A COSMETIC A COSMETIC REPLACEMENT OF REPLACEMENT OF

ANTERIOR TEETHANTERIOR TEETH

ByBy

Zillah HornZillah Horn

In partial fulfilment of In partial fulfilment of

BTech: Den Tech. DegreeBTech: Den Tech. DegreeSeptember 2004September 2004

CONTENTS

Patient historyPatient history Patient condition and backgroundPatient condition and background Possible clinical treatment optionsPossible clinical treatment options Possible technical treatment optionsPossible technical treatment options Treatment option most suitableTreatment option most suitable Treatment option of choiceTreatment option of choice Laboratory proceduresLaboratory procedures Clinical proceduresClinical procedures ReferencesReferences

PATIENT HISTORY

Age: 23 yearsAge: 23 years99

Place of origin: ZimbabwePlace of origin: Zimbabwe99

Jan 2002: Fell from waterfall in Jan 2002: Fell from waterfall in ZimbabweZimbabwe99

PATIENT HISTORY cont.

Le Fort III fractureLe Fort III fracture22

Parade ground fractureParade ground fracture22

Nasal bonesNasal bones33

Lacrimal Lacrimal bonebone33

Inferior Inferior orbital orbital fissurefissure33

Frontal Frontal bonebone33

Zygomatic Zygomatic bonebone33

CONDITION AND BACKROUND

Harare Hospital: treated open Harare Hospital: treated open wounds only wounds only 99

Lost 2.1 and 2.2Lost 2.1 and 2.2 Placement of RPDPlacement of RPD

CONDITION & BACKROUND cont.

May 2002: 1May 2002: 1stst visit visit to Tygerberg to Tygerberg Hospital Hospital (consultation and (consultation and diagnosis)diagnosis)99

Nov 2003: Bone- Nov 2003: Bone- transplant transplant performedperformed99

Screws placed in Screws placed in maxillae to secure maxillae to secure bonebone99

POSSIBLE TREATMENT OPTION 1 Improved RPD (R3 466)Improved RPD (R3 466)

Advantages:Advantages: Lowest cost of 5 optionsLowest cost of 5 options SimpleSimple Replace missing tissueReplace missing tissue88

Disadvantages:Disadvantages: Poor aestheticsPoor aesthetics BulkyBulky Not fully stableNot fully stable RemovableRemovable8 8

Patient too youngPatient too young

POSSIBLE TREATMENT OPTION 2 POSSIBLE TREATMENT OPTION 2 Anterior bridge unit (R5 202)Anterior bridge unit (R5 202)

Advantages:Advantages: No traumaNo trauma Good aestheticsGood aesthetics Quick placementQuick placement1010

Disadvantages:Disadvantages: Preparation neededPreparation needed Elongated crownsElongated crowns Possible tooth Possible tooth

discolorationdiscoloration77

POSSIBLE TREATMENT OPTION 3 POSSIBLE TREATMENT OPTION 3 Implant-supported crowns (R4788)Implant-supported crowns (R4788)

Advantages:Advantages: Very stableVery stable DurableDurable Fairly natural Fairly natural

appearanceappearance66

Disadvantages:Disadvantages: Surgery requiredSurgery required Possible failurePossible failure44

POSSIBLE TREATMENT OPTION 4 Porcelain veneer and implant-Porcelain veneer and implant-supported porcelain crowns (R5 367)supported porcelain crowns (R5 367)

Advantages:Advantages: Good aestheticsGood aesthetics Very stableVery stable DurableDurable Natural Natural

appearanceappearance77

Disadvantages:Disadvantages:

(Veneer (Veneer manufacturing)manufacturing)

Technique-sensitiveTechnique-sensitive Time-consumingTime-consuming Extremely fragileExtremely fragile Not easily repairedNot easily repaired55

POSSIBLE TREATMENT OPTION 5 POSSIBLE TREATMENT OPTION 5 Porcelain crown and implant-Porcelain crown and implant-supported crowns (R5 560)supported crowns (R5 560)

Advantages:Advantages: Very stableVery stable DurableDurable Natural appearanceNatural appearance Good aestheticsGood aesthetics Midline correctedMidline corrected66

Disadvantages:Disadvantages: More expensive than More expensive than

previous optionsprevious options Operation requiredOperation required Possible failurePossible failure77

POSSIBLE TECHNICAL POSSIBLE TECHNICAL TREATMENT PLANTREATMENT PLAN

Option 1:Option 1: Improved RPDImproved RPD

Option 2:Option 2: Improved RPDImproved RPD StentStent Temporary crownsTemporary crowns Implant-supported Implant-supported

porcelain crowns porcelain crowns and a full porcelain and a full porcelain crowncrown

MOST SUITABLE OPTIONMOST SUITABLE OPTION

Implant-supported porcelain crownsImplant-supported porcelain crowns

Reasons for choice:Reasons for choice: stabilitystability durabledurable unobtrusiveunobtrusive naturalnatural66

CHOSEN OPTIONCHOSEN OPTION

Porcelain crown on 1.1 and implant Porcelain crown on 1.1 and implant supported crown on 2.1 and 2.2supported crown on 2.1 and 2.2

Including: Including: Improved RPDImproved RPD StentStent Temporary crownsTemporary crowns Implant-supported porcelain crowns and full Implant-supported porcelain crowns and full

porcelain crownporcelain crown

OPTION OF CHOICE cont.OPTION OF CHOICE cont.

Reasons for choice:Reasons for choice: Very stableVery stable DurableDurable UnobtrusiveUnobtrusive NaturalNatural Good overall appearanceGood overall appearance Aesthetic acceptable tooth colorAesthetic acceptable tooth color Midline correctedMidline corrected6, 76, 7

LABORATORY PROCEDURESLABORATORY PROCEDURES

Models castModels cast 2-tooth RPD wax-up2-tooth RPD wax-up

LABORATORY PROCEDURES LABORATORY PROCEDURES cont.cont.

Alginate impression taken from 2-tooth RPD Alginate impression taken from 2-tooth RPD wax-up in placewax-up in place

RPD wax-up removed from modelRPD wax-up removed from model Stent simulating RPD fabricatedStent simulating RPD fabricated

LABORATORY PROCEDURES LABORATORY PROCEDURES cont.cont.

RPD wax-up invested, processed RPD wax-up invested, processed and finished.and finished.

LABORATORY PROCEDURES LABORATORY PROCEDURES cont.cont.

Preparation done on 1.1Preparation done on 1.1 Diagnostic wax-up on 1.1, 2.1 and 2.2Diagnostic wax-up on 1.1, 2.1 and 2.2 1.1 broader mesio-distally to correct midline1.1 broader mesio-distally to correct midline

LABORATORY PROCEDURES LABORATORY PROCEDURES cont.cont.

Diagnostic wax-up of 2.1 and 2.2 removed Diagnostic wax-up of 2.1 and 2.2 removed 1 Impression takenImpression taken Stent simulating diagnostic wax-up of 2.1 and Stent simulating diagnostic wax-up of 2.1 and

2.2 (corrected midline) fabricated2.2 (corrected midline) fabricated

LABORATORY PROCEDURES LABORATORY PROCEDURES cont.cont.

CLINICAL PROCEDURESCLINICAL PROCEDURES

April 2004: screw April 2004: screw removed in 2removed in 2ndnd quadrantquadrant

Stent simulating Stent simulating diagnostic wax-up diagnostic wax-up of 2.1 and 2.2 of 2.1 and 2.2 placedplaced

CLINICAL PROCEDURES cont.CLINICAL PROCEDURES cont.

Stent used as Stent used as guideline to place guideline to place implantsimplants

Implants placed Implants placed parallel to each parallel to each other other

CLINICAL PROCEDURES cont.CLINICAL PROCEDURES cont.

September2004: September2004: implants were sealed implants were sealed with healing caps.with healing caps.

CLINICAL PROCEDURES cont.CLINICAL PROCEDURES cont.

Healing caps Healing caps removedremoved

Transfer Transfer copings placedcopings placed1111

CLINICAL PROCEDURES cont.CLINICAL PROCEDURES cont.

Custom Custom impression tray impression tray with holes usedwith holes used

Protective caps Protective caps placedplaced

Analog secured Analog secured in impressionin impression11,711,7

CLINICAL PROCEDURES cont.CLINICAL PROCEDURES cont.

Extra hard stone Extra hard stone used to cast working used to cast working modelsmodels

Copings fixed in Copings fixed in placeplace

Framework waxedFramework waxed Pattern investedPattern invested11,711,7

CLINICAL PROCEDURES cont.CLINICAL PROCEDURES cont.

Metal framework Metal framework devesteddevested

Porcelain appliedPorcelain applied Glazing and staining Glazing and staining

appliedapplied11,711,7

Complete restorationComplete restoration

FINAL PLACEMENT OF FINAL PLACEMENT OF APPLIACNCEAPPLIACNCE

Final placement of restorationFinal placement of restoration

REFERENCESREFERENCES

1. Babbush CA. Dental Implants - The Art and Science. WB Saunders Company:

London. 2001: 371-3772. 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

REFERENCES cont.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

REFERENCES cont.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.

REFERENCES cont.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