Contests The Prosthocontest 2019/ 20 May 2019/

Case 45 | Njdeh Shadoyan – Armenia | Prosthocontest2019

Njdeh Shadoyan

A 62 years old male from overseas came for consultation seeking for functional rehabilitation and why not aesthetic as well. After thorough examination a decision was made to Restore the vertical dimension by placing ceramic crowns over zirconium ingots (17 individual crowns 9 upper and 8 lower, 4 units bridge for the upper and 3 units bridge for the lower). Treatment duration; 7 weeks
– Root canal treatment has been done for all the teeth.
– Pre op photos have been taken as well as video recordings to capture jaw movements and pronunciation and primary impressions, (Slides #1,2).
– After analyzing the bite and the jaw movements by studying the photos, videos and stone models a primitive Digital Smile Design has been done using power point tools just to evaluate and imagine the final outcome (slide #3,4,5).
– A decision has been made to elevate the bite approximately 3mm. To avoid possible discomfort and pain on TMJ that the patient might suffer in the future due to the bite elevation, and for maximum muscular adaption of the new masticatory forces, a customized acrylic TMJ splint has been made and the patient wore it for 4 weeks, (slide #6)
– According to DSD wax-up has been made with 3 mm bite elevation and silicon keys prepared accordingly, (slide #7).
– Direct mock-up in the mouth has been done using the keys for primary approval and the Provisionals have been made accordingly, (slide #8).
– Teeth preparation (slide #9,9.2).
– Bite registration has been recorded using acrylic jigs for maximum accuracy (slide #10).
– Zirconium ingots design and in-mouth try-in (slide #11,11.2).
– Final crowns and bridges try-in and temporary cementation (slide #12).
– No bleeding healthy gum is necessary before the final cementation (slide #13).
– Post op photos with comparison (slide #14-21)
– A soft night guard has been advised for 6 months
– 11 months follow up photos (slide #22)