1. A COSMETIC REPLACEMENT OF ANTERIOR TEETH By Zillah Horn In partial fulfilment of BTech: Den Tech. Degree September 2004

2. CONTENTS  Patient history  Patient condition and background  Possible clinical treatment options  Possible technical treatment options  Treatment option most suitable  Treatment option of choice  Laboratory procedures  Clinical procedures  References

3. PATIENT HISTORY  Age: 23 years 9  Place of origin: Zimbabwe 9  Jan 2002: Fell from waterfall in Zimbabwe 9

4. PATIENT HISTORY cont. Le Fort III fracture 2  Le Fort III fracture 2 Parade ground fracture 2  Parade ground fracture 2 Nasal bones 3 Lacrimal bone 3 Inferior orbital fissure 3 Frontal bone 3 Zygomatic bone 3

5. CONDITION AND BACKROUND  Harare Hospital: treated open wounds only 9  Lost 2.1 and 2.2  Placement of RPD

6. CONDITION & BACKROUND cont.  May 2002: 1 st visit to Tygerberg Hospital (consultation and diagnosis) 9  Nov 2003: Bone- transplant performed 9  Screws placed in maxillae to secure bone 9

7. Improved RPD (R3 466) POSSIBLE TREATMENT OPTION 1 Improved RPD (R3 466) Advantages:  Lowest cost of 5 options  Simple  Replace missing tissue 8 Disadvantages:  Poor aesthetics  Bulky  Not fully stable  Removable 8  Patient too young

8. POSSIBLE TREATMENT OPTION 2 Anterior bridge unit (R5 202) Advantages:  No trauma  Good aesthetics  Quick placement 10 Disadvantages:  Preparation needed  Elongated crowns  Possible tooth discoloration 7

9. POSSIBLE TREATMENT OPTION 3 Implant-supported crowns (R4788) Advantages:  Very stable  Durable  Fairly natural appearance 6 Disadvantages:  Surgery required  Possible failure 4

10. Porcelain veneer and implant- supported porcelain crowns (R5 367) POSSIBLE TREATMENT OPTION 4 Porcelain veneer and implant- supported porcelain crowns (R5 367) Advantages:  Good aesthetics  Very stable  Durable  Natural appearance 7 Disadvantages: (Veneer manufacturing)  Technique-sensitive  Time-consuming  Extremely fragile  Not easily repaired 5

11. POSSIBLE TREATMENT OPTION 5 Porcelain crown and implant-supported crowns (R5 560) Advantages:  Very stable  Durable  Natural appearance  Good aesthetics  Midline corrected 6 Disadvantages:  More expensive than previous options  Operation required  Possible failure 7

12. POSSIBLE TECHNICAL TREATMENT PLAN Option 1:  Improved RPD Option 2:  Improved RPD  Stent  Temporary crowns  Implant-supported porcelain crowns and a full porcelain crown

13. MOST SUITABLE OPTION Implant-supported porcelain crowns Reasons for choice:  stability  durable  unobtrusive  natural 6

14. CHOSEN OPTION Porcelain crown on 1.1 and implant supported crown on 2.1 and 2.2 Including:  Improved RPD  Stent  Temporary crowns  Implant-supported porcelain crowns and full porcelain crown

15. OPTION OF CHOICE cont. Reasons for choice:  Very stable  Durable  Unobtrusive  Natural  Good overall appearance  Aesthetic acceptable tooth color  Midline corrected 6, 7

16. LABORATORY PROCEDURES  Models cast  2-tooth RPD wax-up

17. LABORATORY PROCEDURES cont.  Alginate impression taken from 2-tooth RPD wax-up in place  RPD wax-up removed from model  Stent simulating RPD fabricated

18. LABORATORY PROCEDURES cont.  RPD wax-up invested, processed and finished.

19. LABORATORY PROCEDURES cont.  Preparation done on 1.1  Diagnostic wax-up on 1.1, 2.1 and 2.2  1.1 broader mesio-distally to correct midline

20. LABORATORY PROCEDURES cont.  Diagnostic wax-up of 2.1 and 2.2 removed  Diagnostic wax-up of 2.1 and 2.2 removed 1  Impression taken  Stent simulating diagnostic wax-up of 2.1 and 2.2 (corrected midline) fabricated

21. LABORATORY PROCEDURES cont.

22. CLINICAL PROCEDURES  April 2004: screw removed in 2 nd quadrant  Stent simulating diagnostic wax-up of 2.1 and 2.2 placed

23. CLINICAL PROCEDURES cont.  Stent used as guideline to place implants  Implants placed parallel to each other

24. CLINICAL PROCEDURES cont.  September2004: implants were sealed with healing caps.

25. CLINICAL PROCEDURES cont.  Healing caps removed  Transfer copings placed 11

26. CLINICAL PROCEDURES cont.  Custom impression tray with holes used  Protective caps placed  Analog secured in impression 11,7

27. CLINICAL PROCEDURES cont.  Extra hard stone used to cast working models  Copings fixed in place  Framework waxed  Pattern invested 11,7

28. CLINICAL PROCEDURES cont.  Metal framework devested  Porcelain applied  Glazing and staining applied 11,7  Complete restoration

29. FINAL PLACEMENT OF APPLIACNCE  Final placement of restoration

30. REFERENCES 1. Babbush CA. Dental Implants - The Art and Science. WB Saunders Company: London. 2001: 371-377 2.Booth A, Eppley G & Schmelzeisen J. Maxillofacial Trauma and Esthetic Facial Reconstruction. Churchill Livingstone: Edinburgh. 2003: 30-124 3.Brand L & Isselhard C. Anatomy of Orofacial Structures, 6 th Ed. Mosby Company: London. 1998: 136-138

31. REFERENCES cont. 4. Coulthard P & Horner K. Master Dentistry - The Perfect revision aid for final dentistry exams, Volume 1. Churchill Livingstone: London. 2003: 126-128 5.Garber D A. Porcelain Laminate Veneers. Quintessence Publishing Co. Inc: London. 1988: 14-16 6.Hobkrik J A &Watson R. Introducing Implants. Churchill Livingstone: London. 2003: 12-67

32. REFERENCES cont. 7.Mc. Lean J W. The Science and Art of Dental Ceramics, Volume II. Quintessance Publishing Co. Inc: Tokyo. 1980: 21-27 8.Osborne J. Partial Dentures, 4 th Ed. Blackwell Scientific Publications: London. 1989: 57-72 9.Patient File. Hook A. Tygerberg Hospital; No.: 14818.0.

33. REFERENCES cont. 10.Smith G N. Planning and Making Crowns and Bridges, 3 rd Ed. C.V Mosby Company London. 1998: 100-103 11.Straumann. Product Catalog. ASM Consultants (PTY) LTD: Johannesburg