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    6 views24 pages

    QuintessenzArtikel 1 PDF

    Uploaded by

    Alla Mushkey

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    © All Rights Reserved
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    of 24
    A Comprehensive Approach for Restoring Esthetics and Function in Fixed Prosthodontics Walter Gebhard, MDT* federn dental reconstructions do not only aim at restoring the patients mastication, but rather at improving general well- being and quality of life, espacially in terms of es- theties. This is why for many patients today, con- sulting the dentist does not necessarily mean only treatment of thoir teeth, but having their outer ap- pearance improved as well, The madi, the Inter. net, advertising, and many other facets of society contribute to an ineveased cosmatic auiareness, Society today doss not readily perceive accep- tance of factors that may negatively impact a per- son's quality of Ife, Therefore, a variety of modem therapies (erthodontia, bleaching, implart dental prostheses), as well the unlimited possibilities of- fored by intograted dental prostheses (ether peri- “ctr Dental Tecnica, Gebhard AG DantalLabor Zieh, Reprint request: Wr Wier Gebhard, Gaba AG Dena (Sto, Wenbargrvaro toe, C1005 Zc, Stanard Emai:watereohrdahornslcom ‘odontal or implant allow the dentist to satisfy the patient's wishes as superior as they may be. To provide for biologie acceptance, optimum chewing function, and individual esthetics, a sys- tematic procedure in clinical treatment and a stan- dardized method in dental technology are indi- cated. Any restoration should be based on scientifically based result, biologic knowledge, and clasreut technical concepts, including mater: als and applied methods During treatment planning, the following methodology should be obsorved 1. Establish treatment objectives and goals 2. Approach the problems 3. Visualize final results. 4, Determine sequence of treatment. 5. Determine costs To do this, the patients wishes are incorporated and the clinicians, dental hygienists, technician, and patient cooperate in an interdisciplinary way to achieve the optimum result. Ary step leading 10.2 high-quality result should be discussed and or a i cconaro Figs 1 and 2 Because of the achesive technique conservative to tooth stucture, Veneer prepara cartied out in accordance with the ideal concept applicable in the respective case, even ifin individ ual cases compromises cannot he prevented, There are numerous parameters that are 1 sponsible fora high-quality result, including += Biocompatible materiale ‘Non-invasive, reversible procedures; conserva- ‘ive preparations (Figs 1 t0 4) * Intimate ft on abutment, passive fit in implantol- ogy (Figs 5 to 12) + Individual function, madern occlusal concepts * Accessibilty for oral hygiene procedures * Longevity + Proper phonetics + Predictability + Comfort for the patient * Individualized reconstructions (Figs 13 to 23) is possible to minimally propare taath, ‘of mandibular anterior teeth in 1991 E Figs 3 and 4 Micropreparation today on maxillary lft central inizor and after bonding, [ff PREOPERATIVE CLINICAL AND TECHNICAL PROCEDURES. Diagnostic Waxup ‘The first step in fabricating the dental prosthesis in a functional, unobtrusive way should be per formed preoperatively after completion of the clinical examination, diagnosis, and treatment planning. This should include the exact descrip- tion of goals to be achieved by the treating den- tist and a diagnostic waxup or setup, To accom. plish this, the diagnestic (duplicate) models (Figs 24 to 33}, facebow mounted on the articulator, are completed with wax or the plaster teeth. In turn, the occlusal surfaces are equilibrated such that the teeth will be in an ideal contact relation to each other. Also, centric and eccentric paths should allow canine and/or anterior guidance to Fig 5 Finvossimpresion vee exact reproduction of the preparation, The presi should teach beyond ‘he preparation mt fo beter conte emer pores pole Fig 6 Secioned and sold dupeato model are made for faite comectons ond ail ue Figs 710-11 Each chosen reconstuction sytem ‘hed bo ble tobe processed problem feo, 9 that gh pecon inthe margin canbe achive. Light {wansision ar wel er the colgeshape and ght optic {uolies can be conralled and improved thanks tothe Ghreme margin Fig 12 Implantcupported meta ceramic ved pari denture daring the Selfel test ater posststion ‘hough the sparc erosan technique: the ang orm Siecas of enplon-auppoded estore den an ‘gement alsa depends onthe past f/secracy Hicesiaro Fig 13 Modern dental rconswucions often requite a Figs 15 t0.17 Acceptable calor transtionbetaoon the Combination of tetmiques systems on the model and inst Fig 14 On the tieue model: refractory ls for ve- Figs 18 and 19 Preparations anata completion, eer, Spine cores for lseralncears neta ceramic Couns ard beds forthe canines and posteioreeth, Figs 200.23 Before and ater westment Klos: Restoring Esthotics and Function in Fited Prosthodontics Figs 24 and 25 Study model A Fig 26 Study medal mounted on articulator Fig 27 Duplicated model Bas mounted on ecu Tet, with teeth prepared and complemented iealy Fig 28 Diagnostic wane, Figa 29 o 33 From duplicated model B (wasp, tmadelC i obtained whic also mounted on at lator The new stuaton cane ber assessed in form Ailend anol mac ch {ere resin is pressed onthe prepared model Wih thea fcrgue orale ual characterzed: Alec polishing the cron ae thinned! ae much a posse fom the intra cor on El Hi ceonaro Figg 24 and 25 Disonostc plan ‘ings expec iportant for Implontstpported reoratons, ttthis show hygiene access, Shes anc implant space, amon: ther fact can be dterminod Figs 36 to 43 An apparant easy tase Replacement atthe maxillary letecentra incisor Patiant nd dontst suggestions, which are re alisic and predictable, lead tothe ‘best possible esthetic result. With tha analysis of the model, the fel: lowing points become apparent: + Problems in function { Diteren aval of nisl soe 1 Unpleasne anstton of marsinal iterone ses of ed + Diterent ses of gaps compa tothe contalatecl sooth (ght conta 1 Detectin sheolar side SMichshe diagnose now, sev ‘cl options tome aross vl mpantsuppented single. —Inplane supported single crown; vente on te Ie iste —Implertsupporte single ietconval Cronin onthe sight cons ‘ar extension semen onthe Toft contal (posal incosing the ef oer From this analysis, the best possi- ble esthetic result ean bs deter- mined and the necessity of ilge ugmentation, eon elongation, ‘nd laminate veneers can be con- Stored Figg 46 and 45 Diagnortc and finshed work Wit shape and arangement given, one Closely on he nine shading and carame buldup, bbe produced, n applying this method, functional problems will be recognized in an eory stage and 2 formal treatment plan con be discussed. A the ‘same time it ie possible to correcta disharmonic ‘gingival lie or ridge defects and to show this method ina descriptive way. the dentist plans to any out an implart prosthetic reconstuction, the diagnostic waxup constitutes the subsequent technically ideal implant pesition and orientation ‘ofthe implant long axis (Figs 24 to 45), As the patient wil likely not be available, the dental technician should be provided with the d= agnostic madels and standardized photo dacu: mentation. This is expecially cequire in cases of Anterior tooth ceconstruction. However, i the technician isin the position to meet the patient personally, he has the advantage of getting to know the pationt’s personality, facial physiog omy, a well as dental and periodantal statin, To a certain extent, the missing patient contact may be replaced by modem means of digital photography, digital video, and transmission via Invemet ‘The diagnostic waxup allows this information to bee transferred in provisional restorations that al- ready contain the intial corrections (auch as oc- lusal plane, anterior tocth position, etc). In this ‘way, 2 basis of discussion is ertablshed for both the dentist and the patient Computer Imaging Imaging can prove 2 valuable addition to diagnos. tics in patient management, The great ackantage is that the patient can be made aware of esthetic shortcomings in a graphic and accessible manner luring intial conuhations. Virtual idealization of the conditions in the patients mouth allows both the patient and the dentist to splay, assess, and, were necessary modify the desired changes di- rectly on screen. The disadvantage isthe expecta- tions this method occasionally creates ia the pa tient, An unfavorable abutment position or the patient's general dental condition may impose technical mations and thereby prevent the real [ste goal rom being achieved (Figs 46 to 50), oor a0 Khor ns Fig 49 The mason right fist premelar wae femocaled oa canno nth s veneer The Fig 46 Preoperative suai, Fig 47 Gingival canarmories at wal as ‘herasng maul ight otra nar ‘canbe corected by strate analyele Sing ake color lary asa ole feed Aneel Figs a ond 48 Computer mniplatd “ideal Fig 50 Postoperative shone inprvement of the SiebnaodeLeccweet Iaumiee ee Restoring Esthetics ond Function in Fixed Prosthodontics Provisional Restorations The provisional restorations primarily serve to pro- tect and stabilize the prepared tact, 28 well 0 contal the dagnostcally Specified funcional pa- rameters. Furthermore, they make ie posible to ty out new vertical dimensions and to condition the sof tissue in the pantic design proces In general, when producing the provisional shell, dimension, form, and position should be ac- cessed so that the eating dentist can easly ac- ses5 the length of the crown, centerline, incial ‘edge line, lip support, and phonetics. Adltion- ail itis possible to make the calor of the prow Sonal metch the existing dentiion. At this treat ment stage a beauttully created sot of provisional restorations net only contibutes tothe patient's wellbeing, it also allows consideration of the final reconstruction and possible modifications ede ‘for granting the patient time to acclimate, the provisional restorations should be newly as: sossed by the treating team together with the pa- tient and, if necessary, be modified. Depending fn the scope of modification, tis may be carried cut by the dentist inthe patents mouth or inthe laboratory At this time, the thickness ofthe prov sional shell should be measured to assess the space available and to cary out @ subsequent preparation The Metal-Supported Long-Term Provisional Unit Comprehensive reconstructions requiring o%: tended preparation time will need 10 include secondary meta-supported provisional unit inthe tneatment concept which wll be applied after the fist eatment using provisional shes, The metal ‘supported long-term provisional unit flills bas cally the same objectives as provisional restora- tions. However, it has to withstand a higher load resulting fom the pariociontal, surgical, ancio-

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