Dr. Federico Emiliani / DT. Mario Ozimo
Full mouth rehabilitation
ALL CLINICAL CASES
Patient man, 50 years old. He presents high generalized tooth wear. He has no symptoms and asks us to have better aesthetics.
In the comments under each picture you can find explanations of the various clinical steps.
The patient has a high tone of the masticatory muscles. No facial asymmetry, no midline deviation. His face shows more aging than his years because of the loss of tooth substance.
The central incisors have a length of 7 mm, and a width of 7.5 mm. The smile line is low. The smile design, compared to the lower lip, is flat.
The patient asks us to close gaps
The phonetic analysis shows the absence of exposure teeth with lips at rest, and during the phoneme “M”.
The intra-oral view shows occlusion conditioned by the anterior mandibular shift, absence of front and lateral guides, and posterior interferences, loss of vertical dimension of occlusion. No overjet, no overbite.
Patient has old prosthetic posterior rehabilitation in metal and ceramic.
This type of occlusion, combined with the high masticatory forces, determine the progression of dental wear. 
We collect all the data relating to the analysis facial, dental-labial, dental and phonetics within the aesthetic folder. I told to the laboratory the changes to be made to clinical case to obtain a diagnostic wax-up. Meanwhile, I show the patient a virtual preview of the project of his new smile, to strengthen our communication awaiting the mock-up.
I register a wax in CR increasing the vertical dimension of occlusion of 2 mm. This allows us to correct the mandibular sliding, and create space for our restorations. We get from the wax-up 2 thermoformed masks we use to try out the new patient’s occlusion
MOCK UP
In these images there is the result of the mock-up session. We can observe how the right size of the teeth, in accordance with certain aesthetic canons, gives a more youthful appearance to the patient’s face, which looks very satisfied.
MOCK UP
Exposition of central incisor at rest in mock-up
After having had the patient’s approval, the laboratory manufactures the temporary crowns.
Cemented provisional restorations.
Final preparations and precision impression with double cord technique
WAX FOR CROSS MOUNTING.
Now we record the occlusion waxes in CR in order to make the cross-mounting of models in the articulator. We record the articulation of a provisional arch with the abutments of the other arch, and vice versa. Finally the occlusion in CR of the abutments of the two arches. In these recordings always we respect the measures imposed by the new vertical dimension.
Final restorations cemented. Veneers monolithic lithium disilicate (e-max) from 1.3 to 2.3 and from 3.2 to 4.3. Monolithic zirconia crowns painted from 1.4 to 1.6, 2.4 to 2.6, 3.3 to 3.5, and 4.4 to 4.7.
Periodontal health, aesthetic and functional integration of the restorations.
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