2. ✴ 8 years old patient
✴ State of good health
✴ No contraindications for medical treatment
✴ Does not take drugs
Chief Complaint
“I am concerned about my incisors which I broke playing at the pool. I would like
to restore it as soon as possible”
38. ✴22 years old patient
✴State of good health
✴No contraindications for medical treatment
✴Does not take drugs
Chief Complaint
“I am concerned about the smile due to my incisor. I would like to replace the
restoration”.
39.
40.
41.
42.
43. Problems
The patient is referred from a colleague asking to handle only the
restorative aspects.
44. Diagnosis
Generalized gingivitis
No pain or muscle tension or articular clicks
Good occlusal stability; good canine and anterior guidance
14 is missing and 44 is slightly extruded
Defective restoration of (11)
Positive vitality, no fremitus in static and dynamic occlusion (11)
Caries (16, 17, 26, 27, 47, 46, 45, 36, 37)
Wisdom teeth incorrect position
46. Treatment Plan
Professional oral hygiene
Ceramic veneer restoration (11)
Direct composite restorations (12, 22)
Direct composite restorations (16, 17, 26, 27, 47, 46, 45, 36, 37)
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61. Since patient did not want to do orthodontics, 11 has a triangular shape due to a compromise
linked with hygiene management, even if a half ovate pontic could have been performed.
89. ✴24 years old patient
✴State of good health
✴No contraindications for medical treatment
✴Does not take drugs
Chief Complaint
“I am concerned about two teeth which are hurting me. I would like to solve these
problems”.
90.
91.
92.
93.
94.
95. Diagnosis
Generalized gingivitis
No pain or muscle tension or articular clicks
Good occlusal stability; good canine and anterior guidance
Spontaneous pain on (16,37)
Defective restorations of (16, 37)
Caries of (17, 15, 26, 27, 36, 35, 45, 46, 47)
Diastema sextant 2
Wisdom teeth wrong position
150. ✴45 years old patient
✴State of good health
✴No contraindications for medical treatment
✴Does not take drugs
Chief Complaint
“I have pain on my posterior teeth. I would like to solve these
problems and also I would like to change size and shape of my upper incisors
without touching them.”
151. Vailati
F,
Belser
UC.
Full-‐mouth
adhesive
rehabilitation
of
a
several
eroded
dentition:
the
three-‐step
technique.
Part
1.
Eur
J
Esthet
Dent
2008;3:30-‐40.
Part
2.
Eur
J
Esthet
Dent
2008;3:128-‐146.
Part
3.
Eur
J
Esthet
Dent
2008;3:236-‐257.
Spreafico
R.
Composite
resin
rehabilitation
of
eroded
dentition
in
a
bulimic
patient.
Eur
J
Esthet
Dent
2010;5:28-‐48.
Dietschi
D.
Argente
A.
A
comprehensive
and
conservaPve
approach
for
the
restoraPon
of
abrasion
and
erosion.
Part
1:
concepts
and
clinical
raPonale
for
early
intervenPon
using
adhesive
techniques.
Eur
J
Esthet
Dent
2011;6:20-‐33.
152.
153.
154. Diagnosis
Generalized gingivitis
Slight loss of periodontal support
No pain or muscle tension or articular clicks
Anterior and canine guidance are missing
Occlusal plane alterations
Insufficient root canal treatment (16, 15)
Defective restorations (all)
Caries ( 17, 16, 15, 14, 24, 25, 26, 27, 37, 36, 35, 44, 45, 46, 47)
Worn out dentition (sextant 2 and 5)
156. Treatment PlanProfessional oral hygiene (and recalls every 4 months)
Management of urgent therapies: crown lenghthening (46, 15, 16); root canal treatment (46, 16,
15); build-up (46, 15, 16); provisional crowns (46, 15, 16)
Functional and esthetic analysis
Wax-up and mock-up after raising vdo
Direct “guided” composite restorations on sextant 2 and 5
Direct “guided” composite restorations on (17, 26, 24, 35, 34, 47, 44)
Partial indirect composite onlays on (14, 25, 27, 36, 37, 45)
Metal ceramic crowns on (16, 15, 46)
Functional evaluations post-op with “brux checker”
Night guard
157.
158.
159.
160. T h r e e O p t i o n s s e x t a n t 2
1 2
“Incisal edge” I.E. “Palatal/incisal” P.I. “Full veneering” F.V.
Allows to restore incisal edges on anterior
sextants in all cases where VDO increase is
not needed, but canine and anterior
guidance have been lost due to grinding/
erosion.
Allows to restore, increasing VDO, both
incisal edges and the volume on the palatal
aspect, on sextant 2, which have been lost
due to grinding/erosion.
Allows to restore, increasing VDO, both
incisal edges and the volume on the palatal/
buccal aspect, on sextant 2, which have
been lost due to grinding/erosion.
3
221. ✴35 years old patient
✴State of good health
✴No contraindications for medical treatment
✴Does not take drugs
Chief Complaint
“I have pain on my upper incisor and I’m not satisfied with this old crown.”
222. Problems
The patient is referred by an orthodontist just to treat the specific
problem on sextant 2
223.
224.
225. Diagnosis
Generalized gingivitis
No pain or muscle tension or articular clicks
Acute pulpitis on (21)
No fremitus in static and dynamic occlusion (211)
No mobility on (21)
Rotated incisors (12, 11)
Good canine and anterior guidance
227. Treatment Plan
Endodontic treatment (21)
Build up (21)
Direct provisional (21)
Professional oral hygiene
Esthetic analysis
Direct composite restoration (22)
Indirect provisional (21)
Ceramic crown (21)
228.
229.
230.
231.
232.
233. Magne
P.
Composite
resins
and
bonded
porcelain:
the
postamalgam
era?
J
Calif
Dent
Assoc
2006
Feb;34(2):135-‐147.
Devoto
W.
Direct
and
indirect
restoraPons
in
the
anterior
area:
a
comparison
between
the
procedures.
QDT
2003:127-‐138.
Magne
P,
Belser
U.
Bonded
porcelain
restoraPons
in
the
anterior
denPPon.
A
biomimePc
approach.
2002
Quintessence
Publishing
Co.
234.
235.
236. 4 years follow up1 year follow up 6 years follow up
Gengival recession on 11 is under observation over time. Currently no symptoms or esthetic problems due to a low lip smile line.
241. ✴21 years old patient
✴State of good health
✴No contraindications for medical treatment
✴Does not take drugs
Chief Complaint
“I have pain on my posterior teeth and food impaction.”
