IPS E.Max
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After the first online case seminar of yihuojia in 2019, Dr. Zheng danman had professional medical background and solid technical operation.
We have a deep understanding of IPS E.Max and Variolink bonding products, presenting a wonderful case of functional aesthetic restoration of multiple teeth caries resin combined with E.Max porcelain casting.
Due to the limitation of the length of online competition, Dr. Zheng's case describes the whole process of case making in a simplified way.
Then we invited Dr. Zheng to make an all-round analysis and explanation of this case again, hoping to bring some inspiration and thinking to the doctors and friends.
Resin binding of caries in multiple teeth
e. Functional aesthetic restoration of Max cast porcelain
Chief complaint
The patient was a female, 18 years old. The color and shape of the whole tooth had an effect on the beauty for 8 years.
History of Present Illness
During the more than ten years since the eruption and replacement of the permanent teeth, the patients suffered from multiple teeth caries caused by bad eating habits and had repeated treatment history in the external hospital. Now, because the filling body can not meet the aesthetic needs, they come to our hospital for repair.
Past history
Past physical fitness, denial of bruxism, denial of major diseases, infectious history.
Intraoral examination
Dental examination: 17, 13, 23 smooth surface caries; 16, 12, 11, 21, 22, 26, 27, 37, 36, 35, 32, 31, 41, 46, 47 secondary caries; 15, 14, 13, 23, 24, 25 pit groove caries; 13, 33, 45 adjacent surface caries; 11, 22, 36 chronic apicitis;
Periodontal examination: the gingival margin was red, swollen and congested, and bleeding was detected;
Dentition examination: 23 proximal to middle lip torsion; 32 lingual inclination;
X ray examination
11. 22,36 chronic apicitis; 11 apical granuloma; 18,28,38,48 impaction.
Diagnosis
1. Caries; 2. Tooth defect; 3. Chronic apicitis; 4. Apical granuloma; 5. Class a malocclusion in permanent dentition; 6. Chronic gingivitis; 7. Impacted teeth.
Treatment plan:
One
Biological therapy:
Periodontal basic treatment, oral health education
Two
Treatment of dental pulp disease:
11. 21 root canals were treated, 36 root canals were treated, 15, 14, 13, 24, 25, 27, 35, 33, 32, 31, 41, 47 resin filled.
Three
Aesthetic restoration treatment:
The severe caries of many teeth in the whole mouth and the bad control of dental plaque are the contraindications of orthodontic treatment. Therefore, 17, 16, 26, 37 cast porcelain inlay repair, 12, 21, 23 cast porcelain veneer repair, 11, 22, 36, 46 cast porcelain full crown repair were selected.
01
Preoperative pictures
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Dental photographs
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Colorimetric photograph
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Impression, model photo
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Repair photos
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Adhesive photograph
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Postoperative photos
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Other
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Experience of case making
In this case, we present a case of functional aesthetic restoration of multi tooth caries with IPS E.Max.
The female patient was an 18-year-old high school student, who complained that the color and shape of the whole tooth had an impact on the beauty for 8 years.
During the conversation with the patient, I found that there were a lot of old fillings in her upper anterior teeth and secondary caries on the lingual side. Not only that, many of her posterior teeth have been seriously damaged by caries, and have lost their normal apical shape.
As a teenager, the patient was a soda lover and did not establish good oral hygiene habits.
Over the years, she has been visiting different dental medical institutions for cavity filling. There are different filling materials in her mouth, such as amalgam, resin, glass ion, zinc oxide and so on.
When the patient came to see me for medical treatment, she was in senior two. She planned to do a thorough repair treatment after the college entrance examination.
After a comprehensive analysis of the examination and the requirements of the patient, the final diagnosis of the patient was: caries, tooth defect, chronic gingivitis, chronic periapical periodontitis and periapical granuloma.
Based on the diagnosis,
I have a treatment plan for the patient:
The first is biological treatment, removal of local stimulation factors, oral health education. The second is the treatment of dental pulp disease, including root canal treatment and root canal re treatment, a small range of caries cavity resin direct repair. Finally, aesthetic repair treatment.
There was only the first treatment. After orthodontic treatment, IPS E.Max veneer, inlay and full crown were selected according to the range of tooth defect.
But because the patients' serious caries is the relative contraindication of orthodontic treatment, and the period of orthodontic treatment is unacceptable for the patients who have been suffering from caries treatment for many years.
Therefore, on the premise of respecting the patient's wishes, I need to re-establish a compromise scheme - minimally invasive aesthetic repair treatment. It can not only satisfy patients, but also not violate medical principles.
After the second analysis and the diagnosis wax simulation on the plaster model, and the full evaluation of the dental preparation and the final restoration effect, I made a second restoration scheme for the patients:
IPS E.Max ceramic inlay of four posterior teeth, IPS E.Max ceramic veneer of three anterior teeth and IPS E.Max ceramic crown of two anterior teeth and two posterior teeth.
The main reason for this consideration is that the defect in the mouth is too large, so it is no longer suitable for the resin repair which is easy to age and has low strength.
At the same time, at present, IPS E.Max has incomparable advantages over zirconia in adhesive properties and elastic modulus.
The main goal of this case is to restore the beauty and health of the teeth without changing the original occlusal relationship.
The difficulty of this restoration lies in the reconstruction of a large range of teeth. This is a challenge for me and the patient.
Fortunately, the patient is very satisfied with the final repair result. As shown in the photo, the patient finally does not need to cover up his smile.
In the treatment of this patient, we benefited from the excellent aesthetic performance, elastic modulus of IPS E.Max cast ceramic material and excellent bonding performance of Variolink resin cement.
So that the restoration method can have a more scientific, more minimally invasive choice to retain the natural teeth, so that a large number of living pulp teeth part of the healthy enamel can be preserved.
At the same time, good self-cleaning and even distribution of occlusal stress are ensured in the follow-up use of patients. The color and transparence of anterior teeth area also achieved good aesthetic effect.
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