Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2018-04-10, 12:30:21 | version 1.38.0
case report | Fig. 3 Fig. 3: Patient during speaking and smiling. placed and prosthetic solutions were defined before the surgical procedures. The patient was rehabilitated with a fixed restoration in the mandible as established. For the maxilla, the finalisation moved from a fixed to a remov- able solution because of aesthetic and phonetic aspects. Clinical case A 63-year-old male patient edentulous in both arches was evaluated for definitive implant supported resto- rations. Case history The patient had lost his remaining teeth a few years before our visit. He had been restored with complete dentures fabricated on the basis of his repaired previous partial dentures. The patient did not report a significant medical history and occlusal or temporo-mandibular disease. At the preliminary appointment the patient com- municated mainly a functional discomfort due to the instability of the mandibular denture during mastication. He reported several problems using the mandibular denture, complaining of its instability in almost every situ- ation (during speech, eating, etc.). The maxillary denture had low retention and the palatal extension was poorly tolerated. The previous dentist had planned to rehabilitate the patient with fixed implant restoration in both arches, but after the implant placement, the patient had had sev- eral health problems due to an ischaemic stroke and this had delayed the prosthetic finalisation. At the same time, he had been forced to move to our city because he was living with his daughter and she had changed her job. Clinical evaluation At the first visit the patient informed us that the implants had been placed the year before. He reported some sore spots due to the maladaptation of the bearing base to the tissue. The complete dentures were found to be unstable during static evaluation (Figs. 1a & b). Prosthetic evaluation The patient’s lips revealed a lack of support when wear- ing the complete dentures, the free-way space was more than 5 mm and it was mainly the mandibular teeth that were displayed during speaking. The maxillary teeth were not displayed even during smiling (Fig. 3). The lower third of the face was too short when the patient closed the mouth when wearing the complete dentures, revealing more than 10 mm between the vertical rest position and the vertical dimension of occlusion. The occlusal plane also needed to be parallelised to the bi-pupillary and Camper’s planes. The centric occlusion position was not repeatable. Prosthetic goals In order to improve the aesthetic, phonetic and func- tional aspects with definitive restorations, we decided to: – improve the upper lip support, – increase vertical dimension of occlusion, – improve exposure of the maxillary teeth, – reduce exposure of the mandibular teeth, – improve occlusal plane parallelism to the bi-pupillary and Camper’s planes, – establish a stable and repeatable occlusal position, – verify parameters during adaptation time. Treatment plan In order to manage all of the prosthetic goals that may have effected important changes in patient function and adaptation, it was decided to divide the treatment plan into different steps: 1. Restoration of all of the prosthetic parameters with new temporary complete dentures. 2. Verification of all of the parameters during patient adaptation time. 3. Fabrication of two copies of the dentures that could be used to register implant impressions and the inter-arch position in order to retain all of the data required for finalisation. 4. Construction and delivery of the definitive rehabilitation. Clinical and laboratory procedures Radiographic evaluation The dental panoramic tomogram revealed six implants in the maxilla and five implants in the mandible, and slight bone resorption was detected around the fixtures (Fig. 2). Preliminary impressions In the first appointment, two alginate impressions were taken (normal-setting alginate Neocolloid, Zhermack) 1 2018 25