Case 128 | The Award 2017 | Bulgaria

Case 128 | The Award 2017 | Bulgaria

Dr. Sofien Riahi / Dt. Stefan Petrov

ALL CLINICAL CASES

_1

A 40-year old patient presented with generalised occlusal wear. She complained about progressive chipping of her frontal teeth and requested smile improvement. Comprehensive examination was carried out, followed by photographic analysis.
Minimal tooth display was visible at rest position.

_2 _3 _4 _5 _6 _7

The mandibular incisal edges were worn and chipped _8

The maxillary incisal edges were worn and chipped _9

Patient analysis showed generalised occlusal wear and loss of VDO. _10

Patient analysis showed generalised occlusal wear and loss of VDO. _11

Addition silicone impressions from both arches, facebow record and centric relation bite registration were taken. _12

A digital smile design was fabricated, based on the available photographs and the mounted study casts. _13

A digital smile design was fabricated, based on the available photographs and the mounted study casts. _14

A digital smile design was fabricated, based on the available photographs and the mounted study casts. _15

A diagnostic wax-up was fabricated, guided by the digital smile design. The central maxillary incisors were lengthened by 1-1.3mm as proposed by the Digital Smile Design. The VDO in the anterior region was increased by 3mm that led to 1mm increase in the interocclusal space in the posterior area._16 _17

A diagnostic wax-up was fabricated. The central maxillary incisors were lengthened by 1-1.5mm as proposed by the Digital Smile Design. The VDO in the anterior region was increased by 3mm that led to 1mm increase in the interocclusal space in the posterior area.

We started treatment with hygiene and motivation session. On the next appointment her teeth were multi-spot etched and the diagnostic wax-up was transferred more securely with bis-acrylic resin. This allowed the new VDO to be tested for two weeks in function. During that period patient had cleaning sessions twice.

_18
Tooth #16 was referred to an endodontist for retreatment. After removal of the old PFM crown and build up material, the tooth was diagnosed with a vertical root fracture.
The patient was referred to an implantologist. The tooth was extracted and a 4.5mm wide dental implant was placed. _19
After two weeks the patient was feeling comfortable with the new VDO. We proceeded with preparation of the distal teeth. A 1mm preparation was carried through the bisacrylic resin posterior overlays. This ensured only 0.5mm preparation of tooth structure in most areas and abundant enamel substrate for bonding of the restorations. Preparations were kept in enamel and a supragingival finish line was created. _20
After completion of the preparations, teeth were isolated and immediate dentin sealing procedure was carried out. Polyvinylsiloxane impressions were taken and bysacrylic provisional restorations were fabricated using the silicon keys from the diagnostic wax up. _21
After completion of the preparations, teeth were isolated and immediate dentin sealing procedure was carried out. Polyvinylsiloxane impressions were taken and bysacrylic provisional restorations were fabricated using the silicon keys from the diagnostic wax up. _22
Monolithic pressed and painted lithium dislocate restorations were fabricated in the dental laboratory out of A1 HT ingots.

_23

Monolithic pressed and painted lithium dislocate restorations were fabricated in the dental laboratory out of A1 HT ingots. _24
Occlusal thickness
_25
Closer to nature
_26
The restorations were fixed in the mouth of the patient one quadrant at a time in 4 clinical sessions. A strict adhesive protocol was followed. Heated micro-hybrid composite was used for the adhesive fixation. _27
The restorations were fixed in the mouth of the patient one quadrant at a time in 4 clinical sessions. A strict adhesive protocol was followed. Heated micro-hybrid composite was used for the adhesive fixation. _28
The restorations were fixed in the mouth of the patient one quadrant at a time in 4 clinical sessions. A strict adhesive protocol was followed. Heated micro-hybrid composite was used for the adhesive fixation. _29
The restorations were fixed in the mouth of the patient one quadrant at a time in 4 clinical sessions. A strict adhesive protocol was followed. Heated micro-hybrid composite was used for the adhesive fixation. _30
After a 6-month period of osseointegration the dental implant was uncovered and a provisional restoration was fabricated. The provisional was used to modify the emergence profile of the implant. One month after provisionalisation impressions for a final restoration were taken. The emergence profile was transferred to the laboratory cast by an individualised transfer. An individual zirconia abutment was bonded to a titanium base. A pressed monolithic lithium dislocate crown was fabricated. The crown was bonded to the abutment after careful isolation. _31
After a 6-month period of osseointegration the dental implant was uncovered and a provisional restoration was fabricated. The provisional was used to modify the emergence profile of the implant. One month after provisionalisation impressions for a final restoration were taken. The emergence profile was transferred to the laboratory cast by an individualised transfer. An individual zirconia abutment was bonded to a titanium base. A pressed monolithic lithium dislocate crown was fabricated. The crown was bonded to the abutment after careful isolation. _32
The completed posterior restorations provided stable occlusion and we proceeded with preparation of the anterior teeth. Minimally invasive preparations through the mock-up ensured maximum enamel preservation. Polyvinylsiloxane impressions were taken. _33
The completed posterior restorations provided stable occlusion and we proceeded with preparation of the anterior teeth. Minimally invasive preparations through the mock-up ensured maximum enamel preservation. Polyvinylsiloxane impressions were taken. _34
Multilayered feldspathic restorations were created on refractory dies in the dental laboratory.

_35

Multilayered feldspathic restorations were created on refractory dies in the dental laboratory. _36 _37
Multilayered feldspathic restorations were created on refractory dies in the dental laboratory.

_38

The anterior ceramic restorations were bonded under strict adhesive protocol. _39
The anterior ceramic restorations were bonded under strict adhesive protocol.

_40

The superimposed final result on the inital photo showing the increase of the VDO. _41
1 year follow-up
_42
1 year follow-up
_43
Upper incisors
_44
Upper incisors close-up
_45
Lower incisors
_46
Upper occlusal
_47
Lower occlusal
_48
Lateral Smile
_49
Lateral smile
_50

The use of the minimally invasive approach in rehabilitation of cases with worn dentition assures maximum tissue preservation and long-lasting bonded restorations that not only restore function but are aesthetically pleasing.

The patient is completely satisfied with the result of the treatment and is being followed up twice a year.

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Case 128 | The Award 2017 | Bulgaria ultima modifica: 2017-02-28T15:38:46+00:00 da Team Zerodonto

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