E-Max Crown #7 and RPD fabrication

A 64-year-old male presented with macroglossia, limited jaw opening, generalized periodontitis, multiple missing teeth secondary to prior extractions, and long-term provisional crowns on teeth #7 and #10. Clinical and radiographic evaluation revealed secondary caries on tooth #12, which served as the abutment for an existing porcelain-fused-to-metal (PFM) fixed partial denture spanning #12–15.
Fixed Prosthodontics & Oral Surgery: Following removal of provisional restorations, tooth #10 was deemed non-restorable due to extensive secondary caries and insufficient remaining tooth structure. An Essex retainer was fabricated prior to extraction to provide a temporary esthetic replacement. The existing PFM bridge (#12–15), placed approximately 30 years prior, was evaluated. Tooth #12 exhibited significant gingival recession and recurrent decay, rendering it non-restorable and indicated for extraction. Tooth #15 demonstrated a mesial marginal discrepancy but was free of caries and mobility. The bridge was sectioned to preserve the integrity of the crown on #15 while allowing for extraction of #12. The marginal discrepancy on #15 was refined using a high-speed handpiece and restored with amalgam. Given the longevity and structural integrity of the existing crown, and absence of recurrent decay, it was maintained rather than replaced with a surveyed crown prior to removable prosthesis fabrication.
Tooth #7 was restored with a definitive lithium disilicate (E.max) crown without complication. The patient exhibited an edge-to-edge occlusal relationship and generalized attrition consistent with parafunctional bruxism. Occlusion on #7 was carefully adjusted to minimize functional loading and reduce fracture risk. A protective occlusal night guard was fabricated and delivered.
Removable Prosthodontics: Due to macroglossia and limited jaw opening, conventional stock trays were not tolerated. An intraoral scanner was utilized to obtain digital impressions, and diagnostic casts were fabricated via 3D printing. These casts were surveyed, and custom trays were fabricated to obtain definitive impressions. Following extractions, the patient presented with a Kennedy Class II Modification 2 maxillary partially edentulous arch, missing teeth #1–3, #10, and #12–14.
The RPD framework design included:
Major connector: A-P palatal strap
Direct retainer on #4: cast circumferential clasp with DO rest (due to occlusal interference preventing ideal MO placement)
Indirect retainers: cingulum rests on #6 and #11
Direct retainer on #15: clasp placement following height of contour modification of existing PFM crown

All modifications were completed to optimize path of insertion, retention, and stability of the prosthesis while accommodating the patient’s anatomical limitations.