CHIEF COMPLAINT:
Patient was unhappy about having “recessed upper teeth”, and wanted “fixed teeth”.
DIAGNOSIS:
Female patient, 47 years old, non-smoker. Bearing a partial, removable, skeletal upper prosthesis. Missing teeth 1.8/1.7/1.6/1.4/2.1/2.3/2.6 and 2.8. Teeth 1.5/1.3/1.2/1.1/2.2/2.4 and 2.5 presented endodontic treatment, intra-radicular posts and extensive restoration. Good oral hygiene was observed, as well as good gingival health. The patient presented a Class III, and the maxillary edentulous areas were compatible with implant placement.
TREATMENT PLAN:
After clinical analysis and imaging, a rehabilitation of the maxilla was suggested to the patient, including:
• 4 element bridge with Zr infrastructure and ceramic, using teeth 1.5/1.3 and 1.2 as abutment`s and tooth 1.4 as pontic.
• 6 element bridge with Zr infrastructure and ceramic, using teeth 1.1/2.2/2.4/ and 2.5 as abutment`s and teeth 2.1 and 2.3 as pontic.
• Placement of both implants, on the locations of teeth 1.6 and 2.6. Implant rehabilitation with two screw-retained crowns.
A prosthetic rehabilitation of the Class III would also be attempted, should the patient approve this procedure after a preliminary mock-up.
TEAM PLAY ‘DENTIST – DENTAL TECHNICIAN’ NOTES:
The rehabilitation plan originated from a possible end-result envisioned by the technician, during the diagnostic wax-up. The hypothesis was materialized in a mock-up, for evaluation and approval by the patient, the doctor and the technician. This provided the baseline for the entire process. The provisional bridge, produced from the diagnostic wax-up, was aesthetically and functionally tested in-mouth for a period of eight weeks. The final impression yielded a working model, which was scanned. This scan, combined with the diagnostic wax-up scan, allowed the design of infrastructures in compliance with the initial goals. After in-mouth testing, the Zr infrastructures received ceramic coating. The implants were scanned in-mouth, and in a fully virtual workflow, originated two screw-retained crowns. One of the main highlights in this case, is the consistency achieved between the diagnostic wax-up and the final result.