Nalat Wongwatjana
Mr.Rodolphe Saidnattar, MDT
Full mouth habitation with dental implants and multilayer zirconia crown
The 58-year-old patient came into our office complaining for get back his smile and ability to eat. He denied any history of systemic disease, dental trauma.
We requested a panoramic x-ray, facial photo for facial and smile analysis, dental photo for diagnosis and proper treatment plan.
From
clinical and radiographic examination
17 Non
functional tooth
15,16 Edentulous
area with insufficient vertical bone height
25,26 Edentulous
area with left maxillary sinusitis
27 Previously
Root canal treatment & Crown with periapical infection that may lead
to maxillary sinusitis
35,45 Edentulous
area
34,36 Large
defective amalgam restoration
44 Edentulous
area
45,46 Large
defective amalgam restoration
Generalize Tooth wear, attrition and abrasion
Fair oral hygiene
Diagnosis
By correlating the anamnesis with
the clinic, radiographic, photographic, examination,I concluded that aesthetic
problem were caused by lack of posterior teeth which lead to reduced overbite
and overjet, severe anterior teeth wear and loss of vertical dimension, reverse
smile ilne,shorten of facial height and lack of labial support.
Prognosis
#27 Questionable
Others Good
Goals
My treatment plan objective was
restoring the esthetic and function with dental implant and multilayer zirconia
crown
Treatment
plan
1.Periodontal by scaling and root
planning
2.Pre-prostetic restorative with
resin composite.
3. Surgical placement of Dentium super
line fixture dental implant at 26,44
Crestal approach sinus augmentation with implant placement at #25,26
Surgical extraction 27, Immediate
implant placement at 25
4.Applications of acrylic
provisional crown on 45,46
5. 3 months after place dental
implant. Second stage surgery was performed, healing abutment were place for
gingival molding.
One week after second stage
surgery, all soft tissue was stable.
6. Prosthetic habitation with
preparation on 14,13,12,11,21,22,23,24,44,43,42,41,31,32,33,36 were preparations
for zirconia crowns.
45,46,36 old crowns were removed,
core build-up, preparation.
Fixture level implant impression
technique with implant coping
Final impression was performed
with PVSFacebow registration
establishes the relationship of the maxillary dentition to the horizontal
reference plane so that the maxillary cast can be mounted on the articulator in
the correct anatomical position and
centered Bite record by Esthetic Cross Esthetic
CrossRef™
VDO was recorded in Centric relation to increase the overjet and overbite and get proper front guide, as the result of opening the bite, there’s room for increase the length of the incisal .
Laboratory transferred all record to 3shapes dental system Bite registration on virtual articulator(In centric relation) use the virtual articulator from 3shape for increase the VD as recorded.
Dental crowns were design with 3Shape Dental System,3-D positioning of upper incised edge by digital smile analysis and design, PMMA crowns were milled as designed
Temporary
PMMA crowns were try-in and temporary fix with tempbond NE, Weekly follow up and occlusal adjustment was
performedAfter 5 weeks with new VDO, patient s satisfied and had no TMJ or muscle
problem
FINAL SCANNING implant and teeth abutment with iTero intraoral scanner
(Chair side milling mode/High definition)
Temporary crowns was scanned Intraorally UPPER AND LOWER PMMA crown in
occlusion for gave technician all the bite information
Cross-mounting technique forgetting correct occlusal relation
Final
design using 3shape digital system
Multilayer zirconia crown were milled & try in on model
Zirconia crowns were temporary fix with tempbond and let patient try for 2 weeks
Permanent cementation with PANAVIA V5 SYSTEM
Follow up and maintenance every 6 months
