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PUBLISHED IN DUBAI www.dental-tribune.me May-June 2017 | No. 3, Vol. 7 Team players: function and esthetics A systematic approach to full-mouth rehabilitation with all-ceramics IPS e.max Smile Award 2016: The following article describes the complex full-mouth rehabilitation of a female patient who consulted our practice because she was dissatisfied with the appearance of her smile. A reliable and efficient approach made the most of the interplay of esthetics and function and all-ceramic materials. By Anna Giorgadze and Ilias Psarris, DT, Greece Esthetics and function – these two requirements are inseparable in re- storative dentistry. The case outlined in this article highlights just how tightly these two aspects are con- nected. The patient primarily want- ed the treatment to enhance her ap- pearance. The dental team, however, could not fulfil these esthetic de- mands without taking into account the functional considerations. Their aim from the time of the treatment planning stage was to achieve a har- monious result. The extensive pros- thetic work required a systematic treatment approach. Case presentation The young female patient con- sulted our dental practice about a smile enhancement. Her upper and lower anterior teeth were severely abraded and stained (Fig. 1). Moreo- ver, she had received inadequate restorations in the past. The metal- reinforced bridges in the posterior region did not provide suitable func- tion and esthetics. The patient was dissatisfied with the entire situation (Fig. 2). The unesthetic appearance of her teeth was an embarrassment to her, especially when she smiled. Diagnosis and planning The first general diagnosis was based speaking and smiling constituted important diagnostic tools in the treatment process. They provided us with valuable information for the design of the diagnostic wax-up. Im- pressions were taken for the fabrica- tion of the models. A facebow record was taken for the skull-related trans- fer of the situation into the articula- Figs 1 and 2: Severely abraded upper anterior teeth and compromised esthetics ÿPage B2 on the needs of the patient. Further- more, specific aspects of the situa- tion were assessed. A corresponding diagnosis was made and the patient was presented with a preliminary treatment plan. In accordance with our protocol, the plan focused on attaining a satisfactory balance be- tween the functional and esthetic requirements. Furthermore, mainly additive measures were planned, which would make the treatment minimally invasive. The clinical diag- nosis revealed the extent of the dam- age. Severe abrasion had consider- ably shortened the front teeth, which showed well-defined wear facets. The vertical dimension of occlusion was clearly too low. The patient’s smile line was not ideal and therefore, it negatively impacted her expres- sion. The patient was in good general health. She did not complain of any temperomandibular joint pain or of tight jaw muscles. In the develop- ment of the final treatment plan, we first concentrated on the functional requirements. In the process, we es- tablished that the vertical dimension of occlusion needed to be raised by one millimetre and a new occlusal scheme created. Therefore, we pro- posed the following steps: stabilize the situation with the help of long- term temporaries before starting the prosthetic treatment; place two implants to close the gaps left by the loss of tooth 46 and 36; restore the dentition with all-ceramic crowns, bridges and veneers (IPS e.max Press, Ivoclar Vivadent) and provide the patient with a bite guard to protect the teeth after the treatment. The pa- tient agreed to this plan. Prosthetic pretreatment Portrait pictures and video clips showing the patient when she is LIFELIKE ESTHETICS – EFFICIENTLY PRESSED Fig. 3: The master cast clearly shows the functional and esthetic shortcomings. Fig. 4: Additive build-up of the anterior teeth for the diagnostic wax-up IPS e.max® PRESS MULTI THE WORLD’S FIRST POLYCHROMATIC PRESS INGOT • Monolithic LS2 restorations showing a lifelike shade progression • Exceptional combination of strength, esthetics and effi ciency • For crowns, veneers and hybrid abutment crowns • Coordinated with high-precision Programat press furnaces • Maximum cost effectiveness in the press technique c e r a m i c y o u n e e d l l a l a l Fig. 5: The wax-up with approx. 1 mm higher vertical occlusion Fig. 6: The mock-up fabricated on the basis of the wax-up on the model www.ivoclarvivadent.com Ivoclar Vivadent AG Bendererstrasse 2 | 9494 Schaan | Liechtenstein Tel.: +423 235 35 35 | Fax: +423 235 33 60