PMC6607456_01
Intraoral examination; (A, B) arches enlargement; (C) macroglossia; (D) diastema
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The profile view showed a mandibular prognathism and a procheilia of the lower lip (Figure 2), as well as hypertrophic masticatory mucles. The intraoral examination showed the final stage of a bilateral edentulous maxillae and a final edentulism of the mandible bordered by the 44th tooth (Figure 2A, Figure 2B). A prominent macroglossia with the impression of the mandibular teeth on the anterior and lateral edges of the tongue was noted (Figure 2C). The occlusal examination showed an anterior inverted occlusion (Figure 2D), a collapsed vertical dimension of occlusion and a lack of the anterior guidance.
X-Ray examination; (A) orthopantomogram examination; (B) cephalogram examination
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This clinical examination was completed by an X-ray examination (Figure 3A, Figure 3B); an orthopantomogram (OPG) and a cephalogram were requested.
The prosthetic project: (A) lateral view; (B) anterior view
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Therefore, set up diagnostic wax-up and diagnostic occlusal adjustment were made in order to establish accurate diagnosis and treatment planning (Figure 4A, Figure 4B).
Preliminary impressions: (A, B, C) mandibular preliminary impression; (D) maxillary preliminary impression
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The primary impression with high and low viscosity silicone using the flexible impression technique has been a reliable alternative to overcome this problem (Figure 5A, Figure 5B, Figure 5C). Adjustments of the plastic trade tray were made by heating it slightly to spread its edges and then by rectifying it with wax (Figure 5D).
Realization of fixed partial prosthesis; (A) maxillary impression; (B) maxillo-mandibular record; (C, D) metal frame; (E) ceramic mounting; (F) frame millings
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Occlusal registration: the registration of occlusion for the FPP was made in the centric relationship according to the new VDO (Figure 6B) and sent to the lab with the corresponding metallic framework shema. After FPP metal casting (Figure 6C), the metal frame was fitted inside the mouth (Figure 6 D). Thereafter, the technician made the assembly of the ceramic (Figure 6E).
Removable partial prosthesis; (A) anatomic-functional impression; (B) metal framework fitting; (C, D) prosthetic teeth carving; (E) prosthetic teeth mounting; (F) combined prosthesis
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RPP making: an anatomic-functional impression with a polyether was made (Figure 7A) to make the metal frame. After fitting the frame in mouth (Figure 7B), the occlusion was recorded for mounting the prosthetic teeth. As a result, the lab technician proceeded to CAD-CAM tooth carving (Figure 7C, Figure 7D) in order to better align the occlusal contacts with the opposing teeth. The posterior prosthetic teeth (Figure 7E) were mounted on the top of the ridge, the left-side teeth were in the occlusal norms, while on the right side the reports were crossed according to the large width of the mandibular arch.