Chief Complaint: ìMy upper front teeth and gums donít look natural.√¢ÀÜ≈°√É‚Ä∞√¢À܂Ć√ɬ≠√¢ÀÜ≈°√É≈ì√¢‚Ǩ≈°√É‚Äû√ɬ¥√¢ÀÜ≈°√É‚Ä∞√¢‚Ǩ≈°√É‚Äû√ɬ∂√¢ÀÜ≈°√ɂİ√Ǭ¨√É‚Äâ€ÂÂ
History: Forty-five year old female patient presents as a referral from her periodontist. Existing FPD #8-10 failed approximately 1 year ago, therefore opted for placing implant #9. Recently completed final restorations.
Clinical Exam: All-ceramic restorations: #7-veneer, #8, 9, 10-zirconia crowns, #9-zirconia stock abutment.
Diagnosis: Esthetically displeasing porcelain restorations. Gingival architecture asymmetry.
Treatment: Completed diagnostic wax up, following diagnostic photography, casts and patient feedback. Impacted changes in tooth contour, length and gingival management. Removed existing restorations #7-10. Existing stock abutment #9, demonstrated significant undercontour as compared with natural tooth #8. As a provisional measure, added composite to stock abutment to gain desired emergence profile. Fabricated new provisional restorations based on diagnostic wax up. Gained gingival symmetry only by changing abutment and restoration contours. Provisional changes evaluated by patient, restorative dentist and periodontist. Connective tissue graft, distal #9 and 10, recommended by periodontist to gain ideal result, but declined by patient. Proceeded with final impression, capturing ideal contour of custom abutment already achieved intraorally. Evaluated provisionals with restorative dentist and dental technician, with patient feedback for improvement. Direct shade evaluation and documentation by technician.
Final Restorations: #7 - refractory technique feldspathic veneer with Creation Zi porcelain. #9 - Zirconia custom abutment. Nobel BioCare Replace Select 3.5. #8 - 10 - Creation Zirconia crowns with Katana Zi copings.
High level of artistic detail was paid to fabricating an esthetic presentation which was both pleasing and naturally appropriate. Anatomical contour and overall tooth arrangement, staining, value, translucence, gingival form and architecture were specifically designed to blend with the patientís natural dentition. Demonstrates the result which can be achieved when clinician and technician work closely together for functional and esthetic success, with technician having the opportunity to directly evaluate and interact with patient.
