Chief Complaint: Seventy-five year old female patient presented voicing displeasure with the staining and color of the upper teeth. She also complained of inability to properly keep her teeth and implants clean.
History: Existing full arch maxillary composite/metal fixed partial denture supported by 7 Calcitek Integral implants, #3,5,7,10,12,13,14, approximately 15 years old. Pink acrylic gingival tissues had been initially added but recontoured intraorally after cementation in an attempt to improve the ability to clean.
Clinical Exam: Implant fixtures appeared radiographically sound but patient gingival tissues were chronically inflamed due to hygiene difficulties, as confirmed by the patientís current periodontist.
Diagnosis: Failing maxillary fixed partial denture due to esthetics and contours. Chronic gingivitis.
Treatment: Completed maxillary full-arch diagnostic wax up. Modified midline, incisal lengths. Fabricate new provisional full arch bridge. Sectioned and removed existing restoration. Removed existing abutments and made new fixture level impression. Used existing abutments with provisional. Implant angulation necessitated division of the restoration between #11 and 12. Both clinician and technician evaluated the provisional with patient feedback. Made diagnostic photography, casts and occlusal record. Verified master cast and made jaw relation record. Facebow. Technician evaluated and documented custom shade for tooth and tissue color. After evaluating implant position and provisional contours, recommended screw retention for implants #3 and 13. This would allow for cementation with light provisional cement on all other implants, while maintaining both restorative segments #3-11 and #12-14 with predictable retrievability. Fabricated custom abutments for cement retained fixtures. Fabricate metal framework, incorporating screw retention for #3 and 13. Completed metal try in. Made new occlusal record at the intended OVD. Completed porcelain try in. Evaluated fit, function, occlusion and esthetics, with patient feedback. Finalized porcelain contours and delivered abutments and prosthesis with temporary cement. Screws appropriated torqued and covered with occlusal composite to be sealed and esthetically pleasing.
Final Restoration: Metalceramic fixed partial dentures #3-11 and #12-14 with pink porcelain gingival tissues. Jensen Foundation Alloy. Creation Porcelain. Final prosthesis accomplished goal of providing a durable, functional, hygienic and comfortable restoration. High level of artistic detail was paid to fabricating an esthetic presentation which was both pleasing and naturally appropriate for this delightful senior citizen. Anatomical contour and overall tooth arrangement, staining, wear, value, translucence, gingival form, color and architecture were specifically designed and age appropriate. Demonstrates the result which can be achieved when clinician and technician work closely together for functional and esthetic success.
