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A COSMETIC REPLACEMENT OF ANTERIOR TEETH

A COSMETIC REPLACEMENT OF ANTERIOR TEETH. By Zillah Horn In partial fulfilment of BTech: Den Tech. Degree September 2004. CONTENTS. Patient history Patient condition and background Possible clinical treatment options Possible technical treatment options

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A COSMETIC REPLACEMENT OF ANTERIOR TEETH

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  1. A COSMETIC REPLACEMENT OF ANTERIOR TEETH By Zillah Horn In partial fulfilment of BTech: Den Tech. Degree September 2004

  2. CONTENTS • Patient history • Patient condition and background • Possible clinical treatment options • Possible technical treatment options • Treatment option most suitable • Treatment option of choice • Laboratory procedures • Clinical procedures • References

  3. PATIENT HISTORY • Age: 23 years9 • Place of origin: Zimbabwe9 • Jan 2002: Fell from waterfall in Zimbabwe9

  4. PATIENT HISTORY cont. • Le Fort III fracture2 • Parade ground fracture2 Nasal bones3 Frontal bone3 Lacrimal bone3 Inferior orbital fissure3 Zygomatic bone3

  5. Harare Hospital: treated open wounds only 9 Lost 2.1 and 2.2 Placement of RPD CONDITION AND BACKROUND

  6. May 2002: 1st visit to Tygerberg Hospital (consultation and diagnosis)9 Nov 2003: Bone- transplant performed9 Screws placed in maxillae to secure bone9 CONDITION & BACKROUND cont.

  7. Advantages: Lowest cost of 5 options Simple Replace missing tissue8 Disadvantages: Poor aesthetics Bulky Not fully stable Removable8 Patient too young POSSIBLE TREATMENT OPTION 1 Improved RPD (R3 466)

  8. Advantages: No trauma Good aesthetics Quick placement10 Disadvantages: Preparation needed Elongated crowns Possible tooth discoloration7 POSSIBLE TREATMENT OPTION 2 Anterior bridge unit (R5 202)

  9. Advantages: Very stable Durable Fairly natural appearance6 Disadvantages: Surgery required Possible failure4 POSSIBLE TREATMENT OPTION 3 Implant-supported crowns (R4788)

  10. Advantages: Good aesthetics Very stable Durable Natural appearance7 Disadvantages: (Veneer manufacturing) Technique-sensitive Time-consuming Extremely fragile Not easily repaired5 POSSIBLE TREATMENT OPTION 4 Porcelain veneer and implant-supported porcelain crowns (R5 367)

  11. Advantages: Very stable Durable Natural appearance Good aesthetics Midline corrected6 Disadvantages: More expensive than previous options Operation required Possible failure7 POSSIBLE TREATMENT OPTION 5 Porcelain crown and implant-supported crowns (R5 560)

  12. Option 1: Improved RPD Option 2: Improved RPD Stent Temporary crowns Implant-supported porcelain crowns and a full porcelain crown POSSIBLE TECHNICAL TREATMENT PLAN

  13. Implant-supported porcelain crowns Reasons for choice: stability durable unobtrusive natural6 MOST SUITABLE OPTION

  14. CHOSEN OPTION Porcelain crown on 1.1 and implant supported crown on 2.1 and 2.2 Including: • Improved RPD • Stent • Temporary crowns • Implant-supported porcelain crowns and full porcelain crown

  15. OPTION OF CHOICE cont. Reasons for choice: • Very stable • Durable • Unobtrusive • Natural • Good overall appearance • Aesthetic acceptable tooth color • Midline corrected6, 7

  16. LABORATORY PROCEDURES • Models cast • 2-tooth RPD wax-up

  17. LABORATORY PROCEDURES cont. • Alginate impression taken from 2-tooth RPD wax-up in place • RPD wax-up removed from model • Stent simulating RPD fabricated

  18. LABORATORY PROCEDURES cont. • RPD wax-up invested, processed and finished.

  19. LABORATORY PROCEDURES cont. • Preparation done on 1.1 • Diagnostic wax-up on 1.1, 2.1 and 2.2 • 1.1 broader mesio-distally to correct midline

  20. LABORATORY PROCEDURES cont. • Diagnostic wax-up of 2.1 and 2.2 removed 1 • Impression taken • Stent simulating diagnostic wax-up of 2.1 and 2.2 (corrected midline) fabricated

  21. LABORATORY PROCEDURES cont.

  22. CLINICAL PROCEDURES • April 2004: screw removed in 2nd quadrant • Stent simulating diagnostic wax-up of 2.1 and 2.2 placed

  23. CLINICAL PROCEDURES cont. • Stent used as guideline to place implants • Implants placed parallel to each other

  24. September2004: implants were sealed with healing caps. CLINICAL PROCEDURES cont.

  25. Healing caps removed Transfer copings placed11 CLINICAL PROCEDURES cont.

  26. Custom impression tray with holes used Protective caps placed Analog secured in impression11,7 CLINICAL PROCEDURES cont.

  27. Extra hard stone used to cast working models Copings fixed in place Framework waxed Pattern invested11,7 CLINICAL PROCEDURES cont.

  28. Metal framework devested Porcelain applied Glazing and staining applied11,7 Complete restoration CLINICAL PROCEDURES cont.

  29. FINAL PLACEMENT OF APPLIACNCE • Final placement of restoration

  30. REFERENCES 1. Babbush CA. Dental Implants - The Art and Science. WB Saunders Company: London. 2001: 371-377 2. Booth A, Eppley G & Schmelzeisen J. Maxillofacial Trauma and Esthetic Facial Reconstruction. Churchill Livingstone: Edinburgh. 2003: 30-124 3. Brand L & Isselhard C. Anatomy of Orofacial Structures, 6th Ed. Mosby Company: London. 1998: 136-138

  31. REFERENCES cont. 4. Coulthard P & Horner K. Master Dentistry - The Perfect revision aid for final dentistry exams, Volume 1. Churchill Livingstone: London. 2003: 126-128 5. Garber D A. Porcelain Laminate Veneers. Quintessence Publishing Co. Inc: London. 1988: 14-16 6. Hobkrik J A &Watson R. Introducing Implants. Churchill Livingstone: London. 2003: 12-67

  32. REFERENCES cont. 7. Mc. Lean J W. The Science and Art of Dental Ceramics, Volume II. Quintessance Publishing Co. Inc: Tokyo. 1980: 21-27 8. Osborne J. Partial Dentures, 4th Ed. Blackwell Scientific Publications: London. 1989: 57-72 9. Patient File. Hook A. Tygerberg Hospital; No.: 14818.0.

  33. REFERENCES cont. 10. Smith G N. Planning and Making Crowns and Bridges, 3rd Ed. C.V Mosby Company London. 1998: 100-103 11. Straumann. Product Catalog. ASM Consultants (PTY) LTD: Johannesburg

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