Andrea Fabianelli
The patient, a 72 years old male, came in office in February 2018 for a oral rehabilitation. His chief complain was his unpleasant smile, his low masticatory efficiency and a diffuse sensitivity.
He has good general health conditions (ASA1), not smoker.
Patient had tooth 36 pulled out, crowns in tooth 15, 13, 12, 21, 22, 23.
He recently lost a crown placed in tooth 13.
From a periodontal point of view patient has gingivitis with PI >40 % and BOP >40 %treated by plaque control and supra and sub gingival debridement using hand and ultrasonic instruments . This resulted in a reduction of PI and BOP < 20%. Pathologic probing pocket depths 4th sextant and presence of chlorhexidine stain after implant insertion in sextant 4. Radiological status demonstrate slight presence of periodontal sufferance of tooth 33 with slight bone loss and sufficient periodontal support. All teeth are considered part of the rehabilitative project, absence of radiological lesions and symptoms. All teeth are maintained it in the rehabilitative project. Patient has a deep bite, presents a reduced VD so an increase of VDO of 3 mm was planned, with a centric relation registration (Chin post technique). MI slightly was diverse from CO and new hinge axis detected.
The diagnosis was teeth erosion and abrasion, moderate sensitivity during function and when drinking, slight loss of vertical dimension, moderate gingivitis, esthetic issues, Kennedy Class III edentulism (tooth 36). No tmj problem was detected.
Treatment plan was subsequently delivered.
Upper arch: Overlay: 17,16, 24, 25, 27; 13,12,11, 21,22,23 LiDiSi crowns, 15 temporary and PFZ crown, 26 direct composite, scaling and root planing.
Lower arch: Implant 36, PFM crown, open flap curettage and regenerative procedure distal defect tooth 33, scaling root planning , overlay LiDiSi 46, 45, 44, 35, 37; 35 temporary and PFZ crown vep protocol, porcelain veneers 33, 32, 31, 41, 42, 43.
Final evaluations: From a stomatologic point of view nothing relevant , the increase of VDO has been immediately accepted by the patient, occlusal stability was achieved as a group guidance (canine and premolars), improved comfort due to increased vd, From a periodontal point of view was achieved an improved oral care, reduced BOP and the absence of bone defects, absence of apical lesion.Patient is satisfied with his new esthetic. Occlusion is stable, patient is comfortable . A nite guard was given to the patient. Patient improved his ability to maintain oral hygiene
