A female patient reported to our clinic with the following requests:
- She wanted an aesthetic solution for the replacement of her old metal-ceramic crowns.
- She was seeking to have her missing teeth replaced in order to restore masticatory function.
- Aesthetic results were all-important for her
First treatment session (3 workdays)
At the first consultaton we thoroughly examined the condition of the teeth based on a recent panoramic radiograph brought along by the patient. A CBCT (Cone beam computed tomography) scan was made to examine the residual bone mass in 3 dimensions prior to the implant surgery. The CT scan demonstrated that the bone mass was adequate for the missing teeth to replaced by implants.
At the first treatment session implants were installed into the site of the lower molars with gingiva formers (healing abutments) since the stability of the implants exceeded 30 Ncm.
Our patient asked for no immediate denture for the healing period and hence the healing of the implants was unhindered.
Panoramic radiograph brought along by the patient to the first consultation
Second treatment session (10 days)
Following 6 months’ healing the instalment of the final tooth replacements was due. Natural teeth-borne zirconia crowns were fabricated to fully comply with the patient’s aesthetic demands. The lower implants were fitted with cement-retained metal-ceramic implant crowns. Precision impressions were taken of the implants with special closed tray impression copings. Then the remaining natural teeth were prepared (filed) to accommodate crowns, and impressions were taken thereof.
Following impression taking several trial fittings were necessary as the dental technician proceeded with the fabrication of crowns. Framework test fitting allows us to verify the precision of the impressions, the precision of the framework prepared, and whether all tooth replacements seamlessly fit the master cast. Occlusion, the length of the framework and the teeth, the central position of the 2 large incisors and the proper backward curve of the teeth, etc. are checked again. At the preliminary test fitting the crowns are almost finished, the ceramic is sintered onto the zirconia framework. At this trial fitting, the occlusion (function), the shape and colour of the crowns and the middle line and smile lines (aesthetic trial fitting) can still be verified. Several days may elapse between the different trial fittings during which the dental technicians are working at full tilt in the background. Also, between the test fittings the teeth in need underwent a root canal treatment or repeated root canal treatment.
Our patient is fully satisfied with her new teeth. Following the restoration of the missing teeth chewing no longer poses a difficulty and she is at ease to smile again.
The finished tooth replacement needs to be checked regularly, which is also a condition for warranty. It is often thought that tooth replacements need not undergo a professional tartar removal but this is a misbelief. Tartar may also deposit on tooth replacements as well and regular cleaning and tartar removal are indispensable at least once or twice yearly in this case too.
The lower cement-retained implant crowns on the master cast with special artificial gums