Recipes for full mouth rehabilitation: a Stylish way

9 Sep 2017 - 31044

Management of full mouth rehabilitation has to be simplified in 3 different ways

 – Think about the case like an architect, where would you place the white corridor in an ideal 3D position?

– Record data (pictures, face references, model, VDO record) in order to create an accurate wax up

– Validate a full mock-up technique esthetically and functionally

– Bond every restoration one by one using individual dam isolation

Fig. 1

Full mock-up and guided Perio surgery.

Fig. 2

Pink driven by final restoration.

Fig. 3

This patient was treated with two maxillary surgery and 8 years of orthodontic treatment. Now he is twenty years old and he is referred. A class 3 occlusal typology is still present. An increase of the VDO is required to recreate a proper smile line and reverse the occlusion.

Fig. 4

Initial situation with microdontia, pedodontic crown because of amelogenesis imperfecta. We can note a missing canine with a severe concavity between 12 and 14. The goal is to recreate an ideal white architecture balanced with an adequate pink architecture. Same analysis for the lower arch; we can note microdontia and amelogenesis imperfecta recovered by composite and some temporary crown.

Fig. 5

Recording face references is crucial to communicate with the lab and draw on the cast interpupillary line and medium axis. Ditramax device is used for this. Then, creating ideal wax up according to the face analysis will be much easier for the technician.

Fig. 6

Wax-up is transferred into the mouth thanks to a silicone index and a syringeable bis-acryl resin (Luxatemp Star, DMG). Two parameters are controlled: esthetics and function. The full mock-up will visualize the expected project in order to validate it. The same material (Luxatemp star DMG) will be used for the temporary phase too.

Fig. 7

In order to improve the pink architecture in the concave part between 14 and 12 a pink wax is used to simulate the future soft tissue graft. The placement of the graft located in the buccal concavity recreates ideal white/pink architectural proportion. NOTE: The surgery has to be guided by the mock up in order to visualize the new volume of the teeth.

Fig. 8

Occlusal view of prepareded teeth. Every tooth is kept vital.

Fig. 9

Restorations are made with emax multi (just wax then press and then polish) in order to adapt to the esthetic expectations, and economical situation of the patient. It is important to note that, even if the fabrication phase is fast and precise, the polishing step is longer than with ceramic, because of the hardness of the lithium disilicate.

Fig. 10

Monolithic multishade lithium disilicate (emax Multi Ivoclar Vivadent) are bonded one by one using individual dam isolation. The use of dual-cured composite cement is recommended (Multilink Ivoclar Vivadent) because of the thickness of the restoration (more than 0,8 mm) .

Fig. 11

The day of the bridge cementation, a second small soft tissue graft is performed to further improve the emergence profile of the bridge. The bridge is made ideally on the cast in terms of design. The healing of the soft tissues will be guided by the bridge itself.

Fig. 12

Emergency profile of the bridge with ideal convexity of the pink architecture

Fig. 13

Final view with of monolithic restoration. Esthetic integration is more than enough, and the cheaper lab phase resulted in a good compromise for the patient’s requests (ceramist Gerald Ubassy).

Fig. 14

Final view of emax multi crown and emax bridge (12-14).

Fig. 15

Final result, smile. For such a kind of full arch rehabilitation this type of basic restoration (wax and press) can be very useful and fit with economic reality.

Thanks to DT Gerald Ubassy.