Int J Dent Case Reports 2011; 1(2): 112-118

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CAS E S TUDY
A FIXED REMOVABLE PARTIAL DENTURE TREATMENT FOR S EVERE RIDGE DEFECT
Ravi Shankar Y.1, A. V. Rama Raju2, D. Srinivasa Raju 3, P. Jitendra Babu4, D.R.V. Kumar5, D. Bheemalingeswara Rao6
1

Professor & Head, Dept. Of Prosthodontics, GITAM Dental College & Hospital, Visakhapatnam. Andhra Pradesh. India

Professor Department of Prosthodontics, Vishnu Dental College. Andhra Pradesh. India

Professor Department of Prosthodontics, Vishnu Dental College. Andhra Pradesh. India

Professor Department of Prosthodontics, Vishnu Dental College. Andhra Pradesh. India

Reader Department of Prosthodontics, Pacific Dental College. Udaipur. Rajasthan. India

6.

Senior lecturer. Department of Prosthodontics. Vishnu Dental College. Andhra Pradesh. India

Address for Correspondence

Dr Ravi Shankar Y.
Plot No: 23, Door No: 7-5-148,
Ocean View Layout, Pandurangapuram, Visakhapatnam,
Andhra Pradesh. Pin: 530003.
Email; raviys124@gmail.com, raviyalavarthy@yahoo.com
PhNo: 09885307066.

ABSTRACT
It has been well documented that anterior ridge defects present in a patient are very d ifficult to treat properly. These
defects have been treated with great amount of p lanning and co mplexit ies while using the conventional treatment
approaches like removable or fixed prosthesis and options of imp lant. The main aim and purpose of this article is
thus, to describe the process of fabrication of Andrews Bridge (a fixed -removable part ial denture), to treat a Class
III anterior ridge defect using natural teeth as abutments for its fixed co mponent followed a removable co mponent.
The procedure of fabricating Andrews Bridge was undertaken when a 40 year old patient came to the clinic with a
history of sports trauma 10 years ago and sequential radiographs were taken wh ich led to p lanning of the ext raction
of right central and lateral incisors. The patient later on insisted on a fixed treat ment option for the defect, but due to
a class III ridge defect the patient was explained about the Andrews Bridge and the treatment was planned
accordingly.
After the patient was treated with this Andrews Bar System, it was evaluated over a long period of time and
accordingly it was concluded that the patient had a good adaptability, co mfort , pleasing aesthetics and phonetics
were ach ieved as desired and can be given in patients where aesthetics due to repositioning o f teeth creates
difficult ies.

Key words: Andrews Bridge; Class III ridge defect; Cobalt Chro miu m alloy; Bar Attachment

Shankar, Rama Raju, Srinivasa Raju, Jitendra Babu, Kumar, Rao

Treatment For Severe Ridge Defect

INTRODUCTION

comfo rt, hygiene, normal phonetics and mostly

It has been well documented that anterior ridge

normal aesthetics.

defects present in a patient are very difficult to t reat

It was Dr. James Andrews of A mite, Louisiana who

properly (especially aesthetically). However, to treat

introduced

such defects when edentulous anterior portion of

(Institute of Cosmetic Dentistry, A mite, L.A.) (3)

fixed-removable

Andrews

System

maxillary ridge has both inadequate height and width;

INDICATIONS:

the conventional options of fixed part ial dentures

(like bridges) or imp lant supported fixed part ial
dentures are not enough. For such cases where
replacement of teeth along with the supporting
structures necessary for aesthetics can be achieved by
placing Andrews Bridge

a)

Absolute Indications -

1)
2)
3)

Excessive residual ridge defect.

Ridge defects/ jaw defects either due to trauma and/or
surgical ablation.
Cleft palate patients with congenital or acquired defects. (4)

b)

Relative Indications -

1)

Often fixed partial denture failure with badly damaged,

cracked or weakened teeth by fillings and disproportionate
teeth. (5)
Sometimes could be used in patients with periodontal
problems. (6)

Various treatment options available to treat such

ridge defects:
Soft Tissue Procedures- include various options like.
For Class I Defects- The Roll Technique.
For Class II and III Defects - The Interpro ximal
Graft Technique (1);
Free Gingival Graft;
The On lay Graft for aug mentation of ridge width and
height.
Bone Grafting- using Inlay and Onlay grafting
techniques with either autogenous grafts, allografts or
xenografts. (2)
Co mbination of a) and b) - includes Ridge
Augmentation using bone grafts followed by imp lant
placement.
Other Methods- include- Removable Part ial
Dentures; Fixed Partial Dentures with pink ceramic;
Fixed-Removable Partial Dentures (Andrews
Bridge).

2)

ADVANTAGES :
a)

b)
c)
d)
e)

It includes all the advantages of fixed and removable partial

dentures with better aesthetics, hygiene along with better
adaptability and phonetics.
It is comfortable and economical for patients.
There is no plate as in RPD.
No soft tissue impingement and the surrounding structures.
The system acts as stress breaker while transmitting
unwanted leverage forces.

The Andrews System is usually of two types based

on the area of bar attachmenta)
b)

Pontic supported.
Bone Anchored or Implant supported Andrews Bar
System.

HIS TORICAL BACKGROUND

This article thus explains the procedure of fabricating

Andrews Bridge was developed when all the

and correcting a ridge defect using a pontic supported

conventional fixed or removable partial dentures

fixed-removable Andrews Bridge.

were not successful in treating severe residual ridge

resorption or jaw defect cases either due to trau ma
and/or surgical ablation and to improve or achieve

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August 2011, Vol.1, No. 2

Shankar, Rama Raju, Srinivasa Raju, Jitendra Babu, Kumar, Rao

Treatment For Severe Ridge Defect

CAS E STUDY
A 40 year o ld male patient came to the clin ic with a
complaint of discoloration in upper front teeth. Upon
questioning the patient revealed history of sports
trauma ten years back. Radiographs were taken
which showed periapical rad iolucency giving an
appearance of a cyst involving both the maxillary
central incisors and right maxillary lateral incisor and
canine.
Figure 3: Trial of the metal (Co- Cr)framework in patients
mouth consisting of abutment teeth crowns and the CEKA
bar attachment

Figure 1

Figure 4: Shade selection for ceramic

The following sequential steps were followed for

treating the case:
a)

Root canal treat ment was perfo rmed fo r all the

four teeth showing periapical rad iolucency and
patient follow up was done regularly t ill four
months and the new radiographs showed no

Figure 2

regress of the periapical radio lucency pertaining

to right maxillary central and lateral incisor.

FIG.1 and FIG.2- Class III residual ridge defect in the

patients oral cavity to be corrected using Andrews Bar

b) Then the process of apisectomy was to be carried

System fixed removable prosthesis

out for the affected two teeth but due to the loss
of labial cort ical p late and the fenestration.The
teeth were ext racted and a removable partial

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Shankar, Rama Raju, Srinivasa Raju, Jitendra Babu, Kumar, Rao

Treatment For Severe Ridge Defect

denture was given to the patient and was

i)

followed up for an year.

c)

Old RPD was refitted in the patients mouth

along with the temporary restorations/crowns.

After one year the patient co mplained about food

j)

Later on, wax patterns were made on the

accumulat ion and also about the aesthetics and

prepared teeth which were connected using a

requested for a fixed treat ment option.

preformed

plastic

bar

attach ment

(CEKA

d) Radiographs of that region further showed loss

Attachments- PRECILINE), adapted according

of residual ridge both horizontally as well as

to the curvature of the ridge and was attached to

vertically, along

the abutment teeth as posteriorly as possible.

with

presence

of flabby

tissue,(leading to a Class III type defect) thereby

k)

clin ically making the implant placement a

cobalt alloy and this metal framework was tried

questionable procedure (as placement of bone

in the patients mouth and was checked for

graft material in a three sided defect makes

clearance between the bar attachment and

implant p lacement a questionable procedure due

underlying soft tissues.

to the property of osseointegration). Also mini

l)

implant or small diameter imp lant is also

e)

After satisfactory trial in and shade selection was

done for the ceramic.

questionable due to lack of proper bone height

m) The metal cro wns were then covered with a

and support and Class III defect. The patient was

ceramic layer and the whole restoration was

not willing for surgical bone grafting along with

fin ished and polished, then the temporaries were

inplant placement.

removed and the fixed co mponent of the

Hence, treat ment with Andrews Bridge was

Andrews System were cemented over the

chosen. The whole procedure along with its

prepared teeth.

advantages and disadvantages was explained to

f)

The whole pattern was then casted in chrome-

n) Then with the crowns in position, along with the

the patient and an informed consent was taken.

bar, an alg inate imp ression was made and a stone

For this the endodontically treated maxillary

cast was poured.

canine on right side and central incisor on the

o) Later on, the missing teeth were arranged in the

other side were taken as abutments to support the

wax rim and trial was done, which was further

Andrews System.

replaced by pink coloured heat cured acrylic

g) Firstly, diagnostic casts were prepared using an

resin with a clip p laced in the lingual aspect to

alginate as impression material and the whole

attach this RPD over the bar attachment.

treatment was planned accordingly.

p) Later, patients was trained to properly place and

h) Then the selected abutment teeth were prepared

remove the RPD fabricated over the fixed

for metal ceramic crowns and again imp ressions

component of Andrews Bridge and proper oral

were recorded using the putty wash technique

hygiene (including interdental brush) instructions

(using

were g iven to the patient.

polyvinlysilo xane-

Densply- Aquasil

Putty Material) and master casts were poured in

q) Period ic recall was done to check for the

dental stone (Type IV).

adaptability and assess the success of the

treatment.

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Shankar, Rama Raju, Srinivasa Raju, Jitendra Babu, Kumar, Rao

Treatment For Severe Ridge Defect

after the root canal treatment, the process of

fenestration and the loss of labial cort ical bone was
not been controlled which led to a class III type of
ridge defect. Also the presence of loose flabby tissue
and the fact that due to absence of cortical bone at
three sides made the imp lant p lacement procedure
improper because even with the bone grafting in such
cases the success of osseointegration is questionable.

FIG.5- Final metal-ceramic restoration of abutment teeth

along with the Andrews bar being checked for proper
clearance from the underlying soft tissues and bone

FIG.7- Final co mpleted Andrews fixed removable

partial denture for the correction of defect in the
patients oral cavity
This Andrews Bar System and sleeve that is
Figure 6: Heat cured acrylic resin RPD with the clip for bar

constructed is usually rectangular in cross -section

attachment

with its height more than its width to enhance its

rig idity. The system allows a precision fit but also

DISCUSS ION
The advantages of the conventional Andrews

acrylic seg ment to be removed or inserted over and

System are adequately reported in the literature. Such

over again without losing retention. (7)

an assembly provides maximu m aesthetics and

CONCLUS ION

phonetics in Class III ridge defect cases, when other

After the patient was treated with this Andrews Bar

traditional treat ment options prove to be futile (like

System, it was evaluated over a long period of time

implants/FPD). Another main advantage of Andrews

and accordingly it was concluded that the patient had

Bridge System is the criterion of the removable part

good adaptability, was co mfortable and achieved

which can be easily used by patient for hygienic

pleasing aesthetics and phonetics as desired.

access to abutments and surrounding structures.

Hence, it can be concluded that it can be indicated in

Regular

or

mini

implant

p lacement

was

patients

questionable procedure in the above case as even

with

severely

resorbed

ridges

where

aesthetics due to repositioning of teeth creates

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August 2011, Vol.1, No. 2

Shankar, Rama Raju, Srinivasa Raju, Jitendra Babu, Kumar, Rao

difficult ies

hence

giving

Treatment For Severe Ridge Defect

maximu m aesthetics,

tissues and surrounding structures or underlying bone

hygenics, good fit, along with minimal trau ma to soft

at an economical price.

Fig.A- Defect seen on the patients face before

Fig.B- Proper lip support after Andrews Bridge is given

treatment as unsupported upper lip

FIG.C- Front view of the defect area after

Andrews Bridge is given. It shows the proper
aesthetics along with the fixed-removable prosthesis

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Treatment For Severe Ridge Defect

REFERENCES
1)

5)

Rosenstiel; Contemporary Fixed Prosthodontics;

Prosthodontics-crown and bridges.mht

Chapter 20; Page 619-621.

2)

6)

Relationship: A Research Report; J.Pros.Dent.

D.B. Tuin zing. Preimp lant Surgery of Bony

March April 1966.

7)

Issue 2 Page 175-183.

4)

R. Sheldon Stein. Pontic Residual Ridge

J.P.A. van den Bergh, C.M. ten Bruggenkate and

Tissues; J.Pros.Dent; August 1998; Vo l. 80,

3)

Go rdon N. Gates and Andrews J. Boch. Boulder.

Nallaswamy; Textbook of Prosthodontics. 2nd

edition. 606-609.

Walid M . Sadig, Bone Anchored Andrews Bar

8)

R. Sheldon Stein.

Pontic Residual Ridge

System. A Prosthodontic Alternative; Cairo

Relationship: A Research Report; J.Pros.Dent.

Dental Journal; 11 (1). 1995: 11-15.

March April 1966.

James E. Immeleus and Mohamed Aramany. A

9)

Fixed - Removable Part ial Denture For Cleft

Nallaswamy; Textbook of Prosthodontics. 2nd

edition. 606-609.

Palate Pat ients. J.Pros.Dent. Vo l. 34: Issue 3.

Sept 1975: 286-291.

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