The Award contest 2015/ 9 October 2015/

Case 17 | Prosthodontic Award 2015 | Italy

Dr. Fulvio Frezzotti

A 30-years male patient presented to my office to improve his esthetic smile and to resolve a pain symptom in sub nasal area. After clinical and strumental exam, the patient was diagnosed having an periapical infection with severe damage of buccal bone on right upper central incisor, also disproportional teeth were present in esthetic area.

Initial situation with face view, intraoral view, periapical rx, tomographic exam.

We decided to remove the hopeless tooth, insert a fixture in original position and realize guided bone regeneration with Bio Oss, resorbable barrier and connective tissue graft to cover the fixture create the ideal volume of the hard and soft tissue.

During the healing time was inserted a temporary maryland to replace the tooth.

Achieved the osteointegration, a D.S.D. (Digital Smile Design by Christian Coachman) was created to choose which midline use for setting the design of the smile, the ideal line (red line) or not the ideal line (white line). Ideal midline was too right for creating an smile armony, so according Kokich (J Esthet Dent. 1999;11(6):311-24) we project the smile with the white line. With the DSD we can measure the dimension of the digital teeth (personal library) and the laboratory was able to make the waxup according to digital preview.

A generic temporary crown was inserted on the fixture to remove the maryland. A silicon index was used to check the veneer preparation on the left central incisor, to insert the temporary crowns on the right and left central incisors and make temporary composite on lateral incisors and to guide the direct composite on lateral incisors, always according to Digital Smile Design project (definitive direct composite were finished after the cementation of the veneer). The case finished with disilicate crown and zirconium abutment on right central incisor, disilicate veneer on left central incisor and direct composte on the lateral incisors.