CHIEF COMPLAINT:
Patient didn’t like the artificial look of his teeth.
DIAGNOSIS:
Male patient, 42 years-old, non-smoker, had a metal-ceramic rehabilitation made 10 years ago, with exposure of the teeth roots and marginal infiltrations. In the maxilla, patient had a crown on tooth 11, a fixed partial denture on tooth 21 and 22 (cantilever) and a bridge on 24-25-26(pontic)-27. Teeth 16-25 and 27 presented root canal treatment (teeth 24, 25 and 27 needed an endodontic re-treatment).
In the mandible, patient presented a 4-unit metal-ceramic bridge in the incisors and a 3-unit metal-ceramic bridge on 33 and 34 with a supernumerary pontic. Teeth 46, 45 and 42 presented endodontic treatment (tooth 42 needed an endodontic re-treatment). Teeth 43 and 44 presented extensive tooth decay, mostly on the lingual surface with some mesial commitment. Teeth involved in the prosthetic rehabilitation presented marginal tooth infiltration/ decay associated with root exposure.
Patient presented also a reduced occlusal vertical dimension and a cross-bite on the right side. No periodontal disease was diagnosed, and the oral hygiene was good.
TREATMENT PLAN:
Upper and lower full-arch fixed rehabilitation with zirconia frameworks veneered with feldspathic ceramics.
Maxilla: crowns on 13, 12, 11, 21, 22 and 23 ; 3-unit bridge on 14-15-16 and 4-unit bridge on 24-25-26-27.
Mandible: crowns on 43, 42, 41, 31, 32, 35 and 36 ; 3-unit bridge on 44-45-46 and 33-(34)-34.
The aim of this treatment plan was to increase the OVD, correct the cross-bite on the right side, eliminate marginal infiltrations, decays and root exposures, and rehabilitate patient with full-arch fixed dental prosthesis with a more natural look.
TREATMENT NOTES:
The first therapeutic action was to do the endodontic re-treatments on teeth 24-25 and 42. Then, preliminary dental impressions (alginate) and a bite registration (silicone) were done to allow the dental technician to build a provisional acrylic bridge reinforced with a metallic structure (a monobloc with 13 teeth and teeth 26 as pontic). The aim of this provisional bridge was to increase the OVD and correct the cross-bite on the right side
As so, crowns and bridges were removed and teeth were re-prepared. The provisional bridge was then rebased, first with an auto-cured acrylic, and after it with a composite resin, to allow a perfect fit over the re-prepared teeth.
After two-weeks in the mouth, dental impressions were done in the mandible, to do also a provisional bridge in the dental lab. Special attention was given on removing the old crowns. To be less traumatic, an axial cut was done on the crowns to ease its removal.
These provisional rehabilitations were used for 8 weeks to allows a remodelling and a stabilization of the soft tissues. Final impressions were then done. Gingival retraction was done a single retraction cord technique. The impression was done with a double-mixture technique with putty-soft and light silicones. Simultaneously, intermaxillary relation was done together with a face-bow registration. The working casts were then mounted in a semi-adjustable articulator. Afterward, the dental lab built zirconia frameworks to be subsequently veneered with feldspathic ceramics. The bisque bake try-in was done to evaluate the function and aesthetics, and also the passive fit of the structure.
Final rehabilitation was cemented with a resin-reinforced glass-ionomer cement.