CHIEF COMPLAINT:
Patient requested permanent restoration of the implant in tooth 1.2. The aesthetic concern extended to the adjacent teeth.
DIAGNOSIS:
Male patient, 34 years of age, smoker. Presented a provisional implant replacing tooth 2.1, featuring a composite resin tooth, supported by a metallic mesh bonded to the adjacent teeth. Teeth 1.3 and 1.1 presented significant root exposure.
TREATMENT PLAN:
A two-stage rehabilitation procedure was proposed:
1- Production of two feldspathic ceramic veneers with gingival and coronary elements, to mask root exposure and reduce edentulous spacing.
2- Production of a screw-retained crown to place over the implant, also featuring gingival and coronary elements, integrated with the previous veneer restoration.
Tonality of the ceramics for gingival restoration elements would be validated by the patient during provisional restoration.
TEAM PLAY “DENTIST - DENTAL TECHNICIAN” NOTES:
The existing implant was exposed and provisionally restored using a composite resin with gingival tonality. After gingival maturation, an impression of the implant was done, to produce a provisional screw-retained tooth. At the lab, the mesial surface of tooth 1.3 and the distal surface of 1.1 were waxed, simulating the shape of the planned veneers. Two identical provisional teeth were produced, one to be placed on the patient and another for the impression of the teeth used in preparing the veneers. Teeth 1.3 and 1.1 were prepared and an impression was done using one of the provisional teeth. The provisional restorations allowed the patient to decline the aesthetic result of this option, opting instead for gingival tonality ceramics. The feldspathic veneers with gingival component were produced in an attempt to recreate the contralateral white/rose architecture, and bonded in-mouth. A composite resin with gingival tonality was applied to the cervical third of the provisional tooth, matching the buds recreated by the veneers. Once the peri-implant soft tissues were positionally stable, the lab could initiate production of a screw-retained crown to place over the implant, with coronary and gingival ceramics. For the purpose of educational documentation, this clinical case combined a virtual workflow with a traditional workflow. Two crowns were produced using two different materials as infrastructure: gold and zirconium oxide. Given the choice between both, the patient opted for the aesthetic properties of zirconium. Despite the complexity and extent of the rehabilitation, the patient demonstrated significant satisfaction with the final result.
PUBLICATION: The papillary veneers concept: An option for solving compromised dental situations; Couto Viana P., Correia A., Kovacs A; J Am Dent Assoc 2012; 143(12):1313-1316