THE ESTHETIC REHABILITATION: A comprehensive prosthetic approach

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Course Description

Introduction

  • Esthetic analysis
  • Functional analysis and occlusal considerations
  • Communicating with the laboratory
  • Provisional restorations
  • Perio-prosthetic treatment
  • Implants: from single anterior tooth to complex rehabilitations
  • Final tooth preparation - final impressions
  • From provisional to final restoration
  • All-ceramics: crowns, veneers and bridges

Course Objectives

The aim of this course is to outline a systematic approach to prosthetic rehabilitation and help the clinician to confidently address comprehensive treatment involving bridges, crowns, veneers and onlays on natural dentition and on implants, from a single restoration to full-mouth rehabilitation. To help clinicians planning and finishing a case from good to excellent! This goal can be reached also thanks to the MIPP Technique (Minimally Invasive Prosthetic Procedure), an innovative protocol that guarantees a long-lasting result and a better acceptance of the treatment by the patient. This is a high level program focusing mainly on occlusion and function rather than esthetics and materials.

Abstract

The application of a tried and tested system, experimented for over 25 years, represents, especially for complex rehabilitations, an indispensable means of achieving optimal final results, from the esthetic as well as biological and functional viewpoints. The prosthetic treatment plan must allow an ideal integration of esthetics, biological and functional parameters on natural teeth and on implants. The esthetic analysis, thanks to a simple and systematic approach to assessing facial, dento-labial, phonetic, dental and gingival factors, will allow the clinician to optimize the prosthetic treatment plan. Biofunctional provisionals serve as blueprints for the definite prosthesis, providing all information about shape, position, emergence profiles, arrangement of teeth and non-destructive occlusion especially in challenging clinical situations. Material selection with the dental ceramist is fundamental in management of complex rehabilitation cases with porcelain crowns, bridges, implant abutments and veneers. The use of metal-free ceramic materials allows to achieve excellent esthetic results in the
anterior area for crowns and veneers fabrication. Clinical and technical suggestions for obtaining esthetic anddurable results will be supplied.

COURSE PROGRAM

ESTHETIC ANALYSIS

  • Facial analysis Dento-labial analysis Phonetic analysis Tooth analysis
  • Gingival analysis
  • Guide to the correct completion of the esthetic checklist

FUNCTIONAL ANALYSIS AND OCCLUSAL CONSIDERATIONS

  • Achieving, recording and verifying a repeatable mandibular position: RC/MI when and why Occlusal- vertical dimension (OVD): how and when modifying it
  • Occlusal schema: complex and simplified
  • Anterior guidance: how to optimize it
  • Parafunctions: can the occlusion play a role inthe bruxer patient? Bite registration records

COMMUNICATION WITH THE LABORATORY

  • Direct and indirect mock-up
  • Laboratory chart
  • Data transmission to the laboratory for the diagnostic wax-up
  • Face bow and esthetic orientation
  • Communication of the anterior guidance and occlusal schema with a customized incisal guide table Mounting and setting the articulator

PROVISIONAL RESTORATIONS

  • Preliminary tooth preparation Fabrication procedures
  • Direct and indirect technique Modified indirect technique (MIT) Correct insertion, relining and refining Functional and esthetic integration

IMPLANTS

  • Esthetics in implantology
  • Parameters for optimizing the esthetic result in the anterior area Post-extractive and preextractive approach
  • Immediate loading in single restorations and in full arch rehabilitation
  • The use of all-ceramic abutments and crowns to optimize the esthetic result

FINAL TOOTH PREPARATION

  • Intrasulcular preparation - step by step procedure Respect of biological integrity - timing for complete tissue maturation

FINAL IMPRESSIONS

  • Materials and techniques
  • The use of gingival retraction cords - the keys to success

FROM THE PROVISIONAL TO THE FINAL RESTORATION

  • Data transfer
  • Cross mounting procedure
  • Anterior rehabilitation: 1-2 arches Preventive simulation
  • Customized anterior guidance Silicone index

ALL-CERAMICS

  • Porcelain-fused-to-Metal:
    • obsolete technique?
    • principles and concepts
    • long-term follow-up
  • All-Ceramics:
    • silica based - high-strength
    • selection criteria, indications, possibilities and limits of different materials:
    • feldspathic ceramics, glass ceramics alumina ceramics, zirconia-based ceramics porcelain try-in surface treatment of the prepared teeth and porcelain cementation  procedures and material update critical clinical steps
    • veneers: tooth preparation technique, preservation of sound tooth structure, maintenance of vitality, luting procedures, clinical follow-up
    • crowns: tooth preparation technique, principles and concepts
    • bridges: principles and concepts, PFMs vs All- Ceramics
    • CAD-CAM technique for framework fabrication, pressable technique

HANDS-ON TRAINING BY COURSE PARTICIPANTS

OCCLUSAL RECORDS AND FACEBOW RECORDS

  • The participants are trained to take these records one on the other

OCCLUSAL EQUILIBRATION

  • Dr. Fradeani will make an occlusal equilibration on a course participant

HOW TO PROPERLY FILL IN THE ESTHETIC CHECKLIST

  • Correct analysis of the facial, dentolabial, phonetic and tooth parameters

HOW TO PROPERLY FILL IN THE LABORATORY CHECKLIST FOR AN EFFICIENT COMMUNICATION WITH THE DENTAL LABORATORY

  • Esthetic information
  • Occlusal plane vs commisural line - horizon
  • Position, shape and contour modifications
  • Overjet and overbite modifications Functional
  • information
  • Impression
  • Documentation
  • Colour

STEP-BY-STEP TOOTH PREPARATION FOR VENEERS AND CROWNS

  • The participants will work on dental models in the dental laboratory
  • Evaluation of marginal fit of the restorations
  • Try-in paste procedure

LIVE DEMONSTRATION ON PATIENT BY DR. FRADEANI
Preliminary tooth preparation, provisional and final tooth impressions
or
finalization of the prosthetic treatment with luting procedure to bond the restorations
One of the above mentioned procedures will be performed during the live demonstration, whereas the other one will be documented by the means of a DVD presentation showing step-by-step phases of the work.

Full HD movies:

  • Step-by-step tooth preparations
  • Provisionals
  • Final impressions
  • Provisional fitting
  • Provisional relining and finishing
  • Bonding procedures

During the 4-day program Dr. Mauro Fradeani will present several full-mouth rehabilitation cases on natural dentition and implants that were finalized thanks to a multidisciplinary approach.
Cases involving endodontics, periodontics, orthodontics and bruxer patients will be illustrated and explained in-depth.

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