Introduction:

A 42-year old woman had visited Sujay’s Dental Care complaining about metal show of the caps on upper front teeth and missing lower front tooth. Patient had a history of upper and lower anterior PFM crowns were fabricated 10 yrs ago.

Clinical Findings:

  • Existing PFM crowns wrt upper and lower anteriors.
  • Missing 16,37,38,43,47,48
  • Deep dental caries wrt 26, 46.

Alternative Treatment Plan:

  • Replacement of the upper and lower anterior crowns using emax crowns.
  • Replacement of missing teeth by FPD or an RPD.

Evidence-Based Dentistry:

As a part of Evidence-based treatment, we took full mouth OPG. After examining OPG x-ray of the teeth, our team of dentists decided for

  • Root canal treatment wrt 26, 46
  • Surgical Implant placement wrt 16,43.
  • Extraction wrt 17,18,27,28.
  • Full mouth rehabilitation using full veneer crowns and implant restoration.

evidence-based-dentistry-bannerTreatment Procedure:

  • Preoperative models and photographs were taken.
  • Facebow transfer was made, centric, protrusive and lateral occlusal records were obtained.
  • The casts were mounted onto a semiadjustable articulator, and programmed. Broadricks analysis was made to establish the occlusal plane.
  • A mock up was performed.
  • Clinically, surgical implant placement was done wrt 16 and  43.
  • Sutures were removed in a week.
  • The existing PFM crowns were sectioned and removed.
  • They were temporized and anterior guidance was established.
  • The lower posteriors were prepared and temporized and the occlusal plane was established.
  • Following which, the upper posteriors were prepared and temporized.
  • A mutually protected occlusion was achieved.
  • They were kept under observation for 6 weeks before making the final impressions and the interocclusal records.
  • Bisque trial of the all ceramic crowns were done and satisfactory.
  • The final cementation was carried out on the natural teeth using resin cement.
  • The implant restorations were planned for a progressive loading by cement retained crowns at the end of 2 months.

Follow Up:

  • Advised for a regular 6 months follow up.