Case 20: lab

Go to clinical case >

CHIEF COMPLAINT:
Patient requested a full aesthetical and functional rehabilitation. In the patient’s own words, the request was for “treating the entire mouth, with beautiful fixed teeth”.

DIAGNOSIS:
Male patient, 64 years of age and non-smoker. Presented a combined upper prosthesis, composed of a fixed 6 element metal-ceramic bridge (1.3,1.2,1.1,2.1,2.2, and 2.3) and an upper skeletal prosthesis, also with 6 elements. The lower jaw presented two metal-ceramic bridges, one with 3 elements in the fourth quadrant, and another with two elements in the third quadrant. Fitting of the bridges was compromised, and the patient was unpleased by the aesthetic result. Oral hygiene was not satisfactory.

TREATMENT PLAN:
The patient was offered a complete upper rehabilitation over implants, with a provisional screw-retained prosthesis. After osseointegration, a fixed metal-ceramic prosthesis would be installed, and screw-retained if possible. For the lower jaw, the treatment consisted of three implants in the fourth quadrant, to support a three element metal-ceramic bridge.

TEAM PLAY “DENTIST - DENTAL TECHNICIAN” NOTES:
After a TAC, the placement of six implants in the upper jaw was planned. It was decided to place two implants in the canine teeth area, and two more in the second pre-molar area. Lack of bone structure in the distal area of the first quadrant required bone regeneration in the right maxillary sinus. After surgery and implant placement, an impression was taken, for a provisional screw-retained prosthesis, to be installed the following day. After a six-month period, an open-tray impression was made of the six implants, and the working models were built. In a subsequent appointment the working models were assembled on a semi-adjustable articulator, using the facial arch and the inter-mandibular measurement obtained from the provisional prosthesis. A silicon wall was placed over the provisional prosthesis, to guide the lab work. The metallic infrastructure was prepared and tested in place, and definitively installed after the ceramic was applied. As several months had passed since the first TAC, a second one was done for the planning of the fourth quadrant implants. Three implants were placed during the same session as the extraction of the bridge. These were later rehabilitated with a screw-retained, three elements metal-ceramic bridge.