Long-term restorations as key for healthy tissues

A 23-year old female patient came to our practice complaining about the appearance of her anterior prosthesis, and suffering from bleeding from the gum.
According to symptoms, and clinical and X-ray findings, a root canal retreatment was necessary, fiber post placement and build-up of the teeth. One of the most common complaints we hear about is bleeding gums under dental protheses.
Contrary to what many patients think, properly fit indirect dental prostheses do not cause bleeding. Respecting the gums and supporting tissues around the teeth is a key factor when making restorations. This lovely patient had been suffering with bleeding gums for months before she decided to come see us. Our first step, before removing the pre-existing crown, was to take an impression with an Asilicone (DMG A-silicon Honigum) in order to be able to immediately deliver a longterm temporary prosthesis in order to let the soft tissues heal (pink factor). Longterm temporary resin restorations are an actual common reality of our daily practice as we often have to face the replacement of previous restorations that have failed while dealing with the financial capacity of our patients.

unaesthetic and improper dental crowns style italiano styleitaliano

Fig.1
This patient came asking for an aesthetic improvement of her smile. Esthetic analysis showed there is no matching or harmony between pink and white factors, and the soft tissue management is mandatory before the final new prosthesis.

dental prosthesis irritating the gum style italiano styleitaliano

Fig.2
Initial situation (frontal view).

cutting an old dental prosthesis style italiano styleitaliano

Fig.3
Cutting the old prosthesis by crown-cutter bur.

style italiano styleitaliano dmg luxacrown
style italiano styleitaliano dmg luxacrown
short and decayed abutments style italiano styleitaliano

Fig.4
After cutting and removing the old prosthesis, the teeth needed root canal retreatment, fiber post placement and core build-up.

abutments after core build-up style italiano styleitaliano

Fig.5
After post-core build-up, the soft tissues need to be managed with a temporary restoration to achieve periodontal health before final preparation of the teeth.

dmg luxacrown resin for provisional prosthesis style italiano styleitaliano

Fig.6
The silicone index was filled with a bis-acryl chemical cure flowable resin. This material (DMG LuxaCrown) has high mechanical properties together with a good color stability, and thus allows the clinician to fabricate a high-performance provisional.

injection of syringeable dental resin style italiano styleitaliano

Fig.7
This material can ensure margin fit, resilience, high resistance and aesthetic stability for a long time. Injection of DMG LuxaCrown should start from the bottom of the incisal edge up to the cervical part.

ssilicone mold tie injected resin tyle italiano styleitaliano

Fig.8
The material is ready to inserted inside patient mouth.

provisional crowns on upper incisors style italiano styleitaliano

Fig.9
The resin used here is a new generation of temporary material that allows to achieve very good esthetics. This new resin is stronger than all other syringeable materials, and is suitable for bruxist patients as well.
After a few weeks, with a very simple polishing step, the physical stability of the surface texture is quite very acceptable. Also, biofilm and plaque sticking are prevented thanks to this easy, fast, and simple polishing step.

abutments after preparation and insertion of retraction cord style italiano styleitaliano

Fig.10
After the removal of temporaries, final preparation of the teeth. Note the healthy and keratinized gum which will facilitate the good integration between pink and white factors.

honigum silicone for precision impression style italiano styleitaliano

Fig.11
The impression was taken with a single step technique using DMG Honigum Pro Putty Soft and Light.

double paste precision impression style italiano styleitaliano

Fig.12
The light body material is very flowable and able to fill all the space created by the second retraction cord.

lithium disilicate crowns on model style italiano styleitaliano

Fig.13
Separated lithium disilicate (E-max) crowns just received from the dental lab.

cemented lithium disilicate crowns style italiano styleitaliano

Fig.14
Final situation after one month.

smile after crown restoration style italiano styleitaliano

Fig.15
The dentist and the patient were very happy with the final aspect.

before and after crown do-over style italiano styleitaliano

Fig.16
Comparison between the initial and final situation.

before and after prosthesis replacement style italiano styleitaliano

Fig.17
Before & after.

Conclusions

A long-term temporary material can be the perfect solution in a case with uncertain prognosis. It allows both clinician and patient to be quite and confident in waiting for several weeks (or even more) before starting the workflow for the final crown.

Bibliography

1. Koubi S, Gurel G, Margossian P, Massihi R, Tassery H. A Simplified Approach for Restoration of Worn Dentition Using the Full Mock-up Concept: Clinical Case Reports. Int J Periodontics Restorative Dent. 2018 Mar/Apr;38(2):189-197.
2. Vailati F, Belser CU. Classification and treatment of the anterior maxillary dentition affected by dental erosion: the ACE classification. Int J Periodontics Restorative Dent. 2010 Dec;30(6):559-71.

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