Perioprosthetic and Implant-Supported Rehabilitation of Complex Cases: Clinical Management and Timing Strategy
Identifieur interne : 002A27 ( Pmc/Curation ); précédent : 002A26; suivant : 002A28Perioprosthetic and Implant-Supported Rehabilitation of Complex Cases: Clinical Management and Timing Strategy
Auteurs : Luca Landi [Italie] ; Stefano Piccinelli [Italie] ; Roberto Raia [Italie] ; Fabio Marinotti [Italie] ; Paolo Francesco Manicone [Italie]Source :
- Case Reports in Dentistry [ 2090-6447 ] ; 2016.
Abstract
Treatment of complex perioprosthetic cases is one of the clinical challenges of everyday practice. Only a complete and thorough diagnostic setup may allow the clinician to formulate a realistic prognosis to select the abutments to support prosthetic rehabilitation. Clinical, radiographic, or laboratory parameters used separately are useless to correctly assign a reliable prognosis to single teeth except in the case of a clearly hopeless tooth. Therefore, it is crucial to gather the greatest quantity of data to determine the role that every single element can play in the prosthetic rehabilitation of the case. The following report deals with the management of a multidisciplinary periodontally compromised case in which a treatment strategy and chronology were designed to reach clinical predictability while reducing the duration of the therapy.
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DOI: 10.1155/2016/2634093
PubMed: 27891261
PubMed Central: 5116514
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Perioprosthetic and Implant-Supported Rehabilitation of Complex Cases: Clinical Management and Timing Strategy</title><author><name sortKey="Landi, Luca" sort="Landi, Luca" uniqKey="Landi L" first="Luca" last="Landi">Luca Landi</name><affiliation wicri:level="1"><nlm:aff id="I1">Studio di Odontoiatria Ricostruttiva, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Studio di Odontoiatria Ricostruttiva, Rome</wicri:regionArea></affiliation></author><author><name sortKey="Piccinelli, Stefano" sort="Piccinelli, Stefano" uniqKey="Piccinelli S" first="Stefano" last="Piccinelli">Stefano Piccinelli</name><affiliation wicri:level="1"><nlm:aff id="I1">Studio di Odontoiatria Ricostruttiva, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Studio di Odontoiatria Ricostruttiva, Rome</wicri:regionArea></affiliation></author><author><name sortKey="Raia, Roberto" sort="Raia, Roberto" uniqKey="Raia R" first="Roberto" last="Raia">Roberto Raia</name><affiliation wicri:level="1"><nlm:aff id="I1">Studio di Odontoiatria Ricostruttiva, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Studio di Odontoiatria Ricostruttiva, Rome</wicri:regionArea></affiliation></author><author><name sortKey="Marinotti, Fabio" sort="Marinotti, Fabio" uniqKey="Marinotti F" first="Fabio" last="Marinotti">Fabio Marinotti</name><affiliation wicri:level="1"><nlm:aff id="I2">Dental Laboratory Technician, Studio di Odontoiatria Ricostruttiva, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Dental Laboratory Technician, Studio di Odontoiatria Ricostruttiva, Rome</wicri:regionArea></affiliation></author><author><name sortKey="Manicone, Paolo Francesco" sort="Manicone, Paolo Francesco" uniqKey="Manicone P" first="Paolo Francesco" last="Manicone">Paolo Francesco Manicone</name><affiliation wicri:level="1"><nlm:aff id="I1">Studio di Odontoiatria Ricostruttiva, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Studio di Odontoiatria Ricostruttiva, Rome</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="I3">Institute of Clinical Dentistry, Department of Prosthodontics, Catholic University of the Sacred Heart, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Institute of Clinical Dentistry, Department of Prosthodontics, Catholic University of the Sacred Heart, Rome</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27891261</idno><idno type="pmc">5116514</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5116514</idno><idno type="RBID">PMC:5116514</idno><idno type="doi">10.1155/2016/2634093</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">002A27</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002A27</idno><idno type="wicri:Area/Pmc/Curation">002A27</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002A27</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Perioprosthetic and Implant-Supported Rehabilitation of Complex Cases: Clinical Management and Timing Strategy</title><author><name sortKey="Landi, Luca" sort="Landi, Luca" uniqKey="Landi L" first="Luca" last="Landi">Luca Landi</name><affiliation wicri:level="1"><nlm:aff id="I1">Studio di Odontoiatria Ricostruttiva, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Studio di Odontoiatria Ricostruttiva, Rome</wicri:regionArea></affiliation></author><author><name sortKey="Piccinelli, Stefano" sort="Piccinelli, Stefano" uniqKey="Piccinelli S" first="Stefano" last="Piccinelli">Stefano Piccinelli</name><affiliation wicri:level="1"><nlm:aff id="I1">Studio di Odontoiatria Ricostruttiva, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Studio di Odontoiatria Ricostruttiva, Rome</wicri:regionArea></affiliation></author><author><name sortKey="Raia, Roberto" sort="Raia, Roberto" uniqKey="Raia R" first="Roberto" last="Raia">Roberto Raia</name><affiliation wicri:level="1"><nlm:aff id="I1">Studio di Odontoiatria Ricostruttiva, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Studio di Odontoiatria Ricostruttiva, Rome</wicri:regionArea></affiliation></author><author><name sortKey="Marinotti, Fabio" sort="Marinotti, Fabio" uniqKey="Marinotti F" first="Fabio" last="Marinotti">Fabio Marinotti</name><affiliation wicri:level="1"><nlm:aff id="I2">Dental Laboratory Technician, Studio di Odontoiatria Ricostruttiva, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Dental Laboratory Technician, Studio di Odontoiatria Ricostruttiva, Rome</wicri:regionArea></affiliation></author><author><name sortKey="Manicone, Paolo Francesco" sort="Manicone, Paolo Francesco" uniqKey="Manicone P" first="Paolo Francesco" last="Manicone">Paolo Francesco Manicone</name><affiliation wicri:level="1"><nlm:aff id="I1">Studio di Odontoiatria Ricostruttiva, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Studio di Odontoiatria Ricostruttiva, Rome</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="I3">Institute of Clinical Dentistry, Department of Prosthodontics, Catholic University of the Sacred Heart, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Institute of Clinical Dentistry, Department of Prosthodontics, Catholic University of the Sacred Heart, Rome</wicri:regionArea></affiliation></author></analytic><series><title level="j">Case Reports in Dentistry</title><idno type="ISSN">2090-6447</idno><idno type="eISSN">2090-6455</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Treatment of complex perioprosthetic cases is one of the clinical challenges of everyday practice. Only a complete and thorough diagnostic setup may allow the clinician to formulate a realistic prognosis to select the abutments to support prosthetic rehabilitation. Clinical, radiographic, or laboratory parameters used separately are useless to correctly assign a reliable prognosis to single teeth except in the case of a clearly hopeless tooth. Therefore, it is crucial to gather the greatest quantity of data to determine the role that every single element can play in the prosthetic rehabilitation of the case. The following report deals with the management of a multidisciplinary periodontally compromised case in which a treatment strategy and chronology were designed to reach clinical predictability while reducing the duration of the therapy.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Adell, R" uniqKey="Adell R">R. Adell</name></author><author><name sortKey="Lekholm, U" uniqKey="Lekholm U">U. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Case Rep Dent</journal-id><journal-id journal-id-type="iso-abbrev">Case Rep Dent</journal-id><journal-id journal-id-type="publisher-id">CRID</journal-id><journal-title-group><journal-title>Case Reports in Dentistry</journal-title></journal-title-group><issn pub-type="ppub">2090-6447</issn><issn pub-type="epub">2090-6455</issn><publisher><publisher-name>Hindawi Publishing Corporation</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27891261</article-id><article-id pub-id-type="pmc">5116514</article-id><article-id pub-id-type="doi">10.1155/2016/2634093</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Perioprosthetic and Implant-Supported Rehabilitation of Complex Cases: Clinical Management and Timing Strategy</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Landi</surname><given-names>Luca</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Piccinelli</surname><given-names>Stefano</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Raia</surname><given-names>Roberto</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Marinotti</surname><given-names>Fabio</given-names></name><xref ref-type="aff" rid="I2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0003-0283-2903</contrib-id><name><surname>Manicone</surname><given-names>Paolo Francesco</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref><xref ref-type="aff" rid="I3"><sup>3</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib></contrib-group><aff id="I1"><sup>1</sup>Studio di Odontoiatria Ricostruttiva, Rome, Italy</aff><aff id="I2"><sup>2</sup>Dental Laboratory Technician, Studio di Odontoiatria Ricostruttiva, Rome, Italy</aff><aff id="I3"><sup>3</sup>Institute of Clinical Dentistry, Department of Prosthodontics, Catholic University of the Sacred Heart, Rome, Italy</aff><author-notes><corresp id="cor1">*Paolo Francesco Manicone: <email>pfrancesco.manicone@rm.unicatt.it</email></corresp><fn fn-type="other"><p>Academic Editor: Konstantinos Michalakis</p></fn></author-notes><pub-date pub-type="ppub"><year>2016</year></pub-date><pub-date pub-type="epub"><day>7</day><month>11</month><year>2016</year></pub-date><volume>2016</volume><elocation-id>2634093</elocation-id><history><date date-type="received"><day>22</day><month>7</month><year>2016</year></date><date date-type="accepted"><day>9</day><month>10</month><year>2016</year></date></history><permissions><copyright-statement>Copyright © 2016 Luca Landi et al.</copyright-statement><copyright-year>2016</copyright-year><license xlink:href="https://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>Treatment of complex perioprosthetic cases is one of the clinical challenges of everyday practice. Only a complete and thorough diagnostic setup may allow the clinician to formulate a realistic prognosis to select the abutments to support prosthetic rehabilitation. Clinical, radiographic, or laboratory parameters used separately are useless to correctly assign a reliable prognosis to single teeth except in the case of a clearly hopeless tooth. Therefore, it is crucial to gather the greatest quantity of data to determine the role that every single element can play in the prosthetic rehabilitation of the case. The following report deals with the management of a multidisciplinary periodontally compromised case in which a treatment strategy and chronology were designed to reach clinical predictability while reducing the duration of the therapy.</p></abstract></article-meta></front><floats-group><fig id="fig1" orientation="portrait" position="float"><label>Figure 1</label><caption><p>Initial case: clinical frontal view of the patient as she presented in May 2000.</p></caption><graphic xlink:href="CRID2016-2634093.001"></graphic></fig><fig id="fig2" orientation="portrait" position="float"><label>Figure 2</label><caption><p>Initial case: lateral view, right side.</p></caption><graphic xlink:href="CRID2016-2634093.002"></graphic></fig><fig id="fig3" orientation="portrait" position="float"><label>Figure 3</label><caption><p>Initial case: lateral view, left side.</p></caption><graphic xlink:href="CRID2016-2634093.003"></graphic></fig><fig id="fig4" orientation="portrait" position="float"><label>Figure 4</label><caption><p>Initial case: full-mouth intraoral radiographic exam (May 2000).</p></caption><graphic xlink:href="CRID2016-2634093.004"></graphic></fig><fig id="fig5" orientation="portrait" position="float"><label>Figure 5</label><caption><p>A diagnostic wax-up was made on casts mounted on a semi-individual articulator.</p></caption><graphic xlink:href="CRID2016-2634093.005"></graphic></fig><fig id="fig6" orientation="portrait" position="float"><label>Figure 6</label><caption><p>A first set of temporary restorations was developed. The wax-up included implant restorations and radiopaque landmarks embedded in the temporary crowns.</p></caption><graphic xlink:href="CRID2016-2634093.006"></graphic></fig><fig id="fig7" orientation="portrait" position="float"><label>Figure 7</label><caption><p>The abutment preparations were done in one appointment with a feather-edge finishing line.</p></caption><graphic xlink:href="CRID2016-2634093.007"></graphic></fig><fig id="fig8" orientation="portrait" position="float"><label>Figure 8</label><caption><p>First set of temporary restorations relined and occlusally adjusted.</p></caption><graphic xlink:href="CRID2016-2634093.008"></graphic></fig><fig id="fig9" orientation="portrait" position="float"><label>Figure 9</label><caption><p>Coincidence between centric occlusion and maximum intercuspation and determination of the incisal plane.</p></caption><graphic xlink:href="CRID2016-2634093.009"></graphic></fig><fig id="fig10" orientation="portrait" position="float"><label>Figure 10</label><caption><p>Osseous resective surgery in the maxillary anterior sextant.</p></caption><graphic xlink:href="CRID2016-2634093.010"></graphic></fig><fig id="fig11" orientation="portrait" position="float"><label>Figure 11</label><caption><p>A feather-edge preparation was used for the abutment teeth, deeply modifying the root anatomy and opening the interproximal spaces.</p></caption><graphic xlink:href="CRID2016-2634093.011"></graphic></fig><fig id="fig12" orientation="portrait" position="float"><label>Figure 12</label><caption><p>Alveolar bone removal was done until a positive architecture was reached.</p></caption><graphic xlink:href="CRID2016-2634093.012"></graphic></fig><fig id="fig13" orientation="portrait" position="float"><label>Figure 13</label><caption><p>Sling vertical mattress sutures were used to achieve passive flap adaptation to the bone crest.</p></caption><graphic xlink:href="CRID2016-2634093.013"></graphic></fig><fig id="fig14" orientation="portrait" position="float"><label>Figure 14</label><caption><p>Once the initial healing was completed, 3 months later, the temporaries were relined.</p></caption><graphic xlink:href="CRID2016-2634093.014"></graphic></fig><fig id="fig15" orientation="portrait" position="float"><label>Figure 15</label><caption><p>CT scan for evaluation of implant sites.</p></caption><graphic xlink:href="CRID2016-2634093.015"></graphic></fig><fig id="fig16" orientation="portrait" position="float"><label>Figure 16</label><caption><p>Surgical stents were fabricated based upon the information from the CT scan and using the diagnostic wax-up.</p></caption><graphic xlink:href="CRID2016-2634093.016"></graphic></fig><fig id="fig17" orientation="portrait" position="float"><label>Figure 17</label><caption><p>Implant insertion was completed in one surgical session under local anesthesia. Paracrestal full-thickness flaps were elevated.</p></caption><graphic xlink:href="CRID2016-2634093.017"></graphic></fig><fig id="fig18" orientation="portrait" position="float"><label>Figure 18</label><caption><p>An odontoplasty mesial to tooth 17 was then performed to allocate implant 16 in a prosthetically proper position.</p></caption><graphic xlink:href="CRID2016-2634093.018"></graphic></fig><fig id="fig19" orientation="portrait" position="float"><label>Figure 19</label><caption><p>The osteotomy was completed following the surgical stent.</p></caption><graphic xlink:href="CRID2016-2634093.019"></graphic></fig><fig id="fig20" orientation="portrait" position="float"><label>Figure 20</label><caption><p>At the time of the insertion, buccal fenestration appeared on implant 14 that required an autologous bone chips graft covered by a resorbable collagen membrane (Biomend).</p></caption><graphic xlink:href="CRID2016-2634093.020"></graphic></fig><fig id="fig21" orientation="portrait" position="float"><label>Figure 21</label><caption><p>During the surgery, pick-up impression was taken by connecting the implant mounts to the modified surgical stents with a self-polymerizing acrylic resin (Duralay).</p></caption><graphic xlink:href="CRID2016-2634093.021"></graphic></fig><fig id="fig22" orientation="portrait" position="float"><label>Figure 22</label><caption><p>Radiographic postoperative control: coincidence of radiopaque landmarks embedded in the temporary crowns and the implant position of 14, 15, and 16.</p></caption><graphic xlink:href="CRID2016-2634093.022"></graphic></fig><fig id="fig23" orientation="portrait" position="float"><label>Figure 23</label><caption><p>Radiographic postoperative control: coincidence of radiopaque landmarks embedded in the temporary crowns and the implant position of 24, 25, and 26.</p></caption><graphic xlink:href="CRID2016-2634093.023"></graphic></fig><fig id="fig24" orientation="portrait" position="float"><label>Figure 24</label><caption><p>The position of the implants was transferred on the casts used to fabricate the surgical stents.</p></caption><graphic xlink:href="CRID2016-2634093.024"></graphic></fig><fig id="fig25" orientation="portrait" position="float"><label>Figure 25</label><caption><p>Second set of temporaries: frontal view.</p></caption><graphic xlink:href="CRID2016-2634093.025"></graphic></fig><fig id="fig26" orientation="portrait" position="float"><label>Figure 26</label><caption><p>The impression copings used as temporary abutments were milled down according to the prosthetic need, and a second set of temporary restorations was fabricated.</p></caption><graphic xlink:href="CRID2016-2634093.026"></graphic></fig><fig id="fig27" orientation="portrait" position="float"><label>Figure 27</label><caption><p>A second stage was performed 5 months after implant surgery.</p></caption><graphic xlink:href="CRID2016-2634093.027"></graphic></fig><fig id="fig28" orientation="portrait" position="float"><label>Figure 28</label><caption><p>Tightening of the provisional abutments.</p></caption><graphic xlink:href="CRID2016-2634093.028"></graphic></fig><fig id="fig29" orientation="portrait" position="float"><label>Figure 29</label><caption><p>A conservative type of uncovering to preserve and augment the KG tissue present was required.</p></caption><graphic xlink:href="CRID2016-2634093.029"></graphic></fig><fig id="fig30" orientation="portrait" position="float"><label>Figure 30</label><caption><p>Delivery of the second set of temporaries.</p></caption><graphic xlink:href="CRID2016-2634093.030"></graphic></fig><fig id="fig31" orientation="portrait" position="float"><label>Figure 31</label><caption><p>Delivery of the second set of temporaries and extractions of teeth 17 and 27 according to the treatment plan.</p></caption><graphic xlink:href="CRID2016-2634093.031"></graphic></fig><fig id="fig32" orientation="portrait" position="float"><label>Figure 32</label><caption><p>At this point, the patient could be considered stable from a perioprosthetic point of view, waiting 6 more months for a final reevaluation.</p></caption><graphic xlink:href="CRID2016-2634093.032"></graphic></fig><fig id="fig33" orientation="portrait" position="float"><label>Figure 33</label><caption><p>Final preparations from teeth 13 to 23 and positioning of the impression copings for a pick-up impression.</p></caption><graphic xlink:href="CRID2016-2634093.033"></graphic></fig><fig id="fig34" orientation="portrait" position="float"><label>Figure 34</label><caption><p>The final impression was performed using a single-phase technique with double components polyether and individual tray.</p></caption><graphic xlink:href="CRID2016-2634093.034"></graphic></fig><fig id="fig35" orientation="portrait" position="float"><label>Figure 35</label><caption><p>The final restoration included a tooth-borne fixed partial denture from teeth 13 to 23 and two implant-supported fixed partial dentures, one from implant 16 to 14 and the other from implant 24 to 26.</p></caption><graphic xlink:href="CRID2016-2634093.035"></graphic></fig><fig id="fig36" orientation="portrait" position="float"><label>Figure 36</label><caption><p>Final framework and ceramization were performed with the cross-mounting technique.</p></caption><graphic xlink:href="CRID2016-2634093.036"></graphic></fig><fig id="fig37" orientation="portrait" position="float"><label>Figure 37</label><caption><p>Final delivery of the prosthetic reconstruction (May 2002). From a functional standpoint, the objective of restoring good occlusal stability was achieved.</p></caption><graphic xlink:href="CRID2016-2634093.037"></graphic></fig><fig id="fig38" orientation="portrait" position="float"><label>Figure 38</label><caption><p>The occlusal scheme was designed with anterior guidance allowing a complete disclusion in both the lateral and protrusive excursions.</p></caption><graphic xlink:href="CRID2016-2634093.038"></graphic></fig><fig id="fig39" orientation="portrait" position="float"><label>Figure 39</label><caption><p>Adequate plaque control, low inflammatory indices, and physiologic probing ranging from 1 to 4 mm around all the abutment teeth and implants were recorded at the end of treatment.</p></caption><graphic xlink:href="CRID2016-2634093.039"></graphic></fig><fig id="fig40" orientation="portrait" position="float"><label>Figure 40</label><caption><p>From an esthetic standpoint, the objective of restoring a pleasant and harmonious smile line was achieved.</p></caption><graphic xlink:href="CRID2016-2634093.040"></graphic></fig><fig id="fig41" orientation="portrait" position="float"><label>Figure 41</label><caption><p>Final case: full-mouth intraoral radiographic exam (May 2002).</p></caption><graphic xlink:href="CRID2016-2634093.041"></graphic></fig></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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