Chairside complication management of hybrid prosthesis
Leila Nikpour, Akram Nikpour
Introduction: The most common complication after placement of an implant supported hybrid prosthesis is mucositis, mainly associated with prosthetic tail too long and formed concave and therefore difficult to implement proper oral hygiene. The first step to prevent this complication is during the surgical removal of alveolar process in order to create enough room. It is important to form the bone flat with convex borders to prevent concave form of prosthesis on tissue side. If the bone has some deformity, prosthetic modification can make it self-cleansable without compromising the esthetic.
Case: A 74y/o male presented in the clinic after one months of delivering a milled metal-ceramic hybrid prosthesis on the maxilla with chief complaint of "food stuck between my gums and prosthesis”. Upon unscrewing the hybrid prosthesis, the concave form of tissue side and accumulation of plaque and mucositis was noticed. Used Occlude PIP spray to find the tissue contacts. Made the palatal aspect of tissue side round and removed flange extension using porcelain polishing bur. The prosthesis was steam cleaned and the screw channels’ head on intaglio was covered with wax. After sandblasting with Aluminum oxide, the intaglio was etched with 9.6% of Hydrofluoric acid, followed by applying Monobond Plus as primer and OptiBond FL as bonding according to DFU. Used the gingival shade composite to fill the concavity as much as pressure on gingiva was acceptable. Polished and delivered. Upon 1 month follow up, patient reported comfort and cleansability of the prosthesis.