Dr. Davide Foschi / DT Mr.Filippo Giacometti
a full mouth rehabilitation of a patient suffering from severe tooth wear, restored relying only on adhesive techniques and on increase of the vertical dimension of occlusion
ALL CLINICAL CASES
Generalized severe loss of tooth structure
Due to the supra eruption of both the maxillary and mandibular anterior teeth, the patient presented a deep bite
Posterior quadrants affected by dental erosion. Note the recently loss of amalgam filling at the level of tooth 37
Surprisely all the maxillary anterior teeth were still vital
Due to the combination of loss of VDO and severe tooth wear, the tooth display was in contrast with the patient’s age
Deep exposed dentin was immediately sealed to protect the pulp The teeth were supposed to be devitalized to be restored by posts. To keep the teeth vital, NO posts were considered.
The sclerotic dentin was very superficially removed before being infiltrate, no anaesthesia was necessary even though the teeth were all vital Composite core build up directly fabricated in the mouth with the transparent index Speed up therapy: a full mouth bonded mock up
The silicon key fabricated out of the wax up was loaded with Telio (C&B Chairside, Ivoclar) and pressed on the teeth, to test the project in wax directly in the patient’s mouth in a additive manner After 3 months with the mockup in place, the maxillary anterior teeth were prepared for the final restorations. Crowns were selected to restore these teeth. To achieve a minimal tooth preparation a feather edge margin design was selected Provisional Crowns Material chosen for the full mouth rehabilitation
Lava Ultimate – 3M Cutback, Sandblast, Silane, Bond, Lightcure, Composite Every single crown was cemented with warmed up hybrid composite, Enamel Plus Dentin – Micerium 6 facial veneers for the mandibular anterior teeth Laboratory work: 6 cad/cam composite monolithic facial veneers All the Veneers were cemented with warmed up hybrid composite, Enamel Plus Dentin Micerium Follow up at one week The posterior teeth were restored by sextant. The mock up was removed, the impression taken and the new provisional was made using a silicon key out of the existing mock up
Segmented rehabilitation, all the posterior quadrants were still with the mock up in place, except quadrant 3 restored with overlays
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