augmentation surgery. Finally, it was decided to  Casting was done and CPD framework was retrieved.
deliver CAD-CAM cast partial denture in relation to 11,  Framework try-in and jaw relation was done with
12, 13, 21 with root canal treatment and individual crown facebow. In framework try-in, all extensions and rest
in relation to 25, 26, 17. After discussing the treatment was evaluated so that it does not affect the occlusion.
plan, expenditure, time, Informed consent was taken with Minor correction, adjustment and polishing
the patient and his family members. done.(Fig. 2 & Fig 3)
Treatment Steps:-
Surveying and Designing: Diagnostic impression was
taken with alginate impression material, and the cast was
poured with type III gypsum product. Surveying of
diagnostic with cast partial denture designing was done
with proper color coding. Survey tilt of 5 degree and
tripoding done to relocate the cast in the same position. A
maxillary removable partial denture(RPD) was designed
with a closed horseshoe shape major connector, occlusal
rests and cast circumferential embrasure clasps on
15,16,24,26. Mouth preparation is done according to
design and tilt of the cast partial denture framework.
Fig. 2: framework try- in and jaw record
Mouth Preparation: The patient was referred to the
department of periodontics for scaling and root planning.
The patient was further referred to the department of
endodontics for root canal treatment of 25, 26, and 27.
RPI clasp on the maxillary left lateral incisor and
accessory cingulum rest on right canine. Root canal
treated teeth 15,16,25,26 were prepared to receive metal
crowns with rest seats for embrasure clasps. Rest seats
were carved out on wax patterns of 15,16,25,26 (at the
distal side of 15, 25 and mesial side of 16 and 26). After
casting metal crowns with rest seats, were finally
cemented with glass ionomer cement. Guide planes were
made on 14 and 22. A check impression was made with
alginate and cast was made with dental stone (type III).
Final surveying of check cast was done to evaluate the Fig. 3: framework try- in and jaw record
mouth preparation according to designing. Check Cast  Cast was mounted on semi-adjustable articulator and
was placed on surveyor according to tripoding. A custom teeth setting done.
tray with the wax spacer and tissue stop was made on  Try-in done and final approval was taken with
check cast so that proper extension of the labial vestibule patient and his relatives. In try-in shade of anterior
was recorded. Border molding was done on the labial teeth, labial fullness and anterior guidance was
vestibule area with green stick compound on a special checked properly.
tray. After removal of the spacer, the final impression  After final waxing and carving, acrylization was
was taken with the help of addition silicon on the custom done.
tray. The impression was poured with type III gypsum
 Finishing and polishing of acrylized cast partial
product.
denture was done.
Duplication of the master cast: Following steps were  The cast partial denture delivered to the patient after
done: minor adjustments.(Fig.4)
 Die hardener was applied on master cast before  The patient was pleased with the functional and
duplication. esthetic results.(Fig. 5)
 Blocking out of all undercut areas with block out  After follow up of 3 months at the interval of 2
wax was done. weeks, patient did not complain and was satisfied
 Spacer was applied on ridge area of master cast for with the prosthesis.
acrylic flow below minor connector.
 Master cast was placed on the agar duplicating flask DISCUSSION
and molten agar was flowed. After complete setting
of agar, master cast was retrieved. In the mould Restoration of Kennedy’s class IV situation is very
space, refractory material was filled and refractory difficult in a long span edentulous situation with the
cast was retrieved. severe bone loss in the labial vestibule area.

International Journal of Oral Health and Medical Research | ISSN 2395-7387 | MAY-JUNE 2018 | VOL 5 | ISSUE 1 33
 Pandey KK et al.: Cast Partial Denture in Maxillary Anterior Region
Fig. 4: CPD insertion
Fig. 5: CPD insertion
In this case report, implant-supported prosthesis was
discarded due to the severe bone loss in the labial
vestibule area. If we choose an implant for such situation,
bone grafting has to be done and left for 3-4 month. So in
this case, due to high cost and multiple surgical
interventions, the patient was not ready for implant-
supported prosthesis. Cast partial denture was chosen as
it not only restores anterior esthetics, phonetics but also
the function.2-4
While restoring the teeth with removable partial dentures,
sometimes anterior teeth must be used for support. The
use of I bars instead of circumferential clasp may
somehow make restoration less conspicuous, however
slight display will be unavoidable while smiling or
speaking especially in those with high smile line. In this
case report, anterior display of RPI clasp was very
minimal, and acceptable to the patient. As there was a
long edentulous area so RPI clasp was must for anterior
retention, stability and support of the prosthesis. In this
situation, the maxillary labial flange of cast partial
denture was fabricated over anterior bone loss for better
aesthetic results.4-7
In an anterior bone defects with multiple missing teeth, a
cast partial denture would be better choice. This type of
International Journal of Oral Health and Medical Research | ISSN 2395-7387 | MAY-JUNE 2018 | VOL 5 | ISSUE 1
CASE REPORT
the CPD has rotational path of placement, and rigid metal
framework in place of clasp arms cannot be adjusted. In
Kennedy class I and class II with anterior modification,
this type of rigid design are generally not given as it
would cause harmful forces on abutment teeth. A twin-
flex clap can be given to prevent abutment teeth from
harmful torquing forces, and have better esthetic results.
The flexible twin-flex clasp is soldered into a channel
which is cast in the major connector. However, a CPD
with twin-flex claps fabrication for such situation is
technique sensitive and required a good lab support. 6-7
Some clinicians have also adopted camouflaging the
clasp arms with tooth-colored micro filled resins through
the etched metal retentive mechanism. However, this also
doesn’t provide total elimination of clasp display facially
and is temporary.6-8
CONCLUSION
A cast partial denture is good treatment of choice for
anterior bone defects and, when patient is not ready for
extensive surgical ridge augmentation. It is not only
restores esthetics of patient but also function and self
confidence. For fabrication of such type of prosthesis, a
trained clinician and good lab support is mandatory. The
supporting teeth with excessive mobility are not
recommended for the CPD abutment. Patients having
high caries index, are not appropriate for the RPI clasp.
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3. Belles DM. The twin flex clasp: an esthetic alternative. J
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4. Shr estha S, Sah S. Esthetic Rehabilitation with a Cast Par
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2016 May, Vol-10(5): ZD11-ZD13
Source of Support: Nil
Conflict of Interest: Nil
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