This is the case of a 50 year old male, smoker, with severe periodontal disease and ongoing periapical pathology in some of his teeth.
I extract all the teeth, place a temporary removable prosthesis, and wait three months until the sockets are healed and the bacterial flora has hopefully changed.
I place, then, the 8 + 8 implants, but the two last ones in the upper right sector fail, and I have to wait a little longer to replace them. The rest work osseointegrate themselves fine.
after six months from the re-placement of the last two implants, I start with the prosthetical procedures.
This is the trial model, to test size, shape, color, and smile line
This are the final prosthesis on the cast, the upper one divided in four sections 7-4, 3-1, 1-3, 4-7 and the lower one in three 7-5, 4-4, 5-7
The two upper front sections are cemented over gold abutments and the rest are screwed.
Oclusal view with the chimneys filled up
This case shows the procedure to make a smile make over with a combination of periodontal treatment and prosthetics.
The patient arrives with moderate periodontal disease, lack of hygiene, severe stains due to excessive Fluor in the water he drank during childhood, and, of course, smoking.
Exploration with probe shows bleeding and periodontal pockets over 3-4mm. So, first, we clean the gums thoroughly and watch the evolution of new hygienic habits for several weeks. Teeth should be rather taller than wider, in a proportion of 2(width) to 3 (height). This case is the other way around.
Then, I do a gingivoplasty. This is the surgical removal of gum tissue (gingiva), reshaping around teeth to a more proportional, healthy and esthetic shape.
Now we have a healthier, more esthetic look, 2 by 3 in proportion, that even shows the effect of smoke. The light band of previously covered neck section of the teeth vs… the smoked front section.
Stains cannot be removed by bleaching or whitening, since they are too dark and deep in the enamel. Plus, there are open spaces. So I proceed to carve to teeth with a controlled depth of 0.5mm on the front side, up to the gums.
Then, I remove the incisal edge of the teeth to let space for the veneers that will fit on top. Otherwise they would be so thick that the bite would only touch on the veneers, breaking them.
A set of two thin threads are placed in the gun pocket. This phase would have been impossible to carry out without the convenient periodontal treatment explained before.
The ultimate purpose is to get a healthy gum tissue that doesn’t bleed when a silicon impression is taken. Bleeding gums provoke bubble distortions in the silicone impression, and an inaccurate cast.
A precision cast is made out of the silicone impression. The cast is scanned by a in-office CAD-CAM system called Procera. The scanned data are sent to the Procera headquarters in Sweden, where they make the inner part of the veneers.
Temporary acrylic veneers are bonded while waiting for laboratory working times. Several layers of ceramic colors are placed over the Procera nucleus to reach the final translucent color. After we test a perfect adaptation and convenient color match, we bond the ceramic veneers.
In this case we only substituted the four front teeth. If the veneers had been more as to cover 6,8 or 10 teeth, the color could have been completely changed into a new one. But in this case we tried to camouflage the veneers with color and little white stains of the nearby teeth.
Are they strong? Do they come off?
Well, here is a good example.
Three years after, the patient hit himself with the edge of the pool, and here is what happened.
Only a slight ding on the color ceramic covering . No cracks in the under structure. So I repaired it easily with a combination of composite resin colors, to match the ceramic.
You can chew on these veneers as much as you can. They will not come off. The bonding used is the same as for regular fillings, but the bonding force is huge thanks to the large area of bonding, compared to the reduce leverage.
Risk of fracture is minimized by controlling the depth of the carving, and allowing enough thickness to the nucleus and cover not to break upon load.
Se detecta una caries asintomática entre los dos incisivos centrales durante una revisión periódica. En la vista de frente apenas se distingue un cambio de coloración
An asymptomatic decay is detected in between the two central incisors during a routine check. In the front view one can hardly distinguish but a slight color change.
Pero en la exploración de la parte posterior del diente el cambio de color revela una caries bastante grande
But the rear side shows a big decay under the dark colored spot.
se prepara una cavidad en el esmalte para tener acceso a la dentina (parte intermedia del diente, entre el nervio o pulpa y el esmalte exterior). Estas caries casi siempre afectan a las superficies de los dientes contiguos. Una suele ser mayor que la otra.
The cavity is drilled on the enamel in order to expose the dentine (intermediate layer in between the external enamel and the inner pulp). This cavity normally affects to both side by side teeth, but one is usually larger than the other.
se limpia la caries en la dentina y se da forma a la cavidad
Decay is removed from dentine and the final shape of the preparation is carved.
a continuación se coloca el composite de restauración, con pequeños incrementos y mezclas de colores para lograr una mimetización del color
Then, I place the composite filling, in small amounts and mixtures of colors, in order to get maximum color camouflage.
vista después de la obturación, con un excelente resultado estético. Nadie podría adivinar lo que hay detrás.
Result after finishing, with an excellent esthetic result. No one can tell what’s behind…
Este caso muestra la reparación de la fractura de un incisivo central y una caries en el cuello del diente.
This case shows a fractured reconstruction on the incisal edge of a front tooth and a cavity on the gingival border of the same tooth.
Elimino la caries y los restos de los empastes anteriores.
I clean the decay and remove the old fillings
A continuación se aíslan las superficies, se aplica un ácido, una resina adhesiva y el composite, de distintos colores y por capas, para conseguir el resultado estético adecuado, mimetizándose con el color del propio diente y los de al lado.
Then, I apply an acid, a bonding resin and the composite material, with different colors and layers, to provide a convenient esthetic result, matching the color of the tooth.