Case 157 | The Award 2017 | Portugal
Paulo Monteiro / João Rua / José João Mendes / António Lopez / Inês Carpinteiro / João André Rua / Francisco Magalhães / Pedro Brito / Nuno Jesus
When Less is More…
A 42y man, who attended the University Dental Clinic Egas Moniz (CDUEM) for the need to improve his function and essentially aesthetics.
Presenting mesiofacial pattern, decreased vertical dimension of occlusion, without any limitation of mandibular movements and absence of TMJ symptomatology.
At the intraoral level, there was absence of teeth, Class 3 Mod 1 for upper jaw and Class 1 for lower jaw according to Kennedy classification
Additionally, edge-to-edge bite, diastemas between the upper teeth, tooth rotation 24, marked wear with generalized signs of attrition and abrasion with particular incidence in the 2nd and 5th sextant.
Caries and infiltrated restorations were diagnosed.
Periodontal assessment proved to be regular.
Low insertion upper lip frenulum and at the mucosal level there were no changes.
In the era of minimally invasive adhesive dentistry, adhesive or minimally invasive oral rehabilitations brings multiple advantages in functional, aesthetic and biomimetic terms, and should in most cases be the first choice.
Thus a plan of treatment without resorting to endodontic treatments, pins and posts, exodontia, total edentulism, etc., seemed to us the correct approach to follow.
A vertical increase of 10mm was recommended using combined adhesive techniques, using “cad-cam” technology and new restorative materials – Lava Ultimate – and ceramic veneers restorations.
The edentulous areas were rehabilitated using dental implants.
The protocol followed took into account the preservation of the different structures, reestablishment of the vertical dimension and a new occlusal scheme:
Preventive dentistry, with periodontal scaling and probing.
Removal of caries and infiltrated restorations.
Upper lip frenectomy surgery.
Top and bottom impressions and articulator mounting.
Aesthetic and functional waxing.
Oral mock-up to define: VDO, anterior aesthetic, occlusal schemes.
After the final drawing, IDS of the exposed dentin, impressions with intraoral scanner, for palatal veneers with Lava Ultimate.
Adhesion of the palatal veneers (Lava surface treatment: air abrasion with Cojet and silane) with heated resin Z100, A2 color.
Upper and lower teeth prepared for veneers in diferent phases. The upper ones on remaining enamel and on the recently adhered Lava veneers. The lower ones on enamel.
Adhesion of the ceramic veneers (feldspathic ceramic Initial GC), with Miscerium HRI UD2 composite. Additionally, the Lava ultimate surfaces and the surfaces with IDS were sandblasted with Cojet followed by silane.
Simultaneously during treatment, the implants were placed in the edentulous areas to follow the normal course of osseo-integration.
Immediately after the adhesion of the facets, the posterior implant zones were rehabilitated using E-max on titanium interfaces.
The use of new techniques and new biomaterials allows us to solve and increase the range of therapeutic solutions, making it easier to meet patient expectations, restoring function and aesthetics.
It also allows a better prediction of results in oral rehabilitation, which are directly related to wear and loss of dental structure integrity.
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