Digital workflow on the full-arch partial veneered monolithic zirconia fixed prosthetic restoration: A case report

Year 2023, , 46 - 51, 14.04.2023

Doğu Ömür Dede , Ahmet Serkan Küçükekenci , Mustafa Kılıç

https://doi.org/10.21306/dishekimligi.1189450

Abstract

Many dental problems, pathological attrition, and a decrease in vertical jaw relation are observed due to jaw movements above physiological limits. The present case report has described the digital workflow for the rehabilitation of a patient with partial tooth deficiency, advanced attrition, and loss of vertical dimension using full-arch partial veneered monolithic zirconia fixed prosthetic restorations on the lower and upper jaws.
A 55-year-old male patient was referred to our clinic with complaints of his chewing and aesthetic problems. As a result of clinical and radiographic examination, dental/implant-supported full-arch fixed prosthetic restorations have been planned for both jaws to replace the destroyed tooth tissue, increase the vertical dimension and eliminate tooth deficiencies. After the pre-prosthetic treatments and osteointegration duration of dental implants in the place of 36 and 37 numbered teeth, tooth preparations were performed and digital impressions and interocclusal records at the desired vertical dimension were obtained using an intraoral scanner. After the virtual design of full-arch partial veneered monolithic restorations was completed, the temporary try-in restorations were fabricated using a 3D printer for checking the fit, appearance, and occlusion. The required controls and corrections were done, the definitive final restorations were fabricated with the guide of renewed occlusal registrations, and the facial surfaces were veneered with feldspathic glass-ceramic material.
The patient's chewing and aesthetic complaints with loss of vertical dimension were rehabilitated with digital workflow using full-arch partial veneered monolithic zirconia fixed prosthetic restorations. During the 3 years of follow-up, the patient doesn’t have any joint, function, phonation, or aesthetic problems.

Keywords

Digital workflow, monolithic zirconia, loss of vertical dimension, attrition

Tam ark parsiyel veneerli monolitik zirkonya sabit protetik restorasyonda dijital iş akışı: Bir vaka raporu

Abstract

Fizyolojik sınırların üzerindeki çene hareketleri ve çiğneme sonucunda pek çok dental problemle beraber, patolojik atrizyon ve dikey boyutta azalma görülmektedir. Bu çalışmada parsiyel diş eksikliği, ileri seviyede atrizyon ve dikey boyut kaybı görülen bir hastanın dijital iş akışıyla alt ve üst çene tam ark parsiyel veneerli monolitik zirkonya sabit protetik restorasyonlarla rehabilite edilmesi anlatılmaktadır.
55 yaşındaki erkek hasta, çiğneme ve estetik şikâyetleri ile kliniğimize başvurmuş, klinik ve radyografik inceleme sonucunda, harap olmuş diş dokusunun yerine konması, dikey boyutun artırılması ve diş eksikliklerinin giderimlesi için her iki çeneye diş/implant destekli tam ark sabit protetik restorasyonlar yapılması planlanmıştır. Preprotetik tedavilerin, 36, 37 nolu dişlerin yerine yerleştirilen dental implantların osteointegrayonunun ardından, diş preparasyonları yapılmış ve ağız içi tarayıcı kullanılarak dijital ölçüler ve planlanan okluzal yükseklikte kapanış kayıtları alınmıştır. Sanal modeller üzerinde fasiyal yüzeyleri veneerlenecek şekilde tasarlanan monolitik restorasyonların uyumunun kontrol edilmesi için 3B yazıcı kullanılarak geçici restorasyonlar imal edilerek prova yapılmıştır. Gerekli düzeltmelerin ardından kapanış kaydı yenilenmiş ve fasiyal yüzeyleri feldsatik seramikle veneerlenen monolitik zirkonya materyalden final restorasyonlar üretilmiştir.
Hastanın dikey boyut düşüklüğü, çiğneme fonksiyonu bozukluğu ve estetik kaygıları tam ark zirkonyum restorasyonlar ile giderilmiştir. Yapılan 3 yıllık kontrollerde hastada herhangi bir eklem, fonksiyon, fonasyon ve estetik problemin oluşmadığı görülmüştür.

Keywords

Dijital iş akışı, monolitik zirkonya, dikey boyut kaybı, atrizyon

References

• 1. Ray DS, Wiemann AH, Patel PB, Ding X, Kryscio RJ, Miller CS. Estimation of the rate of tooth wear in permanent incisors: a cross-sectional digital radiographic study. J Oral Rehabil 2015;42:460-466.
• 2. Lambrechts P, Braem M, Vuylsteke-Wauters M, Vanherle G. Quantitative in vivo wear of human enamel. J Dent Res 1989;68:1752-1754.
• 3. Rodriguez JM, Austin RS, Bartlett DW. In vivo measurements of tooth wear over 12 months. Caries Res 2012;46:9-15.
• 4. Loomans B, Opdam N, Attin T, Bartlett D, Edelhoff D, Frankenberger R, et al. Severe tooth wear: European consensus statement on management guidelines. J Adhes Dent 2017;19:111-119.
• 5. Abduo J, Lyons K. Clinical considerations for increasing occlusal vertical dimension: a review. Austr Dent J 2012;57:2-10.
• 6. Antov H, Jablonski RY, Keeling A, Nixon P. CAD/CAM techniques for the conservative and efficient management of tooth wear. Br Dent J 2019;227:791-796.
• 7. Schmidt A, Klussmann L, Wöstmann B, Schlenz M. A. Accuracy of digital and conventional full-arch impressions in patients: an update. J Clin Med 2020;9:688.
• 8. Alghazzawi TF. Advancements in CAD/CAM technology: Options for practical implementation. J Prosthodont Res 2016;60:72-84.
• 9. Calamita M, Coachman C, Sesma N, Kois J. Occlusal vertical dimension: treatment planning decisions and management considerations. Int J Esthet Dent 2019;14:166-181.
• 10. Ender A, Zimmermann M, Mehl A, Accuracy of complete- and partial-arch impressions of actual intraoral scanning systems in vitro. Int J Comput Dent 2019;22:11–19.
• 11. Kuhr F, Schmidt A, Rehmann P, Wöstmann B. A new method for assessing the accuracy of full arch impressions in patients. J Dent 2016;55:68–74.
• 12. M. Granell-Ruíz R, Granell-Ruiz A, Fons-Font J, L. Roman-Rodriguez, MF. Sola-Ruiz. Influence of bruxism on survival of porcelain laminate veneers. Med Oral Patol Oral Cir Bucal 2014;19:426-432
• 13. Venezia P, Torsello F, Cavalcanti R, D’Amato S. Retrospective analysis of 26 complete-arch implant-supported monolithic zirconia prostheses with feldspathic porcelain veneering limited to the facial surface. J Prosthet Dent 2015;114:506-512.
• 14. Moreira A, Freitas F, Marques D, Caramês J. Aesthetic rehabilitation of a patient with bruxism using ceramic veneers and overlays combined with four-point monolithic zirconia crowns for occlusal stabilization: A 4-year follow-up. Case Rep Dent 2019.
• 15. Levartovsky S, Pilo R, Shadur A, Matalon S, Winocur E. Complete rehabilitation of patients with bruxism by veneered and non-veneered zirconia restorations with an increased vertical dimension of occlusion: an observational case-series study. J Prosthodont Res 2019;63: 440-446.
• 16. Ramiro GP, Coronel CA, Navarro AF, Hassan B, Tamimi F. Computer-aided design in restorative dentistry: Digital Restorative Dentistry. Tamimi F, Hirayama H, editors. Digital Restorative Dentistry. Springer; 2019. P. 41-54.