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FULL-MOUTH REHABILITATION IN A PATIENT AFFECTED BY SEVERE ATTRITION: INTERDISCIPLINARY PERIO-CONSERVATIVE AND ESTHETIC APPROACH

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FULL-MOUTH REHABILITATION IN A PATIENT AFFECTED BY SEVERE ATTRITION:INTERDISCIPLINARY PERIO-CONSERVATIVE AND ESTHETIC APPROACH

Faus-Matoses V 1, 2 , Faus-Matoses I 3 , Teruel-Rodríguez A 4 , Faus-Llácer VJ 5.

1 Associated Professor , 2 Professor of the Master in Restorative Dentistry and Endodontics, 3 Collaborator Professor of the Master in Orthodontics, 4 Postgraduate Student of the Master in Restorative Dentristry and Endodontics, 5 Professor and Director of the Master in Restorative Dentistry and Endodontics.

Master of Restorative Dentistry and Endodontics, Department of Stomatology, Medicine and Dental School, Valencia University, Spain

OBJECTIVE: To illustrate a conservative approach to achieve the functional and aesthetic full-mouth rehabilitation of a patient with severe attrition.

METHODS:  Healthy 61-year-old female complained about severe incisal wear. After clinical and radiographic examination a DSD was performed, from which we obtained a diagnostic wax-up. The wax-up was transferred to the mouth for the clinical evaluation of aesthetic parameters through photographs and videos, afterwards the treatment plan was performed which included:

•Gingivectomy  in the region of upper incisives defining the gingival zeniths through the  mock-up.
•Direct oclusal composite  on the non-restored posterior mandibular teeth to increase the vertical dimension 2,5 mm.
•Minimally invasive feldsphatic veneers on 1.2, 1.1, 2.1, 2.2, 2.3 and 3.3, 3.2, 3.1, 4.1, 4.2, 4.3, 4.4, 4.5.

The teeth´s surface and the intaglio surface of each veneer were prepared for bonding. The adhesive (Prime&Bond NT Dentsply DeTrey, Konstanz, Germany) was then applied on both surfaces and left uncured, after the previously selected resin cement (Calibra Translucent, Dentsply, Konstanz, Germany) was injected carefully into the veneers. Each restoration was positioned on the specific tooth, cement excesses were removed and the veneers were light-cured for 90 seconds.

•Replacement of old obturations and prosthesis resulting in a final situation with: porcelain fused to metal fixed partial denture from 1.5 to 1.7 cemented with RelyX Luting (3M ESPE, Seefeld, Germany);  feldsphatic single crowns in 1.3, 2.4 and 2.5 bonded with the same procedure used for the anterior veneers; alumina fixed partial denture from 4.3 to 4.5 cemented with SmartCem 2 (Dentsply, Konstanz, Germany) and composite restorations on the remaining teeth.
•Implants: 1.4, 2.6, 3.6, 4.6 and 4.7 to replace the absent teeth.

 CONCLUSION: With an accurate diagnosis, treatment plan and the use of the suitable materials it is possible to achieve excellent aesthetics and function while preserving maximum tooth structure. 

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