贋復學會 20130413 病例討論會-1

Case Conference
Basic Information
Gender: male
Age: 59 y/o
Marriage: married
Occupation: retired
Chief Complaint
Upper teeth mobility
PMH
HBV carrier
Denied other systemic disease
PDH
OD、endo、extraction、fixed prosthesis、
removable prosthesis
2013/04/13
台北⻑⾧長庚醫院
Reporter: R4李⼦子軒
Instructor:Dr.潘裕華
Extraoral Examination
Frontal view:
• Facial asymmetry: (-)
• Facial proportion: 1.0: 1.0: 1.0
• Mentalis strain: (-)
• Lip incompetence: (-)
Smile analysis:
Gummy smile: (-)
Upper incisor show: x
Upper midline to facial midline: x
Lower midline to facial midline:
shift to left side 2mm
Lateral view:
• Facial profile: straight
• Nasolabial angle:116°
• Labiomental fold: average
• Upper lip to E line: retrude
• Lower lip to E line: retrude
Intraoral Examination
Maxilla: fully edentulism
Palatal torus
#34,35,36,37 missing
#31-x-33,45-x-47 bridge
#33 pulp exposed
#42,43 spacing
Occlusal plane canting
Interocclusal space:
• Anterior: 10 mm
• Posterior: 5 mm
Radiographic Examination
#13 residual root
#21-x-23 bridge, advanced periodontitis
#11,12,14,15,16,17,24,25,26,27 missing
#31-x-33, 45-x-47 surveyed bridge
#33 apical periodontitis
#45 incomplete endo
#34,35,36,37 missing
Probing Data
47
46
45
44
43
42
41
31 32
33
L
455
535
527
525
535
524
535
525
B
455
523
533
325
523
325
425
523
Diagnosis and Problem List
•
•
•
•
•
•
•
•
•
FM periodontitis and poor oral hygiene
#21, 23 advanced periodontitis
#13 residual root
#33 apical periodontitis
#45 incomplete endo
#21-x-23, #31-x-33, #45-x-47 ill-fitted fixed prosthesis
#42,43 spacing
#11,12,14,15,16,17,24,25,26,27,34,35,36,37 missing
Occlusal plane canting
Provisionals and Interim Dentures- Intraoral
34 35 36 37
Provisionals and Interim Dentures- Intraoral
Panoramic Radiograph
Definitive Treatment Plan-Option 1
Maxilla:
• #12,14,16,22,24,26 implant
• Implant assissted overdenture
Mandible:
• #31-x-33, 45-x-47 crown/ bridge
• #34,36,37 implant
• #34,35,36,37 implant supported crown/bridge
Definitive Treatment Plan-Option2
Maxilla:
• Complete denture
Mandible:
• #31-x-33, 45-x-47 surveyed crown/ bridge
• #34,35,36,37,46 class II, mod I RPD
• #41,42 crown or CRF to close diastema
Date
Department
Treatment
101-2-13
Prostho
Preliminary impression
101-3-2
Prostho
Upper border molding
101-3-5
Prostho
Upper final impression
101-3-7
Prostho
Occlusal rim establishment, bite
registration, shade matching, face bow
transfer
101-3-19
Prostho
Wax denture try-in
101-3-22
Prostho
#31,33,45,47 final preparation
101-4-5
Prostho
Impression for #31-x-33,45,47 surveyed
crown/bridge
101-4-6
Prostho
Bite registration for master cast mounting
101-4-13
Prostho
#31-x-33,45,47 surveyed crown/bridge
try-in, Impression for lower RPD framework
101-4-20
Prostho
Lower RPD framework try-in
101-4-25
Prostho
Altered cast impression
101-4-26
Prostho
Bite registration
101-4-30
Prostho
Wax denture try-in
101-5-10
Prostho
Delivery
101-5-11
Prostho
Delivery + #41,42,43,44 OD
Definitive Treatment Course
Bite Registration and Facebow Transfer
Diagnostic Wax-up
Wax Denture Try-in
Surveyed Crowns
RPD design and framework
Major connector: lingual plate
Rest: #33 cingulum rest; #45,47 occlusal rest
Retentive clasp: #33, 45, 47 Aker’s clasp
Guiding plane: #33D,45D,47M
Altered cast and wax up
Lab remount
Working
Protrusion
MICP
MICP
MICP
Lab remount
Working
MICP
Lateral excursion
Denture Delivery
Non-working
MICP
Working
Working
MICP
MICP
Non-working
11 Months Follow-up
#33 Follow-up X-ray
100-9-9
100-12-5 RCF
101-3-7 4M F/
102-4-11 17M F/U
Case Conference
Basic Information
Gender: female
Age: 37 y/o
Chief Complaint
Asked for prosthetic treatment
PMH
1. DM [ HbA1c:7% ]
2. HBV carrier
3. thyroid gland cancer s/p total
thyroidectomy in 新光醫院 on 2009
PDH
1. OD & Endo
2. crown
3. orthodontic treatment: 2006.03.15-2008.07.25
4. #14.16.46 implant stage I surgery: 2009.08.22
2013/04/13
台北⻑⾧長庚醫院
Reporter: R5 徐雅嬪
Instructor:Dr.陳雅怡
Extraoral Examination
Frontal view:
• Facial asymmetry: (-)
• Facial proportion: 1.0: 1.0: 1.0
• Lip incompetence: (-)
Smile analysis:
Gummy smile: (-)
Upper incisor display: full crown
Lateral view:
• Facial profile: straight
• Nasolabial angle:116°
• Labiomental fold: average
• Upper lip to E line: retrude
• Lower lip to E line: retrude
Intraoral Examination
Unesthetic upper anteriors
#11#13#21#25#34#35#48 caries
#26#36 missing
Inadequate interocclusal
space over #14#16#46
implant sites
#15#45#47 supra-eruption
Radiographic Examination
Probing Data
18
17
16
15
14
13
12
11
21
22
23
24
25
26
27
B
333
233
323 323 325 323 323 423
423
324
332
P
344
323
223 223 222 332 323 323
322
224
332
48
47
46
45
44
43
42
41
31
32
33
34
L
443
322
223 323 212 212 212 212 212 222 223 323
324
B
334
323
323 323 533 323 522 313 313 323 323 322
323
Diagnosis





FM gingivitis
#26, 36 missing
#18 impaction
#12 PFM crown with incomplete endo
#11, 13, 21, 25, 34, 35, 48 caries
Problem List




Unesthetic upper anterior restorations
#11, 13, 21, 25, 34, 35, 48 caries
#26, 36 missing
Inadequate interocclusal space over #14, 16, 46 implant sites
35
36
37
Tentative treatment plan







FM scaling and OHI
#11, 13, 21, 22, 23, 25, 34, 35, 48 OD
#12 crown removal and re-endo tx
#27 crown lengthening
Fixed retainer delivery to close #11-21 spacing
DBS to intrude #15, 45, 47 (Implants would be
utilized as anchorage.)
#15, 45, 47 sequential occlusal reduction for
increasing restorative space of #14, 16, 46
implants
Definitive Treatment Plan-Option 1
Maxilla:
 #14, 16, 26 implants
 #17, 27 crowns
Mandible:
 #36, 46 implant
 #37 crowns
Definitive Treatment Plan-Option2
Maxilla:
 #14, 16 implants
 #17, 25-x-27 crown/FPDs
Mandible:
 #46 implant
 #35-x-37 FPD
Definitive Treatment Course
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




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2011.11.08 #14, 16, 46 stage II
2011.11.08-11.26 #11, 13, 21, 25, 34, 35, 48 OD
2011.11.29 #17 provisional crown refabrication
#15, 45, 47 1st occlusal reduction
2011.12.06 #35-x-37 provisional FPD fabrication
2011.12.13 #25, 27 crown lengthening
2011.12.20 #37 crown lengthening
2012.01.10-01.17 #14, 16, 46 implant provisional crowns
fabrication
2012.01.19 #25-x-27 provisional FPD fabrication
2012.03.12 #46 final impression
2012.03.17 #14, 16, 17 final impression
2012.03.27 #14, 16, 17, 46 delivery
2012.03.29 #25-x-27 final impression
2012.04.02 #35-x-37 final impression
2012.04.10 #25-x-27, 35-x-37 metal frameworks try-in
2012.04.24 #25-x-27, 35-x-37 delivery
Diagnostic Wax-up
#35-x-37 Provisionals and CLP
Initial
Post-CLP
Impresssion for Screw-retained Provisionals
#25-x-27 Provisionals and CLP
#35-x-37 Provisional relining
#46 Final impression
#14, 16 Final impression
Bite Registration, fully wax-up and cutback
#14, 16, 17, 46 Delivery
#25-x-27＆ #35-x-37 final impression
Metal Frameworks
PFM FPD Delivery
3
W
NW
3
NW
P
P
4
Final Casts and Xray