Sofia Papadiochou
Title: A case of wide anterior interdental
spaces and increased horizontal overjet: A
multivariant challenge for prosthodontic rehabilitation.
Sofia Papadiochou, Greece
- A
53 – year old female patient presented for prosthetic rehabilitation in the
postgraduate department of Prosthodontics in Dental School of Thessaloniki, in
Greece (photo #2).
- The
major aesthetic and functional challenges of the presented maxillary prosthetic
rehabilitation were derived from the closure of the anterior maxillary
interdental spaces as well as the management of increased horizontal overjet. The
latter has direct association with the profile aesthetics of lower lip/
inferior facial third, too (photos #4,50).
- To
achieve an optimal outcome, pre-operative evaluation has taken into account crucial
variables including the: a) shape and the size of the anterior front teeth
during the design of provisional restoration (photos #22,23), b) phonetic
analysis (photos #12,26,42), c) determination
of implant position (photos #29,30), and d) establishment
of appropriate occlusal scheme (photos #39-41).
- A
maxillary complete denture (removable) was not considered as provisional
restoration; such a treatment approach implies reasonable risk of failure since
a denture placed over the bone grafts and inserted implants results in direct
compression of both during the critical period of osseointegration.
- Of
note, the patient was initially reluctant to approve the closure of maxillary
interdental spaces in the anterior region. However, she accepted our suggested
treatment plan (at its trial phase), when a “digital diastema closure” was produced
to simulate the final outcome via GIMP software. (photo #23).
- After
the removal of the existing metal-ceramic restorations the prognosis of #34 re-evaluated
(deteriorated from good to compromised) because of the deficiency of sound
coronal tooth structure (photo #25).
- The
treatment plan dictated placement of 7 dental implants in the maxilla to retain
a metal-ceramic fixed prosthesis (photo #31). According to Misch, 3 implants
should be planned in the premaxilla in case of ovoid dentate arch form; one in
each canine position and one additional anterior implant. In addition, Misch
underscored that at least 4 posterior implants should be splinted to form an
arch in an edentulous maxilla.
- The
first maxillary provisional restoration did not meet the patient’s
expectations; the shape of maxillary anterior teeth was rectangular and the
horizontal overjet was measured 4mm (photo #27).
- Therefore,
we proceed in fabrication of a new maxillary provisional restoration which
involved round-shaped teeth and 3 mm horizontal overjet (photo #28).
- The
impression copings were splinted with dental floss and autopolymerizing acrylic
resin. The open-tray implant technique was implemented in both maxillary and
mandibular implants (photo #32).
- A
silicone index was used to select the proper low- profile abutment in terms of
angulation (photo #34).
- Angled
low-profile abutments were used in implants positions # 22,23,24,25,12,13
(photo #35).
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