Case 51 | Prosthodontic Award 2015 | Spain
Dr Ramón Palomero Langner | DT Iñigo Casares
This 48 year old patient came to our dental clinic with several problems,when I asked him for the reason of the appointment he said he had many symptoms:
Anxiety,stress and tensin
Muscle tenderness,especially in the morning
Teeth sensitivity to hot,cold or sweet
But the most important for him was the …esthetic
He is a fireman,and said that he is subject to constant stress and anxiety .We know people can clench and grind their teeth without being aware of it.It can happen during both day and night.
The goals of treatment are to reduce pain, to prevent permanent damage to the teeth restoring with crowns the correct vertical dimension and reduce clenching as much as posible.
The first thing we should do is evaluate the situation and create a protocol. DSD gives us information about the esthetic situation and the possibility of previously viewing the final results
The malposition of the teeth took us to an orthodontic study.Firstly we had to align arcades,correct occlusion and make space for a future implant in position 25.
Once orthodontics is finished and based on our DSD in the upper jaw. lengthening crown surgery is needed .We use a stent to guide ourselves based on a previous wax model.We then wait three months for the healing.After this we place the implant in position 25
Once our tissue is healed we create a second wax-up to obtain our provisionals.In teeth preparation we are guided by a silicon key to control the quantity to prepare. Once the patient has the provisionals we wait the time necessary for him/her to get used to his/her new vertical dimensión,we control the esthetic,the occlusion,etc…
We will do the biscuit try test before finishing to control line angles,color,texture,shape and occlusion.
We firstly finish the lower jaw,once we haved finished it ,we start the upper jaw.We do this in order to gain more control at the time of adjusting occlusion,therefore having a stable occlusal plan.
Crowns are made of E-MAX MULTIPRESS ,we believe this is the ideal option due to the risk of fractures ,bearing in mind the type of patient and the higher chemical adherence .
At the end of the treatment this patient obviusly uses a protective dental device.We are sure that the natural results obtained are satisfactory for both,the patient and us.