Patient 5

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Patient 5

  1. 1. Patient 4
  2. 2. Patient 4 * female * 55 years * medical condition: none * patient’s request - improvement of the aesthetics of her upper teeth
  3. 3. Facial Analysis Digital Facebow
  4. 4. Facial Analysis long upper lip
  5. 5. Facial Analysis excessive soft tissue display wnl/gummy smile (posterior) facial/dental midline WNL (slight to the left)
  6. 6. Facial /dental Analysis facial/dental midline WNL (slight to the left)
  7. 7. Facial Analysis Straight profile
  8. 8. Facial Analysis Lips in Repose +/- 4 mm tooth structure
  9. 9. Facial Analysis Full Smile Lip Dynamics High lip dynamics
  10. 10. Dental Analysis 15 mm frialit implant Seibert class III Seibert class I 11.5 mm overbite: 5 mm CRO = MIP
  11. 11. Dental Analysis Loss of anatomical form wear anterior teeth (deep bite) wear posterior teeth/flat restorations
  12. 12. Dental Analysis Loss of anatomical form (dento-alveolar eruption) wear anterior teeth (deep bite) deep curve of spee
  13. 13. Dental Analysis dento-alveolar compensation ( premolars) slight angle classs II overbite: 5 mm angle classs II overjet: 4 mm
  14. 14. Intra-Oral Examination
  15. 15. X-ray Examination
  16. 16. patient visits a oral hygienist 2-3 times a year and oral hygiene is at a good level, no abnormal probing depths
  17. 17. deep bite due to dento alveolar eruption of lower anterior teeth due to restorations of the anterior teeth diagnosis crowding lower anterior teeth and malposition 23 and 24 (25 not present) mal-positioned implant 22 soft tissue deficiency siebert class III 22 and siebert class I 12 dento-alveaolar eruption premolars upper jaw los of anatomical form due to restorations: 16,15,14,26,27 34-37 and 44-47 wear lower anterior teeth (attrittion)
  18. 18. what are the patient’s financial constraints? how could we satisfy the patient’s aesthetic? how to treat the hard and soft tissue deficiencies in the aesthetic zone Is the patient willing to go through orthodontic and surgical procedures surgery can we restore this patient predictably with long-term strategy? primary concerns what to do with the implant at the 22
  19. 19. improve hard and soft tissue volume at the 12 and 22 restore anatomy of the teeth satisfy aesthetic concerns develop long term-strategy treatment objectives create a stable occlusion with anterior guidance
  20. 20. treatment plan wax-up hard and soft tissue graft 22 provisional restoration 21=22=23 connective tissue graft pontic site 22 copy provisionals to ceramic restoration soft tissue healing and maturation contouring soft tissue through provisional restoration prep teeth for restorations (16-27 and 33-37,43-47) and open vdo in provisional restoration phase and recontour lower anterior (patients doesn’t want ortho) evaluate biology, function and aesthetics 3 months
  21. 21. Treatment options Increasing the VDO lower anterior rotate back, more ClassII
  22. 22. Treatment options Change Angle of Restorations With or without surgical crown lengthening
  23. 23. Initial Wax-Up
  24. 24. Initial Wax-Up
  25. 25. provisional bridge
  26. 26. surgical procedure
  27. 27. 3 months healing
  28. 28. aesthetic/functional wax-up vacuum shell (duran) prep guide for sufficient reduction if necessary adjust preparation measure provisional restoration thickness
  29. 29. Communication to laboratory VDO registration impression
  30. 30. 6
  31. 31. try inn zirconia frame work
  32. 32. pick-up soft tissue details
  33. 33. 2 Year Result

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