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CAD/CAM - international magazine of digital dentistry, Italian Edition, No.3, 2017

casts, centric relation bite record, face bow tran- sfer and a CBCT using CS 8100 3D (Carestream Dental; Fig. 2). The examination revealed several maxillary teeth with worn composite restora- tions, cracked or leaking amalgam restorations, recurrent decay at the margins of existing re- storations, and abfractions with cervical decay. Tooth #12 had a periapical lesion due to a failing root canal and periodontal disease with class II mobility. Existing crown restorations on teeth #20 and #28 had recurrent decay on the facial aspects, with recession. Teeth #21 and #29 had large amalgam restorations with deteriorating margins, as well as cracks present. Although no restorations were present in the anterior mandi- bular teeth, there was severe incisal edge wear due to possible grinding and parafunction. _Treatment planning After reviewing the clinical findings and mounted models, the patient was diagnosed with a re- stricted envelope of function and decreased verti- cal dimension from continuous wear9. To develop a treatment plan and determine if the vertical di- mension could be increased, the laboratory fabri- cated a diagnostic 3-D White Wax-Up, along with a preparation guide and temporisation fabrication template, based on all of the analogue and digital records that were transferred from the dentist. It was determined that the maxillary central in- cisors could be lengthened by 1.2 mm to impro- ve the aesthetics, and the canines would also be lengthened to restore canine guidance in lateral excursions. Overall, vertical dimension would be increased by 1.5 mm10. For the lower anterior, the goal was to correct the length-to-width ratio and create a less worn appearance11. It was further de- termined from the diagnostic wax-up that aesthe- tics and function could be enhanced by restoring the remaining dentition. Since tooth #12 required an extraction, replacement options were discus- sed with the patient. Further evaluation determi- case report _ full mouth reconstruction Fig. 2_Acquiring a CBCT scan with the CS 8100 3D (Carestream). Fig. 2 ned that the patient would require block grafts in the areas of teeth #18 and #19, as well as #30 and #31, to enable implant placement. In the maxillary arch, placing implants in the molar regions would require sinus augmentation, but implants could be placed in the #4 and #13 positions without major bone grafting procedures12, 13. The ultimate treatment agreed to by the patient consisted of splinted monolithic zirconia (Zenostar, Wieland, Ivoclar Vivadent) crown restorations from #5 to #12, with #12 being a distal cantilever pontic. In the areas of teeth #4 and #13, dental implants would be placed, followed by their corresponding custom abutments and crown restorations. In the lower arch, the teeth would be segmentally con- nected with splinted crowns: premolars, separate canines, and then incisors. According to the ma- nufacturer, the selected zirconia material combi- nes excellent flexural strength with the aesthetics of natural tooth shades. In this particular case, the patient desired a 040 bleach shade (Ivoclar Viva- dent Chromascop). Zenostar is especially suitable for making monolithic restorations, but can also be used as an aesthetic framework material for a layered technique4-8. Surgery and provisionalisation A tooth-supported surgical guide (3D Diagno- stix) and Guided Surgery Kit (OCO Biomedical) was used during the osteotomies (Figs. 3, 4) Fig. 3_Tooth-Borne Surgical guideby 3DDX. Fig. 4_Guided Surgery Kit from OCO Biomedical. Fig. 3 Fig. 4 3_2017 19

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