A 50 years old Caucasian Female patient sought dental treatments, mainly to improve her esthetics and functions. Per examination, the findings and diagnoses included generalized gingivitis with localized periodontitis, failing and missing dentitions, defective restorations, and other esthetic problems, such as uneven maxillary gingiva, shifted dental midline, and maxillary dental crowding. Due to erosion and attrition, mild to moderate worn teeth, especially at lingual surfaces of most teeth, were detected. Her main concern was to have bigger and brighter teeth to show her personality and regain her self- confidence.
The goal of her comprehensive dental treatments was to satisfy her esthetic concerns, to provide a stable and mutually protective occlusion with harmonized neuromuscular envelope function, to improve and maintain her periodontal and endodontic issues, and a long-term follow up care.
Interdisciplinary dental treatment team included an orthodontist, a periodontist, an endodontist, a dental technician, and a prosthodontist. To improve her esthetics and mandibular arch form, the maxillary anterior teeth were orthodontically proclined and intruded, and hence the approximately 4 mm created interocclusal space between the maxillary anterior teeth and her existing mandibular anterior fixed partial denture (bridge). Upon completion of her orthodontic treatment, the vertical dimension of occlusion (VDO) was restoratively increased approximately 2.5 mm at the incisor areas, so the maxillary teeth length was increased about 2.5 mm, while maintaining 4 mm maxillary Central Incisor edge display at the rest position. The full coverage restorations were planned due to the circumferential teeth wears and existing restorations; however, more conservative teeth preparations were achieved by creating interocclusal spaces with combination of increasing VDO and orthodontic movements.
The periodontal treatments included the Guided Tissue Regeneration to correct the periodontal defects on teeth #s’ 30 and 31. Also, #’s 3 & 14 dental implants (Astra Tx 5.0 x 9 mm) were placed with the Osteotome sinus lift procedure. After integration, implant supported screw retained provisional restorations were utilized as absolute anchorages to expedite orthodontic treatments.
CAD/CAM PMMA complete mouth provisional shells were fabricated and relined. Provisional restorations were maintained for three months to test her adaptation for a new vertical dimension of occlusion, new occlusal scheme, neuromuscular envelope functions, and esthetics.
For her definitive prosthesis, zirconia copings (Noritake Katana HT) were fabricated with CAD/CAM techniques. Porcelain fused zirconia restorations were delivered and cemented with Panavia V5 dual cured resin cements.
A hard splint (night guard) was delivered and maintained with 4-month periodontal recall.
