Case 38 | Prosthodontic Award 2015 | Italy
Dr. Giuseppe Marchetti
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.
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)
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
Good prognosis of the remaining teeth.
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.
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
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.
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.
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.
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.
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.
Dr. Paolo Marchetti for the Periodontal Therapy
Dental Design Lab. Parma for the technical work