CHIEF COMPLAINT:
Rehabilitation of the anterior maxilla following traumatic injury in a car accident.
DIAGNOSIS:
Male patient, 22 years old, non-smoker, appear in our dental office 6 months after a car accident where he lost teeth 21, 22, 23 and 24. Teeth 12 and 11 present mobility grade III, thus with a prognosis of extraction. The gengiva architecture of the edentulous area presents a recession and a flat surface.
TREATMENT PLAN:
Extraction of teeth 12 and 11 and wait three months to achieve a complete healing of the area.
Diagnostic wax-up to allow the development of an ‘radiological template’ to proceed with a CT scan, in order to do an implant planning guided by the planned prosthesis.
The aim would be to make an implant-supported ceramic bridge.
TEAM PLAY ‘DENTIST – DENTAL TECHNICIAN’ NOTES:
The diagnostic wax-up enclose the possibility to include, or not, gum-shade ceramics to rehabilitate the interdental papillae. This was essential to present the complexity of the rehabilitation to the patient.
The wax-up allowed us to do a mock-up (to get patient approval) that worked also as a radiological template.
The CT-scan was imported to an implant planning software where three dental implants were simulated, and a surgical template was developed to guide implant placement.
10 weeks after the surgery, a first impression was done to do a provisional bridge (based on the diagnostic wax-up). The initial emergency profiles were created in the artificial gingiva of the model. Then, the model was scanned and a CAD-CAM provisional screwed bridge was constructed based on the diagnostic wax-up.
This provisional prosthesis worked the soft tissue architecture during eigth weeks. Then, this soft tissue contour was captured with an open-tray impression technique. The impression copings were individualized with composite resin to accurately copy the emergency profiles created by the provisional bridge.
The working model was scanned and the dental technician developed a zirconia framework based on the diagnostic wax-up. This framework try-in was done, the perfect fit was assessed, and a final pick-up impression was done with a light silicone. In this same appointment, the color of the final ceramics was assessed in loco by the dental technician. Teeth 13 and 23 had an abnormally high saturation, that we decided not to consider. Instead, we chose to focus on the relation with the lower anterior sector.
A new artificial gingiva was done following the pick-up impression of the framework. Dental ceramics was applied over the framework that was then cemented to the meso-structures.
The bridge was finally placed with a progressive screwing to allow the tissue to accommodate the pressure of the pontics and the abutments emergency profiles.
DENTAL LABORATORY:
Dentalmaia, Castelo da Maia, Portugal