Faulty Prosthesis Replaced With Zirconia Implants

• Name- Masoom Bhati
• Age- 21 years
• Gender – Female

Faulty old prosthesis in the aesthetic zone of the upper arch

Dr. Rajat Sachdeva MDS, MS, Implantologist at Dr. Sachdeva’s Dental Aesthetic and Implant Center, Delhi.

A 21-year-young female visited Dr. Sachdeva’s Dental Aesthetic and Implant Center, Delhi, with a chief complaint of the faulty old prosthesis in the aesthetic zone of the upper arch. She was unsatisfied and unhappy with her 4 unit bridge and with the shade selected for the prosthesis. She had her prior prosthesis cemented a few months ago by a local dentist, who provided her with the natural smile she desired. Her main wish was to improve the aesthetic appearance of maxillary incisors.

Initially, Dr. Rajat Sachdeva, one of the best dentist in Ashok Vihar, Delhi, performed an anamnesis and a thorough clinical examination. The facial aspect, smile harmony, gingival contour, and dental characteristic were evaluated during the investigation.

A complete intraoral examination was done with an intraoral scanner. For the analysis and treatment planning of the case, complete photograph documentation (intraoral and extraoral) was taken. Dr. Sachdeva removed the old 4 unit bridge from lateral to lateral incisors in the upper arch and planned single Emax ZirCAD crowns, also called zirconia implants individual for each tooth, which is more aesthetic than a bridge. The patient also showed up with a high labial frenum attachment. For which Dr. Sachdeva performed a frenectomy.

At Dr. Rajat’s Dentistry, we provide high-quality and long-lasting dental implants in Delhi. In the same appointment, Dr. Sachdeva took the diagnostic impressions with alginate material to obtain die casts scanned for digital smile design. A proper DSD program was made in which initially two lines place in the centre, creating a cross, and the facial photograph was placed behind the lines.

The interpupillary line was used as an initial reference to establish the horizontal plane. The midfacial line was then projected using facial features such as the glabella, nose, and chin. Clinically proportion of the patient’s face was assessed, and the position of the upper lip at rest and in a smile was checked to determine the gingival display. No crown lengthening needed was ruled out.

For smile aesthetics, the relative proportions between teeth are important, and it also depends on how the teeth are arranged in the arch with smile configuration. In this proper facial analysis of the condition of teeth, Dr. Sachdeva examined oral hygiene, any habits, interocclusal distance, occlusal plane, and incisal edge. Then, the dentist determined the dental contour according to lower lip contour and the anteroposterior curvature of the teeth. From the central incisors, a final drawing of the contour of the teeth was performed according to the patient’s characteristics and guided by the lines draw in the extraoral photograph and by the calculated proportion, showing the relationship between ideal dental situation and the midline closing diastema.

Dr. Rajat Sachdeva performed a proper Gingival retraction with the 3M retraction paste, and a rubber-based silicon impression was made. After this step, a provisional restoration was given to a patient with proTemp. Tooth shade was matched according to the Ivoclar Vivadent A-D shade guide. After this, the maxillary impression and mandibular cast were sent to the dental technician to manufacture the final prosthesis.

We planned single crowns (EmaxZirCAD) in this case as Emax ZirCAD crown prosthesis is an enhanced version of Emax and showcases a high level of aesthetics and strength. ZirCAD Prime incorporates gradient technology and enables absolute resemblance of the crown with natural tooth color. Some advantages of EmaxZirCAD crowns are:

• Improved look and aesthetics
• Resembles natural teeth.
• Durable and strong
• Does not fracture easily (improved fracture resistance)
• Less bulky
• Increased bonding with natural tooth structure.
• Longer life span.

After preparing the restorations (Emax ZirCAD crowns) in the next appointment, the patient was tried using try-in paste. Before cementing, the prosthesis was carefully positioned to verify proper marginal adaptation, shape, alignment, and color. Then, the modified rubber dam isolation of the operative field was applied to protect the patient and improve the quality of restorations.

Maxillary four anterior teeth surfaces were conditioned with 37% phosphoric acid for 30 seconds, washed with water, and dried for 60 seconds. After this, an adhesive system was applied and light-cured for 20 seconds. A resin cement (Multilink) was used as a luting agent. It was applied to the internal surface of the Emax ZirCAD crowns, which were then positioned and light-cured on the facial and lingual side for 40 seconds. After luting each of the crowns, the cervical margins were verified, and excess cement was removed.

The clinical follow-up with an intraoral aspect of the patient can be seen after six months of treatment. Aesthetic match, porcelain surface, marginal discoloration, and integrity will be carefully examined in the next recall.

This is what the patient, Ms. Masoom Bhati has to say about the treatment: “I am delighted with the treatment. Earlier, I was unhappy with my prosthesis and desired to improve their appearance. Now, I feel happy and confident, thanks to Dr. Rajat Sachdeva.