CHIEF COMPLAINT:
Fracture of tooth 12 after a trauma.
DIAGNOSIS:
Male patient, 16 years old, non-smoker. Tooth 21 was missing after a traumatic injury two years ago. After the trauma, patient appeared in our clinic with the crown of tooth 21 splinted with composite to the adjacent teeth. After clinical and radiographic exams, it was decided to remove tooth 21. Simultaneously, it was diagnosed a dento-maxillary disharmony that needed to be treated. The patient and his parents showed willingness to solve this problem resulting from the trauma and to correct this disharmony.
TREATMENT PLAN:
After an interdisciplinary evaluation, considering orthodontics, prosthodontics and oral surgery, it was decided to initiate the treatment with an orthodontic correction. After this correction, a long-term provisional bridge (Maryland) would be done and latter, in adulthood, the rehabilitation could evolve, or not, to an implant placement in this area of tooth 21.
A very relevant fact is that this treatment plan would extend for several years. During this time, the patient needs to have an acceptable quality of life considering the function and aesthetics of this area.
TREATMENT NOTES:
The orthodontic treatment took approximately two years, and during this period it was done the extraction of tooth 21. In the day of the extraction, a crown was bonded with composite to a bracket retained by the orthodontic arch. This was the first provisionalization. During the orthodontic contention phase, another crown (reinforced with interproximal palatal wings done with a metallic mesh) was bonded to the adjacent teeth. Traditionally, this crown would last till the placement of a dental implant in adulthood. The patient would be rehabilitated in terms of aesthetics and function and, simultaneously, would splint the incisors. However, we were not satisfied with the result. As so, our option was to do an adhesive resin-bonded fixed partial denture in ceramics (zirconia framework veneered with feldspathic ceramics).
After evaluating the mesio-distal dimension of tooth 21 we realize that this distance was superior to the mesio-distal dimension of tooth 11. An orthodontic correction was done to harmonize this difference. After it, the provisional tooth was removed and a dental impression (double mixture technique, double viscosity). As the palatal and interproximal surfaces could not be touched after this impression, the provisional tooth was bonded to an orthodontic wire. In this way, a temporization was achieved without touching the palatal surfaces.
To ease the process, the color choice was done before the bonding of the brackets/orthodontic wire.
With the working models, the dental lab did a zirconia CAD-CAM framework that was then veneered with a feldspathic ceramic on its buccal surface. In the internal surface of the wings and the connectors, it was applied a ceramic adhesive that would allow us to do an adhesive bonding to the adjacent teeth.
After three years, the patient is satisfied with the rehabilitation. Implant placement is not planned.
PUBLICATION: Couto Viana P, Jaime Portugal, Zsolt Kovacs, Ivo Lopes, André Correia –Resin-bonded fixed dental prosthesis with a modified treatment surface in a zirconia framework: A case report – (Int J Esthet Dent 2016;11:378-392)