CHIEF COMPLAINT:
The patient desired a complete functional and aesthetic rehabilitation.
DIAGNOSIS:
Female patient, 63, smoker. Carried partial acrylic removable dentures, had upper jaw teeth 1.5 / 1.4 / 1.3 / 1.2 / 1.1 / 2.1 / 2.2 / 2.3 / 2.4 . The lower jaw presented the roots of teeth 4.7 and 4.3 and teeth 3.3 / 3.4 / 3.5 and 3.7. All teeth presented with indicated extraction and removable dentures were not in good condition. The patient had a significant gingival recession and had a very open smile, with an elevated smile line.
TREATMENT PLAN:
The patient was offered a full rehabilitation over implants, with the placement of a temporary screwed-retained prosthesis. Treatment would start on the jaw, as this was the most bothersome area for the patient. Once the jaw was provisionally rehabilitated, treatment would proceed with the placement of a screwed prosthesis over the implants to be placed in the maxilla. After verifying proper osseointegration of the implant, soft tissue stability and integration of new intermaxillary relationship, the patient would undergo definitive rehabilitation.
TEAM PLAY ‘DENTIST – DENTAL TECHNICIAN’ NOTES:
After gathering clinical and imaging information, 5 implants were prepared for placement on the jaw. The temporary bridge screwed onto the implants was placed in mouth 24 hours after surgery. This temporary bridge was prepared by the lab. After successful osseointegration of the the jaw implants, surgery was performed for the placement of 6 implants in the jaw and the immediate placement of the temporary screwed-down bridge. Three months later, impressions were made for the preparation of working models. These models were mounted on a semi-adjustable articulator, incorporating the information given by the temporary bridges. A silicone wall was made, to guide the choice of intermediate parts and the subsequent confection of steel infrastructures. The large size of the temporary teeth was considered a negative aesthetic factor, leading us to include the possibility of using gingival tone ceramics. The metal infrastructures were made with this need in mind. Screwed fixation is a priority choice in these situations. After testing the infrastructure, coronary and gingival ceramics were placed, and their aesthetic integration in the mouth was evaluated. The final work was placed in mouth, accompanied by instructions for oral hygiene.