Case 52 | Prosthodontic Award 2015 | Italy
Dr. Fausto Sommovigo – DT Andrea Puntoni
The patient A.F.,a 43 years old man presented with several problems, complaining about the esthetics. He was in general good health. The x-ray examination showed radiolucency on 1.2., 3.4,3.5
4.5, 1.6, 3.6and 3.7 were missing
4.7 had a fracture to the alveolar bone
On 1.2 ,1.4 and 1.5 there were secondary caries.
The periodontal situation was good, except signs of gengivitis on the posterior teeth
Many tooth showed wear facets.
From the esthetic point of view the display of upper teeth was minimal.
At first, after collecting data, we started our treatment with the causal periodontal treatment. Then we established the new incisal plane in order to improve the aesthetic of smile, with the aid of digital smile design.
The dental technician waxed-up the provisional restorations increasing the vertical dimension of occlusion in order to compensate the greater lenght of upper and lower frontal teeth. T the first step of the treatment lower temporaries consisted of 2 crowns on 4.6. and 4.4 and bisacrylic composite restorations pressed by means of a silicone stent on the tooth surfaces. On the upper arch there were acrylic provisionals made in laboratory.
Then started the other therapies.
The treatment planning consisted of:
Surgical treatment . Avulsion of 4.7, (the tooth has a fracture until the bone crest), 3.4-3.5 endodontic lesions and poor dental structure.
Implants in 1.6,4.5 sites
Implants associated with GBR in 1.3
Implants in 3.4, 3.6, 3.7 sites associated with immediate loading
Endodontic treatment. Root canal treatment of1.2
Conservative treatment: Build up of 1.7, composite restoration with fiber-glass post on 1.2.,1.1. Composite fillings of 2.4,2.5,2.6
Orthodontic treatment Uprighting of 4.6.Flattening of the occlusal plane on the 4° quadrant
Parodontal treatment: surgical crown lenghtening in the first and third sextant, CTG on implant in 3.4 site
Prosthetic treatment :Two series of temporary restorations on the upper arch. Two series of temporary restorations on the lower arch. In the lateral movements of mandible the load was shared by canine and first bicuspid.
Lithium disilicate monolithic crowns on 1.5,1.4,1.2,1.1,2.1,2.2,2.3,2.4,2.5
Lithium disilicate monolithic veneers on 3.3,3.2,3.1,4.1,4.2,4.3
Lithium disilicate overlay on 3.4
PFM on natural abutment 2.6,4.6
PFM on implants screwed 1.6,3.4,3.5,3.6,3.7,4.5
PFM on implants cemented 1.3
Composite inlay for the screw hole 3.4,3.6,3.7