Prosthetic rehabilitation of a patient with chronic rheumatic disease

Abstract

Introduction: Ankylosing spondylitis is a chronic, inflammatory rheumatic disease. The temporomandibular joint can be
affected in 6–20% of the cases, therefore it is essential to consider its gnathological aspects during the prosthetic rehabilitation
of these patients.
Case report: A 42-year-old female patient presented to the Department of Prosthodontics of Semmelweis University
with temporomandibular joint pain and for the aesthetic prosthodontic rehabilitation of her missing teeth. After the
conservative therapy of the myogenous and arthrogenous painful temporomandibular disorder symptoms of the patient,
pre-prosthodontic restorative treatments were provided. The prosthetic treatment was performed according to the gnathological
principles: digital jaw movement analysis was performed, and intraoral drawing device was used for the registration
of the future jaw relation. After the digital smile design, temporary restorations were digitally constructed (polymethyl
methacrylate, PMMA) in the increased occlusal vertical dimension so that the neuromuscular system could adapt to
the changed jaw relation. Digital impressions were taken at all phases of the rehabilitation, using the Trios 3Shape Pod
intraoral scanner. The final restorations for the upper dental arch included a 4-unit monolithic zirconia bridge, five zirconia
crowns with cut-back technique and a 5-unit porcelain fused to metal bridge. For the lower jaw, a 3-unit monolithic zirconia
bridge and five ceramic table-tops were made. To prevent the excessive overload of the temporomandibular joints
and the jaw-closing muscles due to sleep bruxism and also for the protection of the prosthetic restorations, a Michigantype
splint was fabricated for the patient.
Summary: Dental treatments for patients living with ankylosing spondylitis should take place with special regard to
the systemic circumstances if extractions, endodontic or periodontal treatments are needed. For the prosthodontic rehabilitations,
the gnathological principles should be followed. Good prosthetic planning and functionally and aesthetically
well-made restorations as well as digital manufacturing can increase these patients’ well-being and quality of life.