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Special Issues
July/August 2017
Volume 38, Issue 2
Peer-Reviewed

Complex Restorative Solutions: Optimize Outcomes With the Right Materials

Jason H. Goodchild, DMD

In this case of a 20-year old male patient with numerous congenitally missing teeth, restorations were done using layered zirconia bridges. The Aquasil® Ultra Cordless Tissue Managing Impression System (Dentsply Sirona Restorative, dentsplysirona.com) was used to precisely capture the details of the preparations, and the dental laboratory was then able to scan the impressions. Zirconia frameworks were fabricated and layered with esthetic porcelain. The final restorations were cemented with Calibra® Universal Self-Adhesive Resin Cement (Dentsply Sirona Restorative). The successful treatment resulted in a dramatic change of life for the young patient.

Key Takeaways

• Effective treatment planning can create restorative opportunities for improved esthetics, function, and quality of life.

• Aquasil Ultra Cordless Tissue Managing Impression System combines a dispenser for precision placement with a material that is optimized for scanning conventionally recorded impressions.

• Partnering with a quality dental laboratory and selecting an appropriate cement based on factors including substrate, preparation design, and the ability to achieveisolation can help optimize outcomes.

 

About the Author

Jason H. Goodchild, DMD
Chairman and Associate Professor Department of Diagnostic Sciences
Creighton University School of Dentistry Omaha, Nebraska;
Clinical Education Manager
Focus North America
Dentsply Sirona Restorative
Milford, Delaware;
Private Practice
Havertown, Pennsylvania

Fig 1. Preoperative view of 20-year-old male patient at presentation. Medical history was thoroughly reviewed and was noncontributory. The patient and his parents requested implant treatment, with a $20,000 budget.

Figure 1

Fig 2. Preoperative maxillary occlusal view. Note the patient had a retained primary tooth H and was congenitally missing teeth Nos. 1, 4 through 6, 11, 12, and 16.

Figure 2

Fig 3. Preoperative mandibular occlusal view. Note the patient had a retained primary tooth T and was congenitally missing teeth Nos. 17, 18, 20, 21, 23, 26, 28, 29, 31, and 32.

Figure 3

Fig 4. Final preparations of maxillary and mandibular teeth. Finish lines were placed equi- or supragingivally where possible. The treatment plan involved layered zirconia fixed partial dentures for the maxilla and mandible.

Figure 4

Fig 5. Milled urethane provisionals on teeth Nos. 3 through 14 and 19 through 30. These provisionals functioned as blueprints for developing esthetics, function, and phonetics. Provisional cementation was accomplished by Integrity® TempGrip® Temporary Crown & Bridge Cement (Dentsply Sirona).

Figure 5

Fig 6. Maxillary view of milled provisionals on teeth Nos. 3 through 14.

Figure 6

Fig 7. Mandibular view of milled provisionals on teeth Nos. 19 through 30.

Figure 7

Fig 8. Final impressions of teeth Nos. 3, 7, 8 through 10, 13, and 14 using a Rim-Lock® maxillary impression tray (Dentsply Sirona) and Aquasil Ultra Cordless Tissue Managing Impression System.

Figure 8

Fig 9. Final impressions of teeth Nos. 19, 22, 24, 25, 27, and 30 using a Rim-Lock mandibular impression tray and Aquasil Ultra Cordless Tissue Managing Impression System.

Figure 9

Fig 10. Scan of articulated models using a 3Shape® scanner (3shape.com).

Figure 10

Fig 11. Scan of articulated models with proposed zirconia frameworks.

Figure 11

Fig 12. Milled zirconia mandibular framework for teeth Nos. 19 through 30 using Cercon® zirconia (Dentsply Sirona).

Figure 12

Fig 12. Milled zirconia mandibular framework for teeth Nos. 19 through 30 using Cercon® zirconia (Dentsply Sirona).

Figure 12

Fig 13. Try-in of frameworks on teeth Nos. 3 through 8, 9 through 14, and 19 through 30. Note the excellent tissue health and fit of the frameworks.

Figure 13

Fig 14. Maxillary view of frameworks on teeth Nos. 3 through 8 and 9 through 14.

Figure 14

Fig 15. Mandibular view of frameworks on teeth Nos. 19 through 30.

Figure 15

Fig 16. Postoperative view after final cementation with Calibra Universal Self-Adhesive Resin Cement (Dentsply Sirona), which was chosen because of its ease of use, including simple cleanup and excellent bond strengths.

Figure 16

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