Case 38 | Prosthodontic Award 2015 | Italy

Case 38 | Prosthodontic Award 2015 | Italy

Dr. Giuseppe Marchetti

 

ALL CLINICAL CASES

On the March of 2013 G.G. 73 years old, female came to my attention, for fixing occlusal and esthetic issues. A large number of teeth was lost, she had extractions recently too, before coming to my Office.

On a 1st clinical examination there were missing teeth: 1.5 1.6 1.7 1.8 2.3 2.5 2.6 2.7 2.8 3.6 3.7 3.8 4.6 4.7 4.8.

There was also difficulty in chewing, and she reported the need to improve the aesthetics of the smile.

The periodontal examination, which followed the initial causal therapy, after the tissue-healing,  revealed no particular periodontal problems with normal probing.

The functional analysis showed a Canine Class I on the right, tending to the third class, and a first class on the left ( if the canine had been present ) an Overjet of 3 mm and an Overbite of 4 mm.

In lateral movement on the right 1.2 led the excursion and the posterior disclusion without premature balancing contacts, 2.2 and 2.4 on the left. Protrusive in the front guide was respected.

Diagnosis:

Gingivitis

Missing teeth (1.5, 1.6,1.7, 1.8, 2.3, 2.5, 2.6,2.7,2.8, 3.6, 3.7, 3.8,4.6, 4.7, 4.8)

Caries

Extrusion of material over the apex of 12 asymptomatic

Incongruous restorations ( 1.1 1.2 2.1 2.4 3.4 3.5 4.4 4.5 )

Abrasions and wear very huge and extended

On the maxillary: 1st Kennedy Class with one modification

On the lower jaw: 1st Kennedy Class

Prognosis:

Good prognosis of the remaining teeth.

Treatment goals:

Restore the function satisfactorily with the combined prostheses ( Chief Complaint: the elderly patient refuses any surgical approach and wanted to keep the diastema between 1.1 and 2.1)

Restore the front guides in protrusive and in laterality and have a proper disclusion in the posteriors with the absence of premature balancing contacts.

Improve aesthetics

Improve phonetics

Problems:

Presence of 2.8 included

Presence of large diastema

Reduced space between the edentulous arches on left

Refusal to surgical therapy in general and in particular the implant one

Treatment plan:

Phase one:

Initial periodontal therapy

Removal of old restorations and incongruous restorations and of primary and secondary caries of 1.1 1.3 1.4 2.1 2.2 3.4 4.5

Endo treatments and retreatments and pre prosthetic build ups.

Phase two:

First Temporary crowns 1.1 1.2 1.3 1.4 2.1 2.2 2.3 2.4 3.4 3.5 4.4 4.5

Provisional removable prosthetics on the upper and lower arch with metal hooks.

Revaluation.

Opening of the VDO in Centric Relation with Leaf Gauge modifying the 1st provisionals directly with acrylic resin, in Centric Occlusion.

Restoration of the cusp of 4.3 with composite.

Functional revaluation of the provisionals and check of the functionalization of the 1st provisionals.

Second temporary crowns in the upper arch and check of the function.

Revaluation.

Phase three:

Face-bow & impressions of the preps.

Impressions of the functionalized provisionals.

Intermaxillary registration at the vertical dimension of the provisionals built in Centric Occlusion and cross mounting of the models.

Creation of a custom anterior guide on the articulator copying the one of the provisionals.

Final wax up done copying the provisionals and creation of an occlusal silicon index to guide the layering of the ceramics.

Cut back of the wax up for the fusions.

Try in of the fusions and of the ceramics and compressive impressions for the removal prosthetics with extracoronal attacks and milled parts.

Cementation of the PFM Crowns, final x ray status and follow up.

Conclusions:

The prosthetic approach, without surgery, in this particular clinical case, seems to be the right choice for the rehabilitation of the oral function and of the esthetic of the smile. The restorations, after two years of follow up, look well integrated with both satisfaction, mine and of the patient.

Thanks to:

Dr. Paolo Marchetti for the Periodontal Therapy

Dental Design Lab. Parma for the technical work

CASO DI PROTESI PER ZERODONTO E AIOP.001

CASO DI PROTESI PER ZERODONTO E AIOP.002

CASO DI PROTESI PER ZERODONTO E AIOP.003

CASO DI PROTESI PER ZERODONTO E AIOP.004

CASO DI PROTESI PER ZERODONTO E AIOP.005

CASO DI PROTESI PER ZERODONTO E AIOP.006

CASO DI PROTESI PER ZERODONTO E AIOP.007

CASO DI PROTESI PER ZERODONTO E AIOP.008

CASO DI PROTESI PER ZERODONTO E AIOP.009

CASO DI PROTESI PER ZERODONTO E AIOP.010

CASO DI PROTESI PER ZERODONTO E AIOP.011

CASO DI PROTESI PER ZERODONTO E AIOP.012

CASO DI PROTESI PER ZERODONTO E AIOP.013

CASO DI PROTESI PER ZERODONTO E AIOP.014

CASO DI PROTESI PER ZERODONTO E AIOP.015

CASO DI PROTESI PER ZERODONTO E AIOP.016

CASO DI PROTESI PER ZERODONTO E AIOP.017

CASO DI PROTESI PER ZERODONTO E AIOP.018

CASO DI PROTESI PER ZERODONTO E AIOP.019

CASO DI PROTESI PER ZERODONTO E AIOP.020

CASO DI PROTESI PER ZERODONTO E AIOP.021

CASO DI PROTESI PER ZERODONTO E AIOP.022

CASO DI PROTESI PER ZERODONTO E AIOP.023

CASO DI PROTESI PER ZERODONTO E AIOP.024

CASO DI PROTESI PER ZERODONTO E AIOP.025

CASO DI PROTESI PER ZERODONTO E AIOP.026

CASO DI PROTESI PER ZERODONTO E AIOP.027

CASO DI PROTESI PER ZERODONTO E AIOP.028

CASO DI PROTESI PER ZERODONTO E AIOP.029 CASO DI PROTESI PER ZERODONTO E AIOP.030 CASO DI PROTESI PER ZERODONTO E AIOP.031

CASO DI PROTESI PER ZERODONTO E AIOP.032

CASO DI PROTESI PER ZERODONTO E AIOP.033

CASO DI PROTESI PER ZERODONTO E AIOP.034

CASO DI PROTESI PER ZERODONTO E AIOP.035

CASO DI PROTESI PER ZERODONTO E AIOP.036

CASO DI PROTESI PER ZERODONTO E AIOP.037 CASO DI PROTESI PER ZERODONTO E AIOP.038 CASO DI PROTESI PER ZERODONTO E AIOP.039

CASO DI PROTESI PER ZERODONTO E AIOP.040

[like]

ALL CLINICAL CASES

Case 38 | Prosthodontic Award 2015 | Italy ultima modifica: 2015-10-19T20:00:01+00:00 da Team Zerodonto

4 Comments

Leave a Comment

Please be polite. We appreciate that.
Your email address will not be published and required fields are marked