ANTERIOR LOOP CONNECTOR FIXED PARTIAL DENTURE INREPLACING MISSING CENTRAL INCISOR: A CASE REPORT

ABSTRACT:Replacement of single anterior tooth is a complex, challenging procedure that can be accomplished withimplant-supported restorations as well as conventional porcelain-fused-to-metal and resin-bonded fixed partialdentures. Different esthetic treatment options must be explored iri treating such patients. Drifting of teeth into theedentulous area may reduce the available pontic space;whereas a diastema existing before an extraction may resultin excessive mesiodistal dimension to the pontic space. Although rarely used, loop connectorsare sometimesrequired to address this problem of excessive mesio-distalpontic space. Loop connectors offer a simple solution fora situation involving an anterior edentulous space albeit with the maintenance of the diastema. This article presentsa case with excessive space in the anterior region treated witha loop connector to achieve ideal esthetic results in themaxillary anterior segment.

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CODS Journal Vol-5 Issue-2, September 2013

Dr. Ashwini B.L.Asst. Professor,

Dept. of ProsthodonticsCollege of Dental Sciences, Davangere

Email: ashwinLprosthodontist@gmail.com

KEYWORDS: Anterior edentulous space, diastema,loop connector, spring cantilever fixed partial denture.

INTRODUCTION: Replacement of single anteriortooth can be achieved through different options vizdental implants,resin bonded bridges, conventional fixedpartial dentures'. Patient's exacting demands, on manyoccasions defeat the possibility of ideal treatment. Insomecases, adapted treatment plans have to betried. Acase is reported where maxillary central incisor wasreplaced with fixed dental prosthesis incorporating dualloop connectors.CASE REPORT: A 35-year-old female patient reportedto the Department of Prosthodontics, college of dentalsciences , Davangere with a missing right maxillarycentral incisor. The anterior edentulous space was large;there was a partial spacing present between anteriors . Asingle tooth implant was a viable alternative as it wouldallow a restoration maintaining both the mesial anddistal diastema. However, an implant would entailsurgery and a more protracted treatment'. But the patientwas neither willing for orthodontic treatment and norsurgery for implant placement and wanted an immediatefixed alternative for the central incisors. There were onlytwo treatment options left: l) a loop connector fixedpartial denture and 2) a spring cantilever (which is in facta variation ofloop connector)'.

Dr. Vinutha Hiremath���������

Dept. of Prosthodontics,KLE'sVK Institute of Dental Sciences,College of Dental Seiences, Belgaum.

In this case, the patient did not require any posteriorcrowns and the left central incisor and the right lateralincisor needed certain esthetic corrections.Therefore, it was decided to fabricate a doble loopconeector fixed partial denture with the right centralincisor as pontic and left central incisor and right lateralas the abutment teeth, maintaining diastema between thepontic and the retainers.Procedure: Tooth preparation was done in relation tothe right lateral and left lateral with slight sub gingivalfinish line. Retraction procedures were carried out, apolyvinyl siloxanes (Aquasil Soft Putty and Aquasil LV,Dentsply Inti) impression was made using the puttyreline technique in a rim-lock impression tray andremovable dies were fabricated. Die ditching was doneto expose the restoration margins. As a result, the softtissue architecture around the abutment dies was lost. Adecision was made to fabricate a soft tissue mask aroundthe removable dies.The impression surface of the final rubber baseimpression (the same one used for making the removabledies) was first coated with a thin layer petroleum jellyand a light body addition silicon (Aquasil LV,DENTSPLY Int) impression material was injectedaround the abutment die. Then the final impression wasfirmly pressed on to the dies. Thus, a soft tissue cast was��������

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(ODS Journal Vol-S Issue-2, September 2013---~--~Wax pattern for the retainers were fabricated with blueinlay wax, casted and ceramic buildup done. The palatalspring cantilever connecting the pontic to the retainerson the right central incisor and the right canine weremade with round 14 gauge wax. Care was taken to keepthe spring away from the rugae. The rest of thelaboratory procedures were common with theconventional metal-ceramic FPD construction. Prior tofinal cementation, the loop connectors were polished tohigh shine.

Conclusion:Although they are rarely used, loop connector FPD aresometimes required when an existing diastema is to bemaintained in a planned fixed prosthesis, as in theabove case. It offers a simple solution to aprosthodontic dilemma involving an anterioredentulous space, albeit with the maintenance of theslight diastema.

Metal Coptng.

DISCUSSION: In a loop connector fixed partialdenture, the connector consists of a loop on the lingualaspect of the prosthesis that connects adjacent retainerand! or pontic. The loop may be cast from sprue wax thatis circular in cross section or shaped from platinum-gold-palladium (Pt-Au-Pd) alloy wire', The choice isentirely up to the dentist or the dental laboratory.Meticulous <design is important to ensure that plaquecontrol is not impeded.The palatal connector in spring cantilever fixed partialdenture is a type of loop connector.However, the connector here is a thin and resilient bar,closely adapted to the palate so that it is partly supportedby soft tissue". It connects the pontic to a posterior toothor teeth requiring full coverage crowns. Although in arare instance healthy and sound, posterior teeth havebeen used as abutments to replace a maxillary anteriortooth with diastema, using a resin bonded springcantilever fixed partial denture", The long palatalconnector in spring cantilever fixed partial denture maydeform, if thin, and produce coronal displacement of thepontic; it may interfere with speech and is often poorlytolerated". For these reasons this design is seldom used.In the above case, the loop connector FPD not only

addressed the problem of excessive mesio-distal widthpontic space, but it also corrected the axial alignment ofthe left central incisor and right lateral incisor. It is alsoeasy to clean and maintain. The connectors should notbe overtly thick and should have an intimate contactwith the underlying mucosa; otherwise, there arechances that the patient may develop the annoying habitof pushing the tip of the tongue into the gap between theloop and the mucosa exerting undue stresses onto the

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