Full-mouth Rehabilitation of a Partially Edentulous Adult using a Combination of Direct Metal Laser-sintered Fixed Partial Dentures and a Cast Partial Denture: A Case Report

Abstract

Background: Long-standing partial edentulism arising from dental trauma or periodontal disease commonly leads to pathological tooth migration, supra-eruption of unopposed teeth, loss of occlusal vertical dimension, and compromised masticatory efficiency and aesthetics. Comprehensive rehabilitation of such cases frequently requires a combination of fixed and removable prostheses rather than a single modality, particularly when residual edentulus spans are of unequal length and bounded differently in each quadrant. Case Presentation: A 45-year-old male presented with missing maxillary anterior teeth secondary to trauma sustained twelve years earlier, together with recently created posterior edentulous spaces following extraction of periodontally compromised molars three months prior. Clinical and radiographic (orthopantomographic) evaluation revealed Grade II mobility, periapical pathology and a hopeless prognosis in relation to four posterior teeth, retained roots, and supra-eruption of two unopposed teeth. After extraction of the hopeless teeth and intentional root canal treatment of a supra-erupted maxillary central incisor, the patient was rehabilitated with direct metal laser-sintered (DMLS) metal-ceramic fixed partial dentures in the mandibular right posterior region and the maxillary anterior-to-premolar region, combined with a cast cobalt-chromium removable partial denture restoring the residual bilateral maxillary posterior edentulous spaces. Conclusion: A staged, biomechanically guided combination of fixed and removable prostheses restored function, aesthetics and occlusal stability while conserving remaining teeth. This case illustrates that a combination prosthesis is a practical, cost-effective alternative to extensive implant-supported rehabilitation when carefully planned and sequenced and reinforces the importance of systematic diagnosis and staged execution in complex partially edentulous patients.