CAMLOG Special Issue

Case report 17 | 2013 The patient, a 63 year old smoker (15 cigarettes a day for 40 years) presented himself with a severe periodontal compromised situation of the residual dentition. In the upper jaw he has a fixed restoration from 15 to 24 with a porcelain to metal fused bridge presenting a mobility of grad 3 based on the now irreversibly damaged periodontal situation. In the lower jaw despite the lingual splint we find mobility between 33 to 43, the dental elements 34 and 35 present a second grade mobility and tooth 48 is mesi- ally inclined. The patient reports a disturbed TMJ function with audible noise during mouth opening and closure, besides pain which is diffusing into the facial muscles and paravertebral region. After an appropriate and adequate clinical and radiographique evaluation (panoramic x-ray, CT scan) the choice was to extract the remaining teeth in both jaws with a provisional rehabilitation by means of two removable den- tures to : INFORMATION ON PATIENT AND TREATMENT t 'VODUJPOBMMZ SF FEVDBUF UIF QBUJFOU t 3FDPWFS UIF IPSJ[POUBM BOE WFSUJDBM EJNFOTJPOT t 3FTPMWF UIF NBM DPPSEJOBUJPO DPOEZMF NFOJTDBM FMJNJOBUJOH UIF NVTDVMBS and articulation disturbances through possible modifications of the re- movable dentures During gnatologic therapy the patient was treated surgically with the inser- tion of 6 implants per jaw to support, after successful osseo integration, an adapted fixed restoration to recover the exact mastication with correct oc- clusal tables. The gnatological situation resolved, during the phase of os- seo integration of the implants the occlusal parameters are reproduced with prosthetic guides which duplicate perfectly the provisional restorations transferring thus the individual therapeutic data. The impression for the re- alization of the provisional dentures is created by underlining the prosthetic guide with silicon. The precision and passivity of the final prosthetic supra structures are achieved using splinted plaster transfers. The provisional resin dentures with a metal reinforcement are screw- retained on the abut- ments with a torque of 25 Ncm. Fig. 1: Radiographic evaluation of the initial situtation. Fig. 4: Soft tissue healing after tooth extraction in the man- dible. Fig. 2: Panoramic radiograph after tooth extraction. Fig. 5: Impression with the temporary dentures to create the radiographic and surgical templates. Fig. 3: Removable temporary dentures. Fig. 6: Lab-putty impression to duplicate. Initial situation Impression taking