CAD0110

14 I I case report _ prosthodontic rehabilitation sintered according to the manufacturer’s recommen- dations.Subsequently,overlayinglow-fusingporcelain material(IPSe.max,IvoclarVivadent)wasmanuallyap- pliedontotheexteriortocreateproperanatomicform. Allmaxillaryandmandibularanteriorteethwerefabri- cated using the same process. The completed restora- tions were cemented in resin-modified glass-ionomer lutingagent(RelyXUnicem,3MESPE;Figs.11–12&15). Thepatientwasevaluated post-operatively.Anterior guided occlusal schemes were verified intra-orally be- foreandafterprosthesiscementation(Figs.13&14).The patientreportednodiscomfortandadaptedwelltothe newrestorations.Noabnormalclinicalsignswerenoted. _Discussion The maintenance and re-establishment of the VDO is a crucial element in full mouth fixed prosthodontic rehabilitation. It was necessary to make impressions thatregisteredallteethpreparationsatonce. As the patient desired a high level of aesthetics, full ceramic restorations were chosen for all restorations. The minimum core thickness for this full ceramic system is 0.4mm, this enabled conservation of tooth structure and achievement of reasonable aesthetics simultaneously. Byprescribingfullceramicrestorations,intra-sulcu- lar placement of crown margins on the labial surfaces becomelessimportantfromanaestheticpointofview. Inthisreport,theteethwereessentiallycariesfree,teeth preparation margins were made at gingival level and gingival retraction procedures were eliminated. As gingival retraction cord placement was not required, there was less physical trauma to the gingival tissues and less clinical time was needed. This is particularly beneficialforthingingivalbiotypes. Full mouth rehabilitation using fixed prostheses usually requires longer-term provisional restoration in order to facilitate a predictable treatment outcome. Inthispatient,owingtohisbusytravelschedule,long- termprovisionalrestorationforverifyinghisadaptabil- ity and multiple professional clinical adjustments of provisional restorations were not feasible. The anterior teeth were restored based on the diagnostic wax-up without long-term provisional restoration before de- finitive cementation of the definitive crown restora- tions. This treatment sequence left almost no room for clinicalerrorsintheexecutionoftheplannedtreatment. Intra-oral verification of the new occlusal scheme and detailed in situ clinical adjustment of the restora- tionsonthedayofprosthesesinsertionareessentialfor proper treatment execution. In this unique treatment approach, the patient should be informed of the po- tentialfinancialandtimeimplicationsshouldanyneed forre-fabricationofthedefinitiverestorationsarise. _Conclusion The functional management of complex prostho- dontic rehabilitation is a clinical challenge. A relatively new restorative material was used in this case. The use ofhigh-strengthfullceramicrestorationsenhancesthe overallaestheticoutcomeandfunctionalpredictability overthelong-term._ Editorial note: A complete list of references is available fromthepublisher. Fig. 11_Occlusal view of completed definitive maxillary full ceramic crown restorations. Fig. 12_Occlusal view of completed definitive mandibular full ceramic crown restorations. Fig. 13_Side view at right latero-trusion, canine-guided occlusion. Fig. 14_Side view at left latero-trusion, posterior teeth were out of occlusion during eccentric movement. Fig. 15_Anterior view of the completed maxillary and mandibular crown restorations. The crown margins were placed at the gingival margin with no sub-gingival extension. CAD/CAM 1_2010 Dr Ansgar C.Cheng Specialist Dental Group™ 3 Mount Elizabeth #08-10 Singapore 228510 Republic of Singapore E-mail: drcheng@specialistdentalgroup.com CAD/CAM_contact Fig. 11 Fig. 12 Fig. 13 Fig. 15Fig. 14