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ePaper created 2017-03-17, 11:21:45 | version 1.38.0
| case report aesthetic rehabilitation Aesthetic rehabilitation and tissue preservation in the anterior region Authors: Dr Jan-Frederik Güth & Hans-Jürgen Stecher, Germany Fig. 1 Fig. 2 Fig. 3 Fig. 1: Situation prior to the orthodontic treatment with an adhesive bridge used to replace tooth 21. Fig. 2: The adhesive bridge shows a compromised fit after repeated removal and placement. Fig. 3: Snapshot during orthodontic treatment with temporarily replaced central incisors. (Image 1–3 courtesy of Prof. A. Wichelhaus) Fig. 4: Situation at the first visit of the young female patient at the LMU Munich private dental office. While there are often several adequate prosthetic treatment options to choose from for one single case, there are some cases where none of the proven solutions seems to be perfectly suitable. The prost- hodontist and his team have to balance the pros and cons for each available option—they have to decide which treatment is best suited to fulfil the needs of the specific patient. This was the case with a 16-year-old female patient who presented at the Department of Prosthodontics of the Ludwig Maxi- milians University of Munich, Germany, in 2015. An orthodontic treatment had just been completed and a further prosthetic rehabilitation was required. preserve tooth 21. The former dentist had replaced it with a four-unit metal-ceramic adhesive bridge (Maryland bridge) (Figs. 1 & 2). Unfortunately, the dismal prognosis for tooth 11 was confirmed in the course of treatment: it had to be extracted during orthodontic therapy. In order to replace both central incisors for the duration of this therapy, a provisional bridge with artificial gin- giva was manufactured and attached to the fixed orthodontic appliances (Fig. 3). Prosthetic treatment plant Fig. 5: Patient with interim prosthesis after removal of the orthodontic Background appliances, replacement of the fillings and palatal tooth preparation. Fig. 6: Computer-aided framework design starting from the anatomical tooth shapes using the Zfx CAD Software. At the age of 10, the patient had suffered an anterior tooth trauma with avulsion and replantation of the maxillary central incisors (teeth 11 and 21, FDI nota- tion). Despite all efforts, it had not been possible to At the patient’s first visit in the private dental office of the LMU Munich, the lateral incisors had large composite restorations not only on the vestibular surfaces, but—due to the previous rehabilitation with an adhesive bridge—also on the palatal sur- faces (Fig. 4). Fig. 4 Fig. 5 Fig. 6 12 CAD/CAM 1 2017