CHIEF COMPLAINT:
To replace a combined dental prosthesis, in the maxilla, with a fixed dental prosthesis.
DIAGNOSIS:
Female patient, 69 years-old, non-smoker, presents a combined dental prosthesis in the maxilla (bridge 13-21, with pontic on 12; removable partial denture in the posterior areas, with 5 teeth) The retention of the RPD is done through a clasp on tooth 14 and a ‘t-type’ attachment on tooth 21.
TREATMENT PLAN:
Implant-supported fixed partial denture in the 2nd quadrant, to avoid the removable partial denture. The number and location of the dental implants would be decided only after the visualization of a CBCT scan. Patient showed no interest in replacing the anterior bridge in the maxilla.
TEAM PLAY ‘DENTIST – DENTAL TECHNICIAN’ NOTES:
The treatment plan was driven by the radiological guide produced in the dental lab after a correct assembly in the articulator. The number and shape of the teeth were discussed together with the clinician in order to simulate the project designed for the definitive rehabilitation. Teeth were made with barium sulfate to show opacity in the CBCT scan. The radiological guide included acrylic retentions to improve the stability during the CBCT scan. After this exam, a pick-up dental impression in silicone was done. The dental model was then scanned, and the generated 3D model was superimposed in the CBCT image. The virtual planning was done by the team and resulted in a surgical guide made with CAD-CAM technology. After dental implants placement and osseo-integration, a final impression was done with a double-mix technique. In the dental lab, a three-element bridge with a cantilevered 22 was executed. With the correct position of the dental implants, it was possible to use standard abutments technically simplifying the work and reducing costs. After the framework try-in the dental technician started the ceramic veneering. Tooth color selection was done by the ceramist in the dental office trying to mimic the shades of the old fixed partial denture that the patient had. After clinical evaluation and patient’s approval the bridge was cemented. The rehabilitation, although not very long (with tooth 26) proved to be esthetically acceptable and functionally able.