The Award contest 2017/ 27 February 2017/

Case 104 | The Award 2017 | Italy

Dr. Massimo Secchiari / DT Andrea Schiavoni

This case shows an alternative to prosthetic rehabilitation in case of lateral teeth’s agenesis.
30 years old patient presented in 2013 having the failure to exchange the teeth of upper canines and upper lateral. His requests was to improve the aesthetics of the mouth.
Examination showed the permanence of 5.3, 5.2, 6.2, 6.3 teeth, deep bite, mandibular deviation to the right.
Radiographic examination showed the presence of the two canines in bone inclusion and agenesis of the two lateral teeth.
An orthodontic treatment with Sato technique was done to replace the canines on oral arch and for solve the deep bite, the space for lateral teeth was kept.
Unfortunately the anatomy of incisive root prevented the placement of two implant.
In according of patient’s request we opted for a solution with no prep veneers of palatal disilicate, vestibular feldspatic veneers and the intermediate element in the lithium disilicated layered bonded on the mesial surface of the canine.

Follow-up 1 year

Initial case before orthodontic treatment

Orthodontic treatment with Sato Technique

After 2 years of ortho terapy, we have this situation….overjet increased, and not esthetic line

Anatomic abnormality of roots that do not allow insertion of implants

Conditioning of the gum parables 1.2,2.2 with a mobile device

Before and after conditioning gum

Gips model mounted in individual articulator and calculated the angle of eminence with CPM

Diagnostic wax-up

Moke-up in mouth

Lingual laminates in LS2 to ripristinated incisal guidance in model gips

Laminated in situ

Shade selection

Feldspatic veneers with platinum foil tecnique

Finished veneers in alveolar model

Veneers bonded with this step:
1) tooth sandblastig with Al2O3 50 micron at 2 atm;
2) tooth etching with orthofosforic acid 35% for 20 sec;
3) tooth bonding
4) ceramic etching with fluoridric acid 9,6 % for 90 sec;
5) ceramic silanized.