Prosthetic Dentistry Posts

16/05/17
Full mouth non-prep adhesive rehabilitation for erosion and attrition – The award “Excellence in Prosthodontics” 2017 winning case
Ionut Branzan Cristian Petri

31/03/17
A multidisciplinary approach to the treatment of a complex case: analog and digital procedures
Matteo Chiapasco Piero Venezia Emilia Casiello Raffaele Cavalcanti

20/07/16
The Classic 3-STEP Technique, a simplified protocol for ADDITIVE adhesive rehabilitations
Francesca Vailati Urs Christoph Belser

03/12/15
Digital Smile Design interdisciplinary approach
Ernesto Guzman

12/10/15
Rehabilitation of maxillary edentulism by means of computer-guided implant surgery and provisional prosthesis with immediate loading
Fabio Cozzolino Roberto Sorrentino Luigi De Stefano

18/11/14
Complex prosthetic rehabilitation due to severe dental wear
Mauro Fradeani

01/03/14
Digital impression by means of Itero intraoral scanning system to fabricate zirconia single crowns
Roberto Sorrentino Fabio Cozzolino Dario Mari Vincenzo Mutone

21/02/13
Porcelain veneers in the Esthetic zone
Roberto Sorrentino Fabio Cozzolino Attilio Sommella

12/12/12
Nobel Guide Implant-Guided Surgery with Nobel Clinician Software
Roberto Sorrentino Fabio Cozzolino Vincenzo Mutone

28/09/12
Mandibular full-arch restoration with Straumann implant-supported metal mesostructures and zirconia-based prosthesis: a case report
Roberto Sorrentino Fabio Cozzolino

01/07/11
An innovative prosthetic-guided Orthodontic technique: case series
Fabio Cozzolino Anna Mariniello Roberto Sorrentino Marcello Sacchetta

27/09/10
Controlled split crest and sonic surgery
Fabio Cozzolino Giuseppe Cozzolino Roberto Sorrentino Vincenzo Mutone

28/06/10
Prosthetic treatment in Esthetic zone with all-ceramic procera zirconia abutment and crown supported by a SLActive Straumann implant
Fabio Cozzolino Roberto Sorrentino Anna Mariniello Vincenzo Mutone

26/04/10
Agenesis of the lateral incisors treated with Straumann Bone Level implants and Etkon zirconia abutment
Fabio Cozzolino Roberto Sorrentino Anna Mariniello Vincenzo Mutone

22/06/09
Porcelain veneers
Fabio Cozzolino Roberto Sorrentino Vincenzo Mutone

10/01/09
A new technique for restoring prosthetic space in implant region: a case report
Fabio Cozzolino Anna Mariniello

19/12/08
Gold ceramic vs zirconia dental crowns
Fabio Cozzolino

27/11/08
Alumina and zirconia prostheses: these unknowns
Roberto Sorrentino


Full mouth non-prep adhesive rehabilitation for erosion and attrition – The award “Excellence in Prosthodontics” 2017 winning case

Full mouth non-prep adhesive rehabilitation for erosion and attrition – The award “Excellence in Prosthodontics” 2017 winning case

 

 

ITALIAN VERSION

 

 

The 28 year old patient came into our office complaining of tooth sensitivity. When doing the anamnesis, she denied any history of dental or facial trauma. But she declared that she has been eating lemons 2 times a day for the past 12 years. On examination, we found no TMJ, muscle or periodontal problems.

As part of our protocol, we requested a panoramic x-ray and did facial and dental photos, on which we discussed the dental problems with the patient. Although her only chief complaint was tooth sensitivity, after seeing the facial photos she realized that  her issues are also related to esthetics.

daniela dinicioiu .135

A multidisciplinary approach to the treatment of a complex case: analog and digital procedures

A multidisciplinary approach to the treatment of a complex case: analog and digital procedures

 

ITALIAN VERSION

 

The clinical case we present here regards a 25-year old girl who underwent an extremely severe car accident in which she was the only one survivor out of 4 passengers of the same age. 

The Classic 3-STEP Technique, a simplified protocol for ADDITIVE adhesive rehabilitations

The Classic 3-STEP Technique, a simplified protocol for ADDITIVE adhesive rehabilitations

VERSIONE ITALIANA

 

Introduction

Patients affected by dental wear often are treated only when their dentation becomes extremely compromised.

However, when pathologies such as dental erosion, and/or parafunctional habits are not intercepted at an early stage, full mouth rehabilitations, mostly implementing crowns, are often considered. Thanks to improved adhesive techniques, the indications for crowns have decreased and a more conservative approach can be nowadays proposed to protect the remaining tooth structure.

Digital Smile Design interdisciplinary approach

Digital Smile Design interdisciplinary approach

The “Excellence in Prosthodontics” award winning case

 

ITALIAN VERSION

 

Summary:

Limitations in treatment planning are unpredictable due to poor communication between operator – patient, interdisciplinary team, lab technician and clinical factors overlooked by the lack of information .

Tools such as photographys , videos and computer are essential for communication with the patient to create expectations through prototypes that can result in a temporary restoration that will help us see the functional , biological, mechanical and aesthetic performance of the same and future the final restoration.

Rehabilitation of maxillary edentulism by means of computer-guided implant surgery and provisional prosthesis with immediate loading

Rehabilitation of maxillary edentulism by means of computer-guided implant surgery and provisional prosthesis with immediate loading

ITALIAN VERSION

 

Computer-guided implantology and immediate loading with CAD-CAM screw-retained full-arch temporary prosthesis

 

A 41 year-old female patient presented with multiple missing teeth at both dental arches and a few remaining elements, among which fractured and non vital teeth. Moreover, the patient, in good general health but with poor oral hygiene, presented with reduced vertical dimension of occlusion (VDO), insufficient labial support and prosthetic space limited by macroglossia. The patient lamented severe functional problems, related both to mastication and speech, as well as serious esthetic concerns, since the maxillary teeth were not visible at all both at rest and during function.

1

Complex prosthetic rehabilitation due to severe dental wear

Complex prosthetic rehabilitation due to severe dental wear

 ITALIAN VERSION

 

In collaboration with Dr. Leonardo Bacherini

Several factors affect the life of a tooth and, consequently, different causes can lead to dental wear. Unfortunately, their effects are cumulative and irreversible and, despite its main cause, tooth wear starts immediately after tooth eruption. As a consequence, clinicians have to diagnose such a condition early, particularly when dental wear occurs suddenly and progressively in young patients. The processes causing tooth wear are attrition, erosion, abrasion, demastication, abfraction and non-carious cervical lesions.

 

Patient’s expectations

    • Remote pathological anamnesis: bulimia during youth
    • Recent pathological anamnesis: gastro-esophageal reflux disease (GERD)
    • Non smoker
    • Dental anamnesis: the patient complained about severe sensitivity on all teeth and wanted to improve the esthetics of her smile; the teeth were short and abraded

    Digital impression by means of Itero intraoral scanning system to fabricate zirconia single crowns

    Digital impression by means of Itero intraoral scanning system to fabricate zirconia single crowns

    ITALIAN VERSION


    Stereomicroscopic analysis of the precision of fit of PFM frameworks fabricated with traditional impression vs zirconia prostheses produced using an optical impression technique

    Case presentation
    A 42 year-old female patient, unsatisfied by the esthetics of her smile, asked for the rehabilitation of the maxillary incisors by means of fixed prostheses, substituting 4 previous metal-ceramic single crowns.

    Porcelain veneers in the Esthetic zone

    Porcelain veneers in the Esthetic zone

     

    ITALIAN VERSION

     

    RESTORATION OF MAXILLARY CENTRAL INCISORS WITH MINIMALLY INVASIVE FELDSPATHIC CERAMIC VENEERS LAYERED ON REFRACTORY MODEL

     

     

    CASE PRESENTATION

    A 26 year-old female patientpresented with fractures of the incisal margins of 1.1 and 2.1.

    2 affollamento inferiore

    Nobel Guide Implant-Guided Surgery with Nobel Clinician Software

    Nobel Guide Implant-Guided Surgery with Nobel Clinician Software

     

    ITALIAN VERSION

     

    MAXILLARY COMPLETE EDENTULISM TREATED WITH IMMEDIATELY LOADED STRAIGHT AND TILTED IMPLANTS AND A SCREWED FULL-ARCH TEMPORARY PROSTHESIS


    INITIAL SITUATION
    A 65 year-old female patient presented with maxillary complete edentulism. During the anamnestic interview, the patient reported a clinical history of adult chronic periodontitis; the patient has been edentulous for 9 years. Good general health and oral hygiene conditions were reported; the patient was a moderate smoker (about 10 cigarettes per day).
    During the clinical examination, a complete maxillary denture was noticed (figg. 1-2) and it was considered satisfactory for occlusion and morphology; on the contrary, such denture was unsatisfactory from an aesthetic point of view, showing wear and pigmentation of the prosthetic teeth.

    Mandibular full-arch restoration with Straumann implant-supported metal mesostructures and zirconia-based prosthesis: a case report

    Mandibular full-arch restoration with Straumann implant-supported metal mesostructures and zirconia-based prosthesis: a case report

     

    ITALIAN VERSION

     

    A 63-year-old female patient presented with a severe chronic periodontitis at the mandibular arch. Only teeth 33 and 44 were present and had been used as abutments for a resin removable partial denture which did not satisfy the functional and estethic needs of the patient. Moreover, a metal-ceramic crown with a supragingival margin and a mesial metal connector was evidenced on tooth 33; the patient reported that the mandibular front teeth had been previously prepared for a metal-ceramic fixed dental prosthesis, in order to limit the discomfort due to the mobility of such teeth.At the maxillary arch, the patient wore a complete removable denture which was esthetically unsatisfactory but valid to accomplish oral functions.
    edentulia mascellare

    An innovative prosthetic-guided Orthodontic technique: case series

    An innovative prosthetic-guided Orthodontic technique: case series

     

    ITALIAN VERSION

     

    A new technique of prosthetic dental abutment movement with individualized fixed resin provisory crowns and resilient material is proposed. Two clinical cases with 4 years of follow up will be showed.




    Clinical case 1

    A man 26 years old came to our observation, previously treated in the maxillary arch with an incongruous fixed prosthetic therapy, a full arch, after a traumatic event. It was necessary the avulsion of tooth 21 and were prepared dental abutments from tooth 15 to tooth 25 to realize the bridge.

    protesi fissa incongrua

    This prosthetic therapy appeared aesthetically incongruous because of the shape and colours aberrations of the crowns. In addition to these aesthetic problems, because of which there was the patient request of a new rehabilitation, it appeared a periodontal suffering with probing depth between 4 and 5 mm. Instead satisfactory and compatible with a good periodontal health were the other teeth conditions.
    The patient had the tooth 12 agenesis, a tooth 53 persistence and a mesial shift of tooth 13. X-rays showed previously incongruous endodontic therapies on teeth 11, 13 e 22 with cronical periapical diseases.
    The clinical examination showed also a vertical bone minus of tooth 53 and an advanced root resorption state of this tooth.

    Controlled split crest and sonic surgery

    Controlled split crest and sonic surgery

     

    ITALIAN VERSION

    IMPLANT-SUPPORTED PROSTHETIC REHABILITATION WITH CONTROLLED BONE EXPANSION BY MEANS OF SONOSURGERY SONIC TIPS AND OSTWILL BONE EXPANDERS

     

    In implant-prosthodontics, the prosthetically-guided implant placement is paramount: implants have not to be positioned where bone is present (as it was advised before bone augmentation techniques were introduced) but the oral surgeon has to place fixtures with shape and dimensions proper to substitute the missing teeth. Moreover, correct emergence profiles as well as proper mesial-distal and buccal-palatal position have to be achieved, in order to dissipate occlusal loads evenly, mainly along the long axis of implants.

    Horizontal bone resorption occurring after the extraction of a tooth is one of the most frequent anatomical limitations that do not allow the ideal placement of an implant. Sometimes, although the buccal-palatal amount of bone seems to allow a proper positioning of a fixture without bone augmentation, such horizontal resorption moves the center of the ridge palatally in the upper jaw and buccally in the lower jaw. Implant placement without correcting such conditions would probably result in a wrong emergence profile of the prosthesis.

    One of the most predictable regenerative technique to improve the amount of buccal bone is the sagittal osteotomy of the ridge (E.R.E.), developed by Dr. Bruschi and Dr. Scipioni. Such technique was reported to have very high success rates (98-100%) and showed the minimum volumetric contraction in the long-term, since the buccal bone is maintained in situ provided with both endosteal and periosteal blod vessels, limiting secondary bone resorption.

    In the present clinical case, a patient needing a single implant in region 13 was treated; the tooth was extracted one year before implant treatment because of severe periodontal damage.

    controlled split crest sonic surgery

    controlled split crest

    The premolar had been previously endodontically treated and restored by means of a glass fiber post. The patient was wearing an acrylic resin temporary restoration luted on tooth 14 with a cantilever in region 13. The provisional restoration was considered incongruous because of both esthetics (too light color) and function (absence of the mesial contact area).

    Prosthetic treatment in Esthetic zone with all-ceramic procera zirconia abutment and crown supported by a SLActive Straumann implant

    Prosthetic treatment in Esthetic zone with all-ceramic procera zirconia abutment and crown supported by a SLActive Straumann implant

     

     ITALIAN VERSION

     

    SURGICAL PHASE

    PROSTHETIC PHASE

    The SURGICAL PHASE of the implant treatment of a maxillary central incisor affected by a root fracture has been previously described. Such fracture was not diagnosed in time and the hopeless tooth was extracted. Then, the patient was subjected to presurgical orthodontic treatment to correct a diastema of about 3 mm between the maxillary central incisors. Finally, a Straumann RN 3.3×10 mm SLA implant was placed to restore the tooth.

    incisor diastema median diastema periodontal probing DSCF5288 maxillary diastema

    In the previous article, the orthodontic treatment has ben described as well. A lingual orthodontic approach without brackets was adopted, bonding the orthodontic wires with a flowable composite resin. Tooth 11 was extracted and a 16-16 steel wire was modelled to passively fit to the palatal surfaces of teeth 12 and 13. Loops were modelled as well to retain the temporary restoration. A 0.195 multistrand wire for passive retainers was then modelled and bonded to the palatal surfaces of teeth 21, 22 and 23. The temporary restoration was drilled in order to bond the retentive loops by means of a flowable composite resin. An elastic chain stabilized with ligatures between teeth 21-22 and 12-13 was used to close the diastema. Such elastic chain was changed every 3 weeks and the space was closed in about 12 weeks. Once the diastema was completely closed, the elastic chain was removed and a passive retainer was bonded onto the palatal surfaces of the temporary restoration and tooth 21.

    Agenesis of the lateral incisors treated with Straumann Bone Level implants and Etkon zirconia abutment

    Agenesis of the lateral incisors treated with Straumann Bone Level implants and Etkon zirconia abutment

     ITALIAN VERSION

    SURGICAL PART

    PROSTHETIC PART

     

    The surgical phase of a case of agenesis of two lateral incisors treated inserting two Straumann Bone Level SLActive implants (4.1 mm diameter, 10 mm long) has been dealt with in a previous article.

    The patient PA, 23 year old male, suffering from bilateral agenesis of the maxillary lateral incisors, was thoroughly informed of the available therapeutic options for his prosthetic rehabilitation. Before and after inserting the implants the patient underwent orthodontic therapy. The patient had come to the chairside examination presenting a malocclusion characterized by a deep bite, a molar and canine first class on the right and a left molar first class while the left canines were in a cusp to cusp relationship, due to the mesialization of the 23.

     

    tooth agenesis straumann implant bone level zirconia etkon
    lateral agenesis implant straumann bone level etkon zirconia
    lateral incisor agenesis

    The aim of the orthodontic therapy was to solve the deep bite and to create the correct spaces to position the implants in region 12 and 22. The situation at the beginning of the therapy was the following: the space for the 22 was almost correct but the 23 was mesialized and there was a diastema of about 3 mm between the 23 and the 24; the space for the 12 was excessive while the position of the canine was correct. In order to normalize the spaces to insert the implants and finish the therapy with a right and left canine first class it was necessary to normalize the ratio between the dental dimensions of the anterior maxillary and mandibular groups either enlarging the maxillary central incisors, best option, or reducing the mesiodistal diameter of the anterior mandibular group. Otherwise the therapy would have resulted in a molar and canine cusp to cusp relationship. Unfortunately the patient wanted neither to enlarge his maxillary central incisors nor to reduce his mandibular anterior group and accepted a trade-off closure with a molar and canine cusp to cusp relationship. After aligning the arches and normalizing overjet and overbite the implants were positioned in an ideal position in respect to the maxillary central incisors, the midline and the previously made waxing.

    Porcelain veneers

    Porcelain veneers

     

     ITALIAN VERSION

     

    MINIMALLY INVASIVE AESTETHIC REHABILITATION OF THE ANTERIOR SECTORS WITH PORCELAIN VENEERS

     

     

    A female patient, aged 33, needed a functional and aesthetic improvement of the maxillary anterior region previously restored with composite veneers. The chair-side examination showed a marked discoloration of the restorations and an evident and generalized wear of the incisal edges of the anterior sectors of both the maxillary and mandibular jaws.

    porcelain veneersveneersceramic veneer

    feldspathic veneers

    feldspathic porcelain veneers

    lumineers

    composite veneer

    veneer

    After explaining the different therapeutic options to the patient, it was decided to build-up 6 feldspatic porcelain veneers to restore elements 11, 12, 13, 21, 22 and 23. Moreover, it was planned to lengthen the incisal margins, in order to improve aesthetics, restore a correct protrusive function and optimize both the overjet and the overbite.

    Evaluation of occlusal parameters is of primary importance for long term success of porcelain veneers. It is particularly important to assess the centric relation and protrusion in order to decide if and up to what point extending the palatal tooth preparation. In fact, the centric contacts have to be placed on porcelain, in order to avoid tensive stresses on the adhesive interface between the dental tissues and the restoration during protrusion.

    A new technique for restoring prosthetic space in implant region: a case report

    A new technique for restoring prosthetic space in implant region: a case report

     

     ITALIAN VERSION

     

    In planning treatment of a prosthetic-implant patient, to obtain a propitious prognosis of a long term rehabilitation, a multi-discipline approach is elementary. However, in some cases, despite the commitment to realize an ideal treatment plan, it may happen to face up with an inadequate space when prosthetic procedures start.

    Such a likelihood may be due to an occlusive stability lack, erroneously not corrected at the beginning of the treatment, or to the limited compliance of the patient who often does not respect periodical recalls established by the dentist. If there is not a correct occlusive mechanism or adequate space keepers, dental elements near the edentus saddle can carry versions of few mms which bring to significant prosthetic difficulties. In extreme cases, it may be impossible to associate implant-prosthetic components because of an inadequate occlusive space to access the implant neck.

    For these cases, by taking advantage of the implant (bone-integrated, it is a steady anchor point and so it cannot move from its position), we created a technique to move dental elements. This idea was born by observing the spaces created mesially and distally to the molars using elastic divisors to insert bands in orthodontics. This technique permits to solve simply problems of space recovery in a non invasive way. It determines an orthodontic movement of uncontrolled inclination suitable for the resolution of these dental inclinations.

    Case report

    Patient S.R., a 32 year old male, was successfully treated by surgical implant therapy in the 16 area, in order to replace a dental element previously avulsed. A careful analysis of the spaces was carried out during treatment planning to introduce fixture in a prosthetic position optimally guided. Regardless, the patient missed periodical controls and returned 2 years after implant surgery. A mesial version of the element n. 17 was promptly highlighted (fig.1- 2) created during that time period.

    Space recovery

    Room recovery

    This mesial version invalidated the restoring treatment plan, making necessary the distalization of the crown of the element n.17, in order to re-open correctly the prosthetic space. However, the patient refused both the realization of an inlay on the element n.17, necessary to recover at least a part of this space by changing the mesial profile of the tooth, and the traditional orthodontic therapy. Therefore, we proceed to screw a full implant abutment (fig 3) which was intra orally prepared to improve thicknesses in a mesial-distal and occlusive way, necessary to make a final prosthetic manufactured product (fig 4-5-6).

    Gold ceramic vs zirconia dental crowns

    Gold ceramic vs zirconia dental crowns

     

     ITALIAN VERSION

     

    PROSTHETIC REHABILITATION IN THE ANTERIOR SECTORS WITH HIGH AESTHETIC IMPACT: CLINICAL CASE STUDY

    This report describes a case of a 28 year-old male patient who complained of aesthetic discomfort due to composite resin restorations in regions 11 and 21. They were fractured and structurally compromised too. Furthermore, the patient felt abnormal occlusal contact during the movement of the mandibular protrusion. Radiographic examination through endoral radiography showed evidence of infiltration of restorations (Fig 1).

    After discussing with the patient the various therapeutic treatments available for his clinical case, the approach chosen was to replace the previous restorations with 2 integral zirconia-based ceramic crowns made via CAD-CAM technology.

    A periodontal therapy of support through scaling/root planning and prophylaxis procedures was carried out. The previous composite restorations were removed and replaced.

    We proceeded to correct the prosthetic geometries creating two circular shoulder preparations with a chamfer of 1 mm amplitude according to the traditional principles

    concerning the preparation for fixed dental prostheses. In the dental stumps a convergence of about 15° was performed (fig.2) according to the procedures for prosthetic preparations for integral ceramic restoration. Literature justifies such indication by virtue of the CAD-CAM scan; the lesser retention with respect to the traditional prosthetic preparations for metal-ceramic crowns, is compensated by the mechanical and chemical composite adhesive resin cementation of the integral ceramics.

    Alumina and zirconia prostheses: these unknowns

    Alumina and zirconia prostheses: these unknowns

    ITALIAN VERSION

    When the Italian soccer team plays a game, everyone, even who does not know anything about sport, becomes a soccer supporter: the day after the match, you can not go to the bar without knowing the result so you can discuss it with friends and colleagues! In the last few years, we have seen a similar phenomenon in the field of all-ceramic prostheses: everyone’s talking about them, everyone uses them, everyone claims to be experienced with them, even if they don’t really know a thing about them! Of course, nowadays, a dental surgeon can not do anything but use the most innovative materials and most up-and-coming techniques…!

    However, confusion on this matter is widespread, testified by the fact that during courses and conferences there is not even any clarity concerning the terminology. What name should be given to integral ceramics? Alumina or zirconia? Alumina and zirconia? Some say they are oxides, but doesn’t an oxidized material suggest ideas of something that is used up, damaged or, in any case, not excessively resistant? Well, let’s clarify the ideas.

    The use of gold and metallic alloys in prosthodontics is almost disappearing, thanks to the introduction of “white” materials whose aesthetic results are without doubt more attractive. The possibility to eliminate the visibility of unattractive metallic edges is a very pleasing solution, both for dentists and patients. And today integral ceramics allow both to plan new rehabilitations and re-operate on previous work that maybe does not satisfy the ever more pressing aesthetic demands.

    Figure 1 – Gold-ceramic fixed partial prosthesis.