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loop connector fdp

1. Anterior loop connector Fixed dental prosthesis: A simple yet effective solution to complex esthetic Dilemma DR. ZARMINA ASHRAF FCPS RESIDENT DEPARTMENT OF PROSTHODONTICS SUPERVISOR LT COL.MUHAMMAD SAJJAD

2. 2 CRITICAL APPRAISAL TITLE Anterior loop connector Fixed dental prosthesis: A simple yet effective solution to complex esthetic dilemma AUTHORS Dr Pardeep Bansal, Dr Kashish Narang , Dr Preetika Bansal, Dr Manan Gupta , Dr Ambuja , Dr Pardeep Bansal JOURNAL Journal of Positive School Psychology ,published in 2022 METHODOLOGY Case Report

3. OUTLINE

4. A 55-year-old female patient reported to the department of Prosthodontics, with chief complaint of missing upper left front tooth Patient had a diastema between front teeth previously and wished to have that diastema in the replacement teeth as well CASE REPORT

5. Medical history : Insignificant Family history : Insignificant Dental history : Trauma 5 Months back due to which patient lost 21 and partial damage to 11 Parafunctional habits : None HISTORY

6. Intraoral examination revealed missing 21 with large edentulous space of 14mm CLINICAL EXAMINATION

7. Partially dentate maxillary arch with kennedy’s class III with missing 21 , fractured 11 and midline diastema DIAGNOSIS

8. Flexible denture Maryland bridge Fiber –reinforced composite resin bridge Conventional tooth supported FDP Implant supported crown FDP with palatal loop connector Spring cantilever FDP TREATMENT MODALITIES

9. Fixed dental prosthesis with palatal loop connector was planned with 11 and 22 as abutment teeth PROPOSED TREATMENT PLAN

10. Oral prophylaxis phase-I therapy : Radiograph of the abutment teeth was done and revealed 11 to be root canal treated Upper and lower diagnostic impressions were made with the irreversible hydrocolloid i.e. Alginate and cast poured in type III gypsum TREATMENT PLAN

11. M ock reduction of abutments on study cast was done and diagnostic wax up completed An alginate impression of this mock up was taken and duplicated in type III dental stone

12. Putty index of addition polyvinyl siloxane was made which was later used to fabricate provisional restoration

13. Tooth preparation was done in relation to 11 and 22 with subgingival finish line Gingival retraction was done and an impression with Polyvinyl siloxane soft putty was made using putty wash two step technique in a rim lock impression tray Impression was poured and master cast fabricated

14. Interocclusal registration was done using quick setting rigid polyvinyl siloxane provisional restoration was relined intraorally , finished, polished and cemented with temporary cement Zinc oxide eugenol

15. Phase 2 therapy : Casts were mounted on a semi adjustable articulator using facebow transfer Two coats of die spacer were applied on the dies to provide space for cementation Wax pattern for the retainers were made with Inlay Casting Wax

16. Loop connector wax up was done with 2 mm circular sprue wax, keeping in mind the vallies of the palatal rugae

17. Pattern was invested in phosphate bonded investment and casted in Ni- Cr base metal alloy M etal framework was tried for fit , occlusion and it was found to be accurate

18. Porcelain firing was done and bisque trial was checked intraorally E sthetics and positioning of pontic was verified cervicoincisal length of the incisors was verified by phonetics and esthetic method F inal glazing was done and cementation was performed with GIC cement

19. S

20. P atient was instructed regarding proper oral hygiene procedure and the importance of periodic recall and follow up was reinforced to the patient

21. DISCUSSION

22. CONNECTOR According to GPT-9 Connector in fixed Prosthodontics is that portion of a fixed partial denture that unites the retainer(s) and pontic (s )

23. CLASSIFICATION

24. LOOP CONNECTOR Loop connector is a rigid connector used when an existing diastema is to be maintained in a planned fixed prosthesis Consists of a loop on the lingual aspect of the prosthesis that connects adjacent retainer or pontics

25. Cast from a circular sprue wax or shaped with platinum gold palladium alloy Should not be overtly thick and should have an intimate contact with the underlying mucosa It should be meticulously planned to ensure that plaque control is not impeded REQUIREMENTS

26. It should be oval or rounded in cross section so that less food lodgement occurs positioning of loop should be such that there is no/minimum tongue interference and speech discomfort

27. Enhances natural appearance of restoration Maintains diastema Proper emergence profile ADVANTAGES

28. Requires additional laboratory procedures Difficulty in maintenance and oral hygiene May effect phonetics especially linguopalatal sounds DISADVANTAGES

29. Fabrication of fixed prosthesis with loop connector provides maximum esthetic and functional rehabilitation of a patient with extensive anterior diastema . Proper design and the patient acceptance is important to apply such designs in daily dental practice. Frequent follow up recalls are vital to achieve a good long-term prognosis. CONCLUSION

30. References Humaira , T. and Jasmeena , T., 2020. Compound loop connector as an indication to incorporate multiple diastema in a fixed partial denture. Journal of Advanced Medical and Dental Sciences Research, 8(10), pp.22-24 . Singh , V., Singh, S., Gupta, V. and Sinha, A.K., 2016. Loop connector: A treatment option to achieve optimal esthetics for maintaining the diastema -A case report. Journal of Advanced Medical and Dental Sciences Research, 4(2), p.75. Gupta , I., Rahangdale , T., Nayak , K., Kotnala , P., Jain, N. and Noorani , S.M., 2017. Loop connectors: The lost boon in prosthodontics. Acta Sci Dent, 1, pp.26-30. 4. Yunus , N., Rahman, S.U. and Jain, S., 2020. Twin cantilever twin loop connector fixed partial denture to restore diastema . International Journal of Medical Reviews and Case Reports, 4(7), pp.63-65 . 5. Dandekeri , S.S. and Dandekeri , S., 2014. Single anterior tooth replacement by a cast lingual loop connector-a conservative approach. Journal of Clinical and Diagnostic Research: JCDR, 8(9), p.ZD07.

31. Shenoy , K. and Sajjad , A., 2008. Anterior loop connector fixed partial denture: A simple solution to a complex prosthodontic dilemma. The Journal of Indian Prosthodontic Society, 8(3), p.162 . Nayar , S., Jayesh , R. and Venkateshwaran , V.D., 2015. Loop connectors in dentogenicdiastema . Journal of Pharmacy & Bioallied Sciences, 7( Suppl 1), p.S279 . Chaudhari , P., Bhandari, A., Sehwal , K. and Tarle , S., 2018. Prosthodontic Management of median diastema using Maryland bridge with Loop connectors. Pravara Medical Review, 10(3), pp.32-34. Mattoo , K., Singh, M. and Goswami , R., 2014. Resin bonded loop