CHIEF COMPLAINT:
The patient was missing the upper left premolar and would like to rehabilitate this area with a fixed tooth, also expressing the desire for a less expensive treatment.
DIAGNOSIS:
Female patient , 65 years old , non-smoking . Missing tooth 2.4, but the adjacent teeth were intact . The edentulous space was compatible with the size of a natural tooth. Occlusion was favorable and the soft tissues were healthy. The patient had good oral hygiene.
TREATMENT PLAN:
The suggested treatment consisted of a Maryland type adhesive bridge, with a ceramic coated Zr infrastructure. This bridge would feature two retentive wings: one mesial, based on the palatal surface of the canine, and another distal, supported on the occlusal surface of the premolar and on its palatal surface .
TEAM PLAY ‘DENTIST – DENTAL TECHNICIAN’ NOTES:
A collared gingival retraction cord was placed before tooth preparation. This preparation gave particular attention to the fact of having to make the mesial wall of the pre-molar compatible with the insertion axis. Also in the pre-molar, a niche was prepared in the occlusal surface with expulsive axial walls. The canine was not prepared. In the prepared areas, IDS (immediate dentin sealing) was done. The impression used double mixing technique with silicone "Putty soft" and silicone "Light". Color selection was made in the same session. The lab prepared a Zr infrastructure using CAD-CAM technology. Ceramics were placed over this infrastructure. On the inner surface of the wings and connectors, as well as the occlusal support, a ceramic adhesive was applied in order to bond the bridge to the adjacent teeth. After bonding a careful evaluation of occlusion was made, especially concerning laterality. A temporary bridge was not used during this treatment.