XXIII CONGRESSO INTERNAZIONALE AIOP LA PROTESI ED IL VOLTO: NON SOLO L’ESTETICA Bologna 20-22 Novembre 2014 MULTIDISCIPLINARY APPROACH IN THE MANAGEMENT OF COMPLEX CASES: IMPLANT-PROSTHETIC REHABILITATION OF A PERIODONTAL SMOKING PATIENT WITH PARTIAL EDENTULISM, MALOCCLUSION AND AESTHETIC PROBLEMS Alessandro Lanza .1 DDS, OSS  , Fabio Scognamiglio.2 DDS. (*), Gennaro Minervini 1 MDS,DDS ABSTRACT The aim of this case report is to describe how the multidisciplinary approach is the best way to resolve the cases of complex prosthetic rehabilitation. In this report we described how to solve with fixed prostheses a smoker patient who presents active periodontitis, multiple edentulous areas, dental malocclusion (anterior open bite, tooth extrusion and rotation), and severe aesthetic problems (multiple diastema, tooth discoloration, gingival recession). The whole programming of this specific clinical case was performed in a team including a periodontist, an oral implant surgeon, an orthodontist and a prosthodontist: All together specialists have carefully examined the list of the problems and after consideration of the potential rehabilitation programs, together drew up the best suited for the patient. 1 (Second University of Naples, Multidiscilinary Department of Medical, Surgical and Dental Sciences). 2 (University of Naples Federico II, Graduate school of oral surgery). 1 2b 2a Fig.1 Initial clinical situation Fig. 2 Initial radiographical situation. Ortophantomografy (a) and telecranio (b) 2d 2c MATERIAL AND METHODS A male patient of 46 years old, smoker (more than 20 cigarettes per day), comes to our attention manifesting numerous problems related to the bad condition of his oral cavity. In particular, pain and masticatory limitation, difficulty in pronouncing certain words or letters, inadequacy of the aesthetic appearance. The patient was in good health general state. Considering the clinical (fig.1) and radiographic exams (fig.2 ,a,b,c,d,) and examination of plaster models (3a), specialists in periodontics, implantology, prosthetics and orthodontics have made ​​a diagnosis and the best therapeutic choice for this complex case. It is realized and analyzed with the patient a simulation of the final rehabilitation through a diagnostic wax (3b) that highlights what will be the advantages and disadvantages of the prothesis. The program will include the construction of fixed aesthetics rehabilitation on natural teeth and fixed prostheses on dental implants aimed at improving the aesthetic and functional aspect of the patient. The patient throughout the course of therapy was maintained periodontally stable and at each control was motivated to oral hygiene, this in accordance with the guidelines set out recently in the seventh European Workshop on Periodontology (1). 3 implants (OsseoSpeed ​​™ Astra Tech AB, Mölndal, Sweden) were inserted in a prosthetic guided position (2) in region #14-15-16 (fig.4 a,b,c). During the healing period natural teeth were preparated and abutments were than covered with a provisional prothesis to conditioning soft tissues. After osteointegration period (4 months) we proceed to take the impression for the definitive rehabilitation. Fig. 2 TC dentalscan examination before surgery 3a 3b Fig. 3 Master model (a) and diagnostic wax up (b) 4a 4b 4c Fig. 4 Implant surgery. Prosthetic guided implant insertion (a - b). Radiogrphic examination (c) 5a 5b 5c Fig. 5 Definitive ceramic restoration on models 5d 5e 5f RESULTS AND CONCLUSION The multidisciplinary approach (3) together with the control of local risk factors such as plaque and smoke (4) has allowed to obtain an aesthetic and functional integration of the final restoration on natural teeth and on implants (fig.5 a,b,c,d,e,f). The radiographic control at one year of follow-up (fig.6) demonstrates no bone loss around implants and teeth respect to the initial condition. Fig. 5 Clinical aspect of the definitive restoration 6 REFERENCES Fig. 6 Radiological control at one year of follow-up 1 Lang NP, Berglundh. T. Periimplant diseases: where are we now?Consensus of the Seventh european workshop on Periodontology. J Clin Periodontol. 2011; 38 Suppl 11:178-81 2 Garber DA, Belser UC. Restoration-driven implant placement with restoration-generated site development. Compend Contin Educ Dent 1995.16(8):796-804. 3 Goyal MK, Goyal S,Hegde V, Balkrishana D, Narayana AL. Recreating an esthetically and functionally acceptable dentition: a multidisciplinary approach. Int J Periodontics Restorative Dent 2013;33(4):527-32.. 4. Heitz-Mayfield LJA. Peri-implant diseases: diagnosis and risk indicators. J Clin Periodontol. 2008; 35 (Suppl. 8): 292–304.