CHIEF COMPLAINT:
The patient could not stabilize the upper removable denture , did not like its looks, and wanted fixed teeth.
DIAGNOSIS:
Female patient, 52, non-smoker and carrying partial upper and lower acrylic removable dentures. In the upper jaw, teeth 1.6 / 1.5 / 1.3 and 2.7 were present. Canine presented with indicated extraction. In the lower jaw, canines and incisors were present. Removable prostheses were not in good condition. The patient had a significant lack of support from the upper lip but the edentulous areas of the upper jaw were favorable to implant placement.
TREATMENT PLAN:
After clinical and imaging analysis, the patient was offered a rehabilitation of the upper jaw, with 4 implants, and subsequent rehabilitation with a hybrid prosthesis. This would also include an attempt at prosthodontic correction of lack of upper lip support, if approved aesthetically by the patient after a prior "mock -up".
TEAM PLAY ‘DENTIST – DENTAL TECHNICIAN’ NOTES:
Initially, two new dentures were prepared. Tooth 1.3 was extracted when placing the prosthesis. The necessary imaging study was performed, and 4 implants were placed on the upper jaw. After 3 months of osseointegration, printing was done in order to prepare pivot waxes, mounted on a base plate screwed to the implants. These waxes were used in collecting inter-maxillary relationships in an attempt to provide support for the upper lip. Teeth were tested in.place with these mounted on screwed-down base plates, allowing a very interesting dynamic aesthetic evaluation. Being validated aesthetically by the patient, this trial led to a silicon wall which guided the manufacture of the metal infrastructure by the lab. The metal infrastructure with teeth set in wax was tested in mouth, allowing to check their fit and final aesthetic result. The final work was placed in mouth, accompanied by strict instructions on oral hygiene techniques and required periodic monitoring visits.