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.
TEAM PLAY ‘DENTIST – DENTAL TECHNICIAN’ NOTES:
Initial situation was evaluated by the Dentist and the Dental Technician. It was considered a priority to change teeth shape, increase the OVD in 1.5mm and correct the cross-bite in the 1st quadrant.
All this changes were reflected and evaluated in the maxilla provisional rehabilitation. A monobloc structure was chosen to allow the stabilization/splinting of the re-prepared teeth.
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. This bridge allowed us to finally correct the occlusal plan.
Final impressions were then done. 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 CAD-CAM zirconia frameworks. Ceramic veneering was done with the aim to reproduce a more natural tooth anatomy. Tooth color was conditioned by the patient’s will. A bisque bake try-in was done for aesthetic validation and technical check.
After patient’s approval, the final rehabilitation was cemented.