ammannato case group 1

C a s e 1

✴ 8 years old patient✴ State of good health✴ No contraindications for medical treatment✴ Does not take drugs

Chief Complaint“I am concerned about my incisors which I broke playing at the pool. I would like to restore it as soon as possible”

DiagnosisGeneralized gingivitisTraumatic fracture of (21)Physiological sounding (21)Positive vitality (21)No mobility (21)

Prognosis

General Good

Specific Questionable (21) for the long term pulp vitality

Treatment PlanProfessional oral hygieneDirect composite restoration (21)

6 m o n t h s f o l l o w u p

baseline post-op

2 years follow up

5 years follow up2 years follow upbaseline

. . . . 5 , 5 y e a r s l a t e r . . . n e w t r a u m a !

Full wax up Full index

Cut back wax up

Cut back index

Cut back indexFull index

Full buccal index Full palatal index

step by step video available

1 month follow up

1 year follow up

baseline 5 years follow up 5,5 years new trauma 1 year follow up

baseline 6 y e a r s l a t e r , p o s i t i v e v i t a l i t ypost op

C a s e 2

✴22 years old patient✴State of good health✴No contraindications for medical treatment✴Does not take drugs

Chief Complaint“I am concerned about the smile due to my incisor. I would like to replace the restoration”.

Problems

The patient is referred from a col league asking to handle only the restorative aspects.

DiagnosisGeneralized gingivitisNo pain or muscle tension or articular clicksGood occlusal stability; good canine and anterior guidance14 is missing and 44 is slightly extrudedDefective restoration of (11)Positive vitality, no fremitus in static and dynamic occlusion (11) Caries (16, 17, 26, 27, 47, 46, 45, 36, 37)Wisdom teeth incorrect position

PrognosisGeneral Good

Specific Good

Treatment PlanProfessional oral hygieneCeramic veneer restoration (11)Direct composite restorations (12, 22)Direct composite restorations (16, 17, 26, 27, 47, 46, 45, 36, 37)

Since patient did not want to do orthodontics, 11 has a triangular shape due to a compromise linked with hygiene management, even if a half ovate pontic could have been performed.

6 years Follow up

6 years Follow up and positive vitality baseline

6 years Follow up and positive vitality patient did not want to extract 38

5 years Follow upbaseline

5 years Follow up and positive vitality baseline

6 years Follow up positive vitalitybaseline

4 years Follow up positive vitalitybaseline

C a s e 3


Chief Complaint“I am concerned about two teeth which are hurting me. I would like to solve theseproblems”.

DiagnosisGeneralized gingivitisNo pain or muscle tension or articular clicksGood occlusal stability; good canine and anterior guidanceSpontaneous pain on (16,37)Defective restorations of (16, 37)Caries of (17, 15, 26, 27, 36, 35, 45, 46, 47)Diastema sextant 2Wisdom teeth wrong position


Specific Good

Treatment PlanProfessional oral hygieneRoot canal treatment; build-up; provisional; ceramic partial indirect restoration (16)Root canal retreatment; build-up; provisional; distal crown lengthening; ceramic crown (37)Direct composite restorations (17, 15, 26, 27, 36, 35, 45, 46, 47)

Distal emergence profile

provisional

try in restoration

3,5 years follow up

3,5 years follow up and positive vitality

follow up 3,5 years and positive vitality

3,5 years follow up

follow up 3,5 years

C a s e 4


Chief Complaint“I have pain on my posterior teeth. I would like to solve theseproblems and also I would like to change size and shape of my upper incisors without touching them.”

Vailati F, Belser UC. Full-‐mouth adhesive rehabilitation of a several eroded dentition: the three-‐step technique. Part 1. Eur J Esthet Dent 2008;3:30-‐40. Part 2. Eur J Esthet Dent 2008;3:128-‐146. Part 3. Eur J Esthet Dent 2008;3:236-‐257. Spreafico R. Composite resin rehabilitation of eroded dentition in a bulimic patient. Eur J Esthet Dent 2010;5:28-‐48.Dietschi D. Argente A. A comprehensive and conservaPve approach for the restoraPon of abrasion and erosion. Part 1: concepts and clinical raPonale for early intervenPon using adhesive techniques. Eur J Esthet Dent 2011;6:20-‐33.

DiagnosisGeneralized gingivitisSlight loss of periodontal supportNo pain or muscle tension or articular clicksAnterior and canine guidance are missingOcclusal plane alterationsInsufficient root canal treatment (16, 15)Defective restorations (all)Caries ( 17, 16, 15, 14, 24, 25, 26, 27, 37, 36, 35, 44, 45, 46, 47)Worn out dentition (sextant 2 and 5)

Prognosis

General Good

Specific Questionable (46) due to caries and endodontic treatment

Treatment PlanProfess i ona l o ra l hyg iene ( and reca l l s every 4 months )Management of urgent therap ies : c rown l enghthen i ng (46 , 15 , 16 ) ; r oot cana l t reatment (46 , 16 , 15 ) ; bu i l d -up (46 , 15 , 16 ) ; p rov i s i ona l c rowns (46 , 15 , 16 )Funct i ona l and esthet i c ana l ys i s Wax-up and mock-up after ra i s i ng vdoD i rect “ gu ided” compos i te restorat i ons on sextant 2 and 5D i rect “ gu ided” compos i te restorat i ons on ( 17 , 26 , 24 , 35 , 34 , 47 , 44 )Part i a l i nd i rect compos i te on l ays on ( 14 , 25 , 27 , 36 , 37 , 45 )Meta l ceram ic crowns on ( 16 , 15 , 46 ) Funct i ona l e va l uat i ons post -op w i th “brux checker ”N ight guard

T h r e e O p t i o n s s e x t a n t 21 2

“Incisal edge” I.E. “Palatal/incisal” P.I. “Full veneering” F.V.Allows to restore incisal edges on anterior sextants in all cases where VDO increase is not needed, but canine and anterior guidance have been lost due to grinding/erosion.

Allows to restore, increasing VDO, both incisal edges and the volume on the palatal aspect, on sextant 2, which have been lost due to grinding/erosion.

Allows to restore, increasing VDO, both incisal edges and the volume on the palatal/buccal aspect, on sextant 2, which have been lost due to grinding/erosion.

3

2 years follow up

3 years follow up positive vitality

2 years follow up

2 years follow upbaseline

2 years follow up

3 years follow up3 years follow upbaseline

2 years follow up

2 years follow up occlusal static and dynamic video available 3 years follow up

C a s e 5


Chief Complaint“I have pain on my upper incisor and I’m not satisfied with this old crown.”

Problems

The patient is referred by an orthodontist just to treat the specific problem on sextant 2

DiagnosisGeneralized gingivitisNo pain or muscle tension or articular clicksAcute pulpitis on (21)No fremitus in static and dynamic occlusion (211)No mobility on (21)Rotated incisors (12, 11)Good canine and anterior guidance


Specific Good

Treatment PlanEndodont i c t reatment (21 )Bu i l d up (21 )D i rect prov i s i ona l (2 1 )Profess i ona l o ra l hyg ieneEsthet i c ana l ys i sD i rect compos i te restorat i on (22 ) Ind i rect prov i s i ona l (2 1 )Ceram ic crown (21 )

Magne P. Composite resins and bonded porcelain: the postamalgam era? J Calif Dent Assoc 2006 Feb;34(2):135-‐147.Devoto W. Direct and indirect restoraPons in the anterior area: a comparison between the procedures. QDT 2003:127-‐138.Magne P, Belser U. Bonded porcelain restoraPons in the anterior denPPon. A biomimePc approach. 2002 Quintessence Publishing Co.

4 years follow up1 year follow up 6 years follow up

Gengival recession on 11 is under observation over time. Currently no symptoms or esthetic problems due to a low lip smile line.

7 years follow up

7 years follow upBaseline

C a s e 6


Chief Complaint“I have pain on my posterior teeth and food impaction.”

Problems

The patient finished an orthodontic treatment a year ago and has no intention to begin a new one.

DiagnosisGeneralized gingivitisNo pain or muscle tension or articular clicksGood anterior and canine guidanceGood occlusal stabilityCross bite (44)Improper root canal treatment (25, 45)Defective restorations (all)Caries (15, 14, 13, 12, 22, 23, 24, 25, 26, 37, 36, 35, 44, 45, 47)Wisdom teeth incorrect position

Prognosis

General Good

Specific Questionable (25) due to caries

Treatment PlanProfess i ona l o ra l hyg ieneCrown l engthen i ng (25 ) Root cana l t reatment (25 , 45 )Compos i te bu i l d up w i th f iber post (25 )Bu i l d up (45 )Prov i s i ona l restorat i ons (25 , 45 )D i rect compos i te restorat i ons ( 17 , 16 , 15 , 14 , 13 , 12 , 22 , 23 , 24 , 26 , 27 , 34 , 44 , 45 , 47 )Part i a l i nd i rect compos i te restorat i ons (36 , 37 , 46 )Ceram ic crowns (25 ,35 )Wisdom teeth extract i on

ammannato case group 1

Documents

up2 years

e v i t

years new trauma

p o s i t

positive vitalitybaseline

n e w t r

medical treatment

positive vitalitypatient