Removal of infected teeth, dental implant surgery, fabrication of metal-ceramic crowns, screw-retained metal-ceramic crowns borne by implants (Case presentation) (71)

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Removal of infected teeth, dental implant surgery, fabrication of metal-ceramic crowns, screw-retained metal-ceramic crowns borne by implants

Treatment phase III – the fabrication of permanent metal ceramic crowns and bridges for natural teeth and implants

Male patient aged 55

Antecedents:

Professional tartar removal and teeth polishing was performed due to a massive pile-up of sub and supragingival tartar.
At the previous session 6 caried and infected lower molars and their periodontal pockets were eliminated.
At the second treatment 3 implants were installed into the mandible per quadrant.
At the third session a new metal-ceramic arch bridge was fabricated with no implants being necessary for the fixed restoration

Third treatment: the fabrication of metal ceramic crowns and bridges for natural teeth and implants (10 workdays)

Following 3 months of healing (osseointegration) we were able to set about the fabrication permanent crowns for implants and natural teeth. Our patient’s choice fell on metal ceramic crowns and he would favour a screw-retained bridge for the 3 implants installed per lower quadrant. With such major aesthetic restorations, a minimum of 10 days is required for the dental technician to deliver superior workmanship and shape the tiniest details of the replacement teeth to “artistic” perfection. If the dental technician has insufficient time for the fabrication of the replacement teeth, that may compromise aesthetics. Please observe the recommendations as to the number of treatment days at all times for the best possible results.

Following the removal/ cutting off of old crowns and filing/preparation of teeth the gingiva formers/healing abutments were unscrewed from the implants and precision impressions were taken of the tooth preparations and implants.

Kontroll panorámaröntgen-felvételek az implantátumokba behelyezett lenyomatvételi fejekkel

Follow-up panoramic radiographs of the impression coping placed inside the implants

The tooth preparations receive provisional crowns (using the Scutan method). These provisional crowns protect the filed-down tooth stumps and provide reasonable aesthetics until the permanent crowns are finished. The provisional crowns are different from the crowns handed over at the end of the treatment. Impression taking is followed by a so-called gnathological treatment, that is an instrument-aided bite registration, for the dental technician to see the occlusal position of the temporomandibular joints in the articulator and mould the future replacement teeth accordingly.

Articulator: the articulator is a dental instrument reproducing the movements of the mandible and the maxilla, “mimicking the patient’s head” in the dental laboratory, as it were, without the patient actually being present.

Rendelőnkben az Amann Girrbach Artex CR artikulátort használjuk.

At our clinic an Amann Girrbach Artex CR articulator is used.

The precision impressions are followed by several trial fittings.

First trial fitting: During the trial fitting of the framework the precision impressions and metal frameworks of the crowns are verified for accuracy, since all future replacement teeth must seamlessly fit the master cast. During this trial fitting not only the frameworks of natural teeth-borne crowns are tested, but also the implant-borne crowns and abutments are checked for trueness.

Az alsó frontfogakra készülő fémkerámia hidak és az implantátumokra készülő csavarozható fémkerámia hidak fémváza a mestermintán

The metal framework of metal ceramic bridges designed for the lower front teeth and the screw-retained metal ceramic bridges intended for implants on the master cast.

A felső állcsontra készülő fémkerámia körhíd fémváza a mestermintán

The metal framework of the metal ceramic arch bridge on the master cast

Second trial fitting: at the trial fitting of the matte teeth the crowns are almost complete with the ceramic already sintered on. This trial fitting allows for a closer verification of occlusion (function) and the shape, colour, centre line and the smile (aesthetic trial fitting). If no adjustments are required (both function and aesthetics leave nothing to be desired) the dental technician completes the crowns by coating them with a glossy finish (glaze). Once this final glossy finish is burnt on, the crowns are ready to be glued on.

Between the different work phases and trial fittings several days may intervene, during which the dental technicians are working on the replacement teeth.

The permanent cementing of the crowns is a meticulous process occasionally requiring anaesthetics when cementing or screwing the crowns and bridges in place.

Anaesthetics often hinder the “fine-tuning” of occlusion as the patient does not have a precise sensation of the height of the new crown or bridge, which may necessitate another appointment for the dentist to check and adjust occlusion. These appointments are crucial as an inappropriately adjusted occlusion may result in overload or pressure to the crowns and exhaust the muscles, which may bring on tooth clenching or tooth grinding at night. Overload, on the other hand, may subject the temporomandibular joints to undue wear and compression, which may entail toothache and the chipping off of ceramics.

When the permanent bridges were glued on and the screw-retained implant bridges were screwed in place and occlusion was precisely adjusted our patient was immensely satisfied with his new teeth and smile.

He was advised on the importance of home cleaning and regular check-ups and was shown the accessories of home cleaning and their use (interdental brush, dental floss, Super Floss), all of which are essential for the long-term success of replacement teeth.