Case 39: lab

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CHIEF COMPLAINT:
Patient wanted to "replace the old bridge because it was ugly”.

DIAGNOSIS:
Female patient, 30 years old, non-smoker. Carried a metal-ceramic bridge of 2 elements with tooth 2.3 as abutment, tooth 2.2 as pontic, and presented a metallic support on the palatal surface of 2.1. The cervical surface of the bridge dental abutment presented a composite resin restoration. It is presumed that this restoration resulted from exposure of the cervical finishing line with possible infiltration of the same. The tooth surface in contact with the mesial bridge support was also infiltrated. Tooth 2.3 was vital. The edentulous space corresponding to tooth 2.2 had a reduced mesio-distal dimension. The patient showed good periodontal health and good oral hygiene habits.

TREATMENT PLAN:
It was proposed to replace the ceramic metal bridge with a bridge with Zr infrastructure coated with ceramic. The dental abutment cervical finishing line of 2.3 would be re-prepared and the palatal support on tooth 2.1 eliminated. The cavity that served as a receptacle to this support would be restored with composite resin. The vitality of the dental abutment would be maintained.

TEAM PLAY “DENTIST – DENTAL TECHNICIAN” NOTES:
The ceramic metal bridge was removed after completion of longitudinal cuts with diamond burr on the bridge dental abutment. This removal process was aimed at keeping the dental abutment on tooth 2.3 as complete as possible. First, a silicone putty índex was made, to later build a provisional restoration at the office. The dental abutment was re-prepared with the objective of placing the cervical finishing line at the intra-sulcular level. With the silicone index, resulting from the pre-impression, a provisional bridge was made in composite resin of dual polymerization. The provisional bridge was used to evaluate the dental shape to be adopted on the definitive bridge, with feedback on the subject from the patient and the ceramist. The definitive impression was made with double mixture technique impression with silicone of heavy and regular consistency, both with fast setting. The die of tooth 2.3 in the working model was painted black, chromatically mimicking the dental abutment in the mouth. It was intended that during confection of the work, the ceramist could better circumvent this situation, testing the best way to mask the chromatic effect of this limitation. The dental shape sought to dimensionally reproduce the homologous teeth, and in this sense a slight crowding was assumed. The patient evaluated the work on the mouth and was satisfied with the aesthetic result. The bridge was bonded with composite resin of dual polymerization and the disto-palatal cavity of tooth 2.1. was restored with composite resin.