Ammannato case group 1

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Ammannato case group 1

  1. 1. C a s e 1
  2. 2. ✴ 8 years old patient ✴ State of good health ✴ No contraindications for medical treatment ✴ Does not take drugs Chief Complaint “I am concerned about my incisors which I broke playing at the pool. I would like to restore it as soon as possible”
  3. 3. Diagnosis Generalized gingivitis Traumatic fracture of (21) Physiological sounding (21) Positive vitality (21) No mobility (21)
  4. 4. Prognosis General Good Specific Questionable (21) for the long term pulp vitality
  5. 5. Treatment Plan Professional oral hygiene Direct composite restoration (21)
  6. 6. 6 m o n t h s f o l l o w u p
  7. 7. baseline post-op
  8. 8. 2 years follow up
  9. 9. 5 years follow up2 years follow upbaseline
  10. 10. . . . . 5 , 5 y e a r s l a t e r . . . n e w t r a u m a !
  11. 11. Full wax up Full index
  12. 12. Cut back wax up
  13. 13. Cut back index
  14. 14. Cut back indexFull index
  15. 15. Cut back indexFull index
  16. 16. Full buccal index Full palatal index
  17. 17. step by step video available
  18. 18. 1 month follow up
  19. 19. 1 year follow up
  20. 20. baseline 5 years follow up 5,5 years new trauma 1 year follow up
  21. 21. baseline 6 y e a r s l a t e r , p o s i t i v e v i t a l i t ypost op
  22. 22. C a s e 2
  23. 23. ✴22 years old patient ✴State of good health ✴No contraindications for medical treatment ✴Does not take drugs Chief Complaint “I am concerned about the smile due to my incisor. I would like to replace the restoration”.
  24. 24. Problems The patient is referred from a colleague asking to handle only the restorative aspects.
  25. 25. Diagnosis Generalized gingivitis No pain or muscle tension or articular clicks Good occlusal stability; good canine and anterior guidance 14 is missing and 44 is slightly extruded Defective restoration of (11) Positive vitality, no fremitus in static and dynamic occlusion (11) Caries (16, 17, 26, 27, 47, 46, 45, 36, 37) Wisdom teeth incorrect position
  26. 26. Prognosis General Good Specific Good
  27. 27. Treatment Plan Professional oral hygiene Ceramic veneer restoration (11) Direct composite restorations (12, 22) Direct composite restorations (16, 17, 26, 27, 47, 46, 45, 36, 37)
  28. 28. Since patient did not want to do orthodontics, 11 has a triangular shape due to a compromise linked with hygiene management, even if a half ovate pontic could have been performed.
  29. 29. 6 years Follow up
  30. 30. 6 years Follow up
  31. 31. 6 years Follow up and positive vitalitybaseline
  32. 32. 6 years Follow up and positive vitalitypatient did not want to extract 38
  33. 33. 5 years Follow upbaseline
  34. 34. 5 years Follow up and positive vitalitybaseline
  35. 35. 6 years Follow upbaseline
  36. 36. 6 years Follow up positive vitalitybaseline
  37. 37. 4 years Follow upbaseline
  38. 38. 4 years Follow up positive vitalitybaseline
  39. 39. C a s e 3
  40. 40. ✴24 years old patient ✴State of good health ✴No contraindications for medical treatment ✴Does not take drugs Chief Complaint “I am concerned about two teeth which are hurting me. I would like to solve these problems”.
  41. 41. Diagnosis Generalized gingivitis No pain or muscle tension or articular clicks Good occlusal stability; good canine and anterior guidance Spontaneous pain on (16,37) Defective restorations of (16, 37) Caries of (17, 15, 26, 27, 36, 35, 45, 46, 47) Diastema sextant 2 Wisdom teeth wrong position
  42. 42. Prognosis General Good Specific Good
  43. 43. Treatment Plan Professional oral hygiene Root canal treatment; build-up; provisional; ceramic partial indirect restoration (16) Root canal retreatment; build-up; provisional; distal crown lengthening; ceramic crown (37) Direct composite restorations (17, 15, 26, 27, 36, 35, 45, 46, 47)
  44. 44. Distal emergence profile
  45. 45. provisional
  46. 46. try in restoration
  47. 47. 3,5 years follow up
  48. 48. 3,5 years follow up
  49. 49. 3,5 years follow up and positive vitality
  50. 50. follow up 3,5 years and positive vitality
  51. 51. 3,5 years follow up
  52. 52. follow up 3,5 years
  53. 53. C a s e 4
  54. 54. ✴45 years old patient ✴State of good health ✴No contraindications for medical treatment ✴Does not take drugs Chief Complaint “I have pain on my posterior teeth. I would like to solve these problems and also I would like to change size and shape of my upper incisors without touching them.”
  55. 55. Vailati  F,  Belser  UC.  Full-­‐mouth  adhesive  rehabilitation  of  a  several  eroded  dentition:  the  three-­‐step  technique.  Part  1.  Eur  J  Esthet  Dent   2008;3:30-­‐40.    Part  2.  Eur  J  Esthet  Dent  2008;3:128-­‐146.    Part  3.  Eur  J  Esthet  Dent  2008;3:236-­‐257.   Spreafico  R.  Composite  resin  rehabilitation  of  eroded  dentition  in  a  bulimic  patient.  Eur  J  Esthet  Dent  2010;5:28-­‐48. Dietschi  D.  Argente  A.  A  comprehensive  and  conservaPve  approach  for  the  restoraPon  of  abrasion  and  erosion.  Part  1:  concepts  and  clinical  raPonale  for   early  intervenPon  using  adhesive  techniques.  Eur  J  Esthet  Dent  2011;6:20-­‐33.      
  56. 56. Diagnosis Generalized gingivitis Slight loss of periodontal support No pain or muscle tension or articular clicks Anterior and canine guidance are missing Occlusal plane alterations Insufficient root canal treatment (16, 15) Defective restorations (all) Caries ( 17, 16, 15, 14, 24, 25, 26, 27, 37, 36, 35, 44, 45, 46, 47) Worn out dentition (sextant 2 and 5)
  57. 57. Prognosis General Good Specific Questionable (46) due to caries and endodontic treatment
  58. 58. Treatment PlanProfessional oral hygiene (and recalls every 4 months) Management of urgent therapies: crown lenghthening (46, 15, 16); root canal treatment (46, 16, 15); build-up (46, 15, 16); provisional crowns (46, 15, 16) Functional and esthetic analysis Wax-up and mock-up after raising vdo Direct “guided” composite restorations on sextant 2 and 5 Direct “guided” composite restorations on (17, 26, 24, 35, 34, 47, 44) Partial indirect composite onlays on (14, 25, 27, 36, 37, 45) Metal ceramic crowns on (16, 15, 46) Functional evaluations post-op with “brux checker” Night guard
  59. 59. T h r e e O p t i o n s s e x t a n t 2 1 2 “Incisal edge” I.E. “Palatal/incisal” P.I. “Full veneering” F.V. Allows to restore incisal edges on anterior sextants in all cases where VDO increase is not needed, but canine and anterior guidance have been lost due to grinding/ erosion. Allows to restore, increasing VDO, both incisal edges and the volume on the palatal aspect, on sextant 2, which have been lost due to grinding/erosion. Allows to restore, increasing VDO, both incisal edges and the volume on the palatal/ buccal aspect, on sextant 2, which have been lost due to grinding/erosion. 3
  60. 60. 2 years follow up
  61. 61. 3 years follow up positive vitality
  62. 62. 2 years follow up
  63. 63. 2 years follow upbaseline
  64. 64. 2 years follow up
  65. 65. 2 years follow up
  66. 66. 3 years follow up3 years follow upbaseline
  67. 67. 2 years follow up
  68. 68. 2 years follow up
  69. 69. 2 years follow up occlusal static and dynamic video available 3 years follow up
  70. 70. C a s e 5
  71. 71. ✴35 years old patient ✴State of good health ✴No contraindications for medical treatment ✴Does not take drugs Chief Complaint “I have pain on my upper incisor and I’m not satisfied with this old crown.”
  72. 72. Problems The patient is referred by an orthodontist just to treat the specific problem on sextant 2
  73. 73. Diagnosis Generalized gingivitis No pain or muscle tension or articular clicks Acute pulpitis on (21) No fremitus in static and dynamic occlusion (211) No mobility on (21) Rotated incisors (12, 11) Good canine and anterior guidance
  74. 74. Prognosis General Good Specific Good
  75. 75. Treatment Plan Endodontic treatment (21) Build up (21) Direct provisional (21) Professional oral hygiene Esthetic analysis Direct composite restoration (22) Indirect provisional (21) Ceramic crown (21)
  76. 76. Magne  P.  Composite  resins  and  bonded  porcelain:  the  postamalgam  era?  J  Calif  Dent  Assoc  2006  Feb;34(2):135-­‐147. Devoto  W.  Direct  and  indirect  restoraPons  in  the  anterior  area:  a  comparison  between  the  procedures.  QDT  2003:127-­‐138. Magne  P,  Belser  U.  Bonded  porcelain  restoraPons  in  the  anterior  denPPon.  A  biomimePc  approach.  2002  Quintessence  Publishing  Co.  
  77. 77. 4 years follow up1 year follow up 6 years follow up Gengival recession on 11 is under observation over time. Currently no symptoms or esthetic problems due to a low lip smile line.
  78. 78. 7 years follow up
  79. 79. 7 years follow upBaseline
  80. 80. C a s e 6
  81. 81. ✴21 years old patient ✴State of good health ✴No contraindications for medical treatment ✴Does not take drugs Chief Complaint “I have pain on my posterior teeth and food impaction.”
  82. 82. Problems The patient finished an orthodontic treatment a year ago and has no intention to begin a new one.
  83. 83. Diagnosis Generalized gingivitis No pain or muscle tension or articular clicks Good anterior and canine guidance Good occlusal stability Cross bite (44) Improper root canal treatment (25, 45) Defective restorations (all) Caries (15, 14, 13, 12, 22, 23, 24, 25, 26, 37, 36, 35, 44, 45, 47) Wisdom teeth incorrect position
  84. 84. Prognosis General Good Specific Questionable (25) due to caries
  85. 85. Treatment Plan Professional oral hygiene Crown lengthening (25) Root canal treatment (25, 45) Composite build up with fiber post (25) Build up (45) Provisional restorations (25, 45) Direct composite restorations (17, 16, 15, 14, 13, 12, 22, 23, 24, 26, 27, 34, 44, 45, 47) Partial indirect composite restorations (36, 37, 46) Ceramic crowns (25,35) Wisdom teeth extraction
  86. 86. 3 years follow up
  87. 87. 3 years follow up
  88. 88. 3 years follow upbaseline
  89. 89. 3,5 years follow up
  90. 90. 3,5 years follow upbaseline
  91. 91. 6 months follow up
  92. 92. 3,5 years follow up
  93. 93. 3,5 years follow up
  94. 94. 3,5 years follow upbaseline
  95. 95. 6 months follow up
  96. 96. 3,5 years follow up
  97. 97. 3,5 years follow upbaseline
  98. 98. 3,5 years follow up

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