CHIEF COMPLAINT:
The patient would like to "put a fixed tooth in the fault behind the canine" and, if possible, "the two front teeth larger"
DIAGNOSIS:
A 65-year-old female non-smoker. Lower skeletal removable prosthesis and para-functional occlusal habits. The incisal edges of the Incisors as well as the canine cusps display wear. Agenesis of tooth 1.2 and absence of tooth 1.4, with manifest reduction of corresponding mesio-distal space.
The incisal edge of the upper central incisors is worn, showing the teeth with a reduced height. This fact, associated with the inversion of the superior incisal border, gives the smile an aged appearance. The edentulous space corresponding to tooth 1.4 shows a mesio-distal reduction incompatible with the placement of a dental implant. Satisfactory oral hygiene.
TREATMENT PLAN:
After eliminating more extensive treatment hypotheses, a minimalist and minimally invasive intervention was proposed to the patient, including two feldspathic veneers to rehabilitate the upper central incisors, and a Maryland bridge with a ceramic-coated infrastructure to be bonded to teeth 1.5 and 1.3. The veneers would increase the vestibular volume of the teeth, and increase their size, bringing the incisal edge further down, ending with the inversion of the incisal edge. The Maryland bridge would allow a fixed rehabilitation without significant Dental Preparation of adjacent teeth.
TEAM PLAY “DENTIST – DENTAL TECHNICIAN” NOTES:
After placement of the gingival retraction cord, tooth preparation was performed on the upper central incisors to be rehabilitated with veneers. Dental preparation for the Maryland bridge consists of parallelizing the inter-proximal walls of the teeth adjacent to the edentulous space.
The preparation was done with a double-mix technique. We used addition silicone with putty-soft and regular consistency. Two veneers of feldspathic ceramics and a Maryland bridge with ceramic-coated Zr infrastructure were made in the laboratory. On the surface of the infrastructure that will contact the dental surface, a ceramic liner was applied in order to facilitate the bonding of this infrastructure to the dental enamel. The mouth bonding began with the Maryland-type bridge. Different relative insulation was applied using Teflon for this purpose. The bonding of the veneers was done with absolute isolation in a conventional manner. The patient was pleased with the result obtained.