Dr Marco Toia
TITLE: Aesthetic complex rehabilitation of upper frontal region of a patient affected by Addison’s disease.
Marco Toia DDS, Alessandro Orsini DDS, Alessandro Toia MD DDS. (ITALY)
CASE PRESENTATION: A 58-year-old female complained of upper front esthetic.
The anterior upper and lower teeth were splinted together with composite from canine to canine. Severe recession and occlusal wearing was detected in the dentition.
The periodontal charting did not reveal pockets or BoP. The x-ray status, however, showed a severed reduced length of the maxillary central incisors. The upper frontal region was not in occlusal contact with the lower arch because of malocclusion.
Patient’s request was to solve the unaesthetic area of the frontal zone. Furthermore she asked to have all her teeth saved.
During treatment, patient had an Addison’s disease severe exacerbation. As a consequence, an iper-pigmentation of the mucosa appeared, as showed in Fig.6. Patient was immediately suggested to visit the emergency medical service.
In accordance with the patient, the final solution was to splint the frontal upper group with a FPD.
This option provided the necessity to maintain all the frontal teeth vital during the preparation steps. Teeth vitality is crucial, especially in very reduced roots and to obtain it an orthodontic treatment was needed to de-rotate the lateral incisors.
After consultation with patient’s endocrinologist, a coronal advanced flap (CAF) and a free connective tissue graft(CTG) was applied to increase soft tissue volume and reduced teeth recessions. For final restoration a fixed partial denture (FPD) with a Zirconia framework was applied from the six frontal teeth. A two years follow-up was reported and non differences were noted in soft as well as hard tissue from the base-line visit.
CONCLUSION: In this challenging case, a combination of advanced periodontal, orthodontic and prosthetic treatment gave the chance to save very compromised teeth with an aesthetically result, as requested by the patient. The overjet was a significative advantage in the choice of the treatment plan. The role of the dentist in the individuation of exacerbation of the systemic deseases The Addison’s disease, which was detected by the dentist and promptly controlled by the endocrinologist, did non influence the final outcome.