CHIEF COMPLAINT:
The patient did not like the bridge he had placed on teeth 2.1 and 2.2. He didn't particularly like the "metal margins". The transition from the bridge to the root surface also showed a thin metallic edge that “scraped” the upper lip.
DIAGNOSIS:
64-year-old male patient, non-smoker. The 2-element metal-ceramic bridge that rehabilitated teeth 2.1 and 2.2 had infiltrated margins and very exposed. The abutment teeth were vital in responding to thermal stimuli. The bridge seems to have extruded further increasing the sensation of discrepancy between the cervical boundary of the bridge abutments and the adjacent teeth. Teeth have generalized root exposure and gingival recession is manifest. The teeth were mobile. The gingival phenotype is thick and oral hygiene is poor.
TREATMENT PLAN:
It was proposed to replace the metal-ceramic bridge by a Zr bridge or 2 crowns in Zr. The objective was to aesthetically rehabilitate the patient while maintaining the vitality of the teeth
TREATMENT NOTES:
A pre-print in silicone was made to make a temporary bridge in composite resin with dual polymerization. The metal-ceramic bridge was removed with turbine cuts and micro luxators. After removing the bridge, the cores were carefully re-prepared, trying to maintain the vitality of the teeth. Cervical finishing lines were placed at the intra-sulcular level. Abutment teeth were re-prepared for crowns because the parallelism required for making a bridge required greater wear on the tooth structure. Immediately after the dental preparation, the dentin was sealed with the application of adhesive. Gingival retraction was performed using the kaolin technique pressed by the temporary bridge. The impression was made using the double-mix technique with double viscosity and quick-setting silicones. In the laboratory, 2 crowns were made in Zr. Particular care was taken in root characterization, seeking to mimic the roots of adjacent teeth. The definitive work was placed in the mouth, verifying the adjustment and approval by the patient. The final cementation of the crowns was made with resin-reinforced glass ionomer cement.