Case 29 | Prosthodontic Award 2015 | Italy
DT. Devis Bertoni | Dr. Cristian Pandini
M.F. male patient, 49, with serious esthetic & functional problems, as well as a mistaken TMJ posture. Teeth improvement with e.max Press Multi lithium-disilicate crowns as well as four Zimmer Trabecular Metal implants.
After accepting the case, our team started a two-step analysis protocol, namely:
First step _ It consists in filing specific photos for Keynote Digital Smile Design, in order to obtain a new virtual smile, where it is possible to show the final esthetic result to the patient. A measurable project is applied to 3D articulator-mounted stone models for the shape waxing. The diagnostic waxing is duplicated in a precision silicone mask and filled with acrylic resin in order to be tested in the patient’s mouth by Mock up. Afterwards, other pictures and a video are taken to understand if we need to carry out another touch-up .
Second step _ After checking the occlusion problem, we took the mean value by Kavo Face-bow and afterwards we deprogrammed the lower head of lateral pterygoid muscles by Denar Deprogrammer to achieve the TMJ correct posture in centric relation. The diagnostic waxing realized in this posture showed us the complete diagnosis: in this way we could see the comprehensive work more clearly and so we could perform the dental procedure step by step. Diagnostic waxing results into temporary crowns and transparent masks, helping the dentist to check and finish off the preparation stumps with gaps and suitable characteristics to fix temporary crowns. Meanwhile, four Zimmer’s Trabecular Metal implants were fixed in the patient’s mandibular bone.
After 4 months of temporary crown trim, checking the correct masticatory function, we took the individual values by Kavo Arcus Digma. These values are helpful to finish final restorative metalfree crowns. Also Zimmer’s prosthetic components are made of a Ti-base metal and they are made esthetic with lithium-disilicate cover of the abutments; moreover other lithium-disilicate crowns are created and fixed on the stumps by an adhesive and aesthetic resin cement.