Multiple crowns

Chronic apical periodontitis
,
Chronic gingivitis
,
Dental caries penetrating into dentin
,
Partial loss of tooth
,
Unsatisfactory restoration
Courtesy of Dr D. Bo, 2021
Highlighted picture of treatment

Treatment Summary

Patient Information

  • Age: 23
  • Gender: female

Diagnosis

  • Dental caries penetrating into dentin on 2.4 (UL4)
  • Chronic apical periodontitis on 1.4 (UR4), 1.6 (UR6), 2.5 (UL5), 3.6 (LL6)
  • Chronic gingivitis on 1.1 (UR1), 1.2 (UR2), 1.3 (UR3), 1.4 (UR4), 1.5 (UR5), 1.6 (UR6), 1.7 (UR7), 2.1 (UL1), 2.2 (UL2), 2.3 (UL3), 2.4 (UL4), 2.5 (UL5), 2.6 (UL6), 2.7 (UL7), 4.1 (LR1), 4.2 (LR2), 4.3 (LR3), 4.4 (LR4), 4.5 (LR5), 4.6 (LR6), 4.7 (LR7), 3.1 (LL1), 3.2 (LL2), 3.3 (LL3), 3.4 (LL4), 3.5 (LL5), 3.6 (LL6), 3.7 (LL7)
  • Partial loss of tooth on 2.4 (UL4)
  • Unsatisfactory restoration on 1.4 (UR4), 1.6 (UR6), 2.4 (UL4), 2.5 (UL5), 2.6 (UL6), 3.6 (LL6)

Total Treatment Visits

  • 7

Treatment planning

  • Before surgery, iTero was used for intraoral scanning and photography. The patient's condition was analyzed and a diagnosis and treatment protocol was formulated:
    - Treatment plan on which caries teeth will be filled, old prosthesis removed, and RCT will be carried out was formulated.
    - RCT: Post and Core with temporization of 14 was done. In addition, crown lengthening periodontal surgery was performed to retain tooth 14.
    - RCT followed by crown restoration for tooth #16, 25, 36.
    - Onlay restoration for tooth #24 and
    - Crown restoration for tooth # 26
  • Basic periodontal treatment and OHI were recorded. Oral hygiene education for patient was conducted.
  • Post-surgery: In order to establish occlusal relationship, iTero intraoral scan, CBCT examination, and electronic face bow transfer were carried out 2 months after surgery. These data were combined to construct a 4D virtual dental patient, which was used to examine the occlusal relationship to design the prosthesis.
  • CAD/CAM was used to create a temporary crown. After two months, occlusal relationship and periodontal tissues were stabilized, temporary crown scan was used to replicate for a permanent crown, with the same occlusal height and appearance. Finally, zirconia from Zenostar was used and occlusion was found to be good on postoperative examination.

Comments

  • Preoperative iTero intraoral scanning and analysis of condition and communication of treatment plan enabled the patient to have more confidence in treatment suggested.
  • This is a secondary restoration case involving multidisciplinary combination therapy in which multiple teeth were repaired again.
  • We considered the occlusal relationship of the patient, particularly the edges of multiple teeth are at the subgingival region, which increased the difficulty of making the impression.
  • As iTero has high precision and we have extensive experience in iTero, we have a lot of confidence in managing this case.
  • We completed gingival retraction and successfully carried out intraoral scanning and impression taking, which were combined with the patient’s dynamic occlusal movement trajectory to create a crown that is most suitable for the patient.
  • The edges of the crown were sealed and the occlusal height did not require a lot of adjustment.
  • Prosthesis implantation was successfully completed. The patient was extremely happy and satisfied with us.

Images

Initial and final

InitialFinal
After picture of treatment
Before picture of treatment
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Radiographs

Initial Final
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Progress Images

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