Ana Krtolica Georgiev
Dear colleagues, I would like to present the following case,
Full mouth rehabilitation of teeth discolored by tetracycline.
By Dr. Ana Krtolica Georgiev (Macedonia) Dt. Zarko Trendovski (Macedonia)
A 50 years old female patient was interested in smile improvement and fixing her problem with the unilateral chewing because of missing of teeth No. 37 and 36.
The patient is in a good health condition.
Intraoral examination showed:
· teeth discoloured by tetracycline
· presence of old filings with sufficient marginal closure,
· old metal ceramic bridges from 26 to 23 and from 44 to 47,
· Teeth No. 24, 25, 36, 37, 44, 46 are missing,
· Dental wear is evident in teeth from upper intercanine region,
· Soft tissues are in good condition and no disease was detected
· The patient keeps good oral hygiene.
Throughout the examination, I have evidenced deviation of mandible while opening. I suspect that this occurs as a result of the elevator muscle hyperactivity caused by unilateral chewing.
Radiographic findings:
· Correct bone level,
· Endodontic treatment of teeth No.16, 15, 11, 37, 48.
· Periapical process on tooth No. 37 ( Tooth was extracted two months before my examination)
· Prosthetic bridges from 23 to 26 and from44 to 47
Treatment plan
I prefer minimum invasive prosthetic approach on every intact tooth. Teeth from 33 to 43 are reconstructed with feldspathic veneers. Posterior regions with missing teeth are reconstructed with bridges (in lower jaw made of metal ceramic), and Zirconium oxide veneering crowns (made with cut back technique with GC initial porcelain in CAD CAM system). Compromises about the chosen materials were made out of financial reasons.
After prosthetic preparation of the teeth (shoulder paragingival preparation), I made double cord impression with polyvinyl siloxane.
Bite transfer with face bow. Bite registration in CR after relaxation of the m. Pteryogoideus lateralis inferior (made with leaf gauge). Registration in CR allowed reconstruction of anterior dental wear (space for reconstruction 1280 microns )
Restorations were fixed with dual cure resin cement system from GC.
Bite check was made with 8 microns occlusal foil and 8 microns Shimstock foil. Canine guided lateral movement is established. Disocclusion in molar region through anterior guiding.
I wish you all the best. Greetings from Macedonia.
