PMC3912759_01
Initial intraoral (a) and radiographic (b) view of the patient.
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The patient exhibited heavy plaque accumulation, xerostomia, and excessive dental caries (Figure 1(a)), as well as moderate gingival inflammation with no periodontal attachment loss. The radiographic examination revealed that the teeth 14, 24, 25, 26, and 36 had periapical lesions, teeth 27 and 37 were impacted, and altered teeth development was observed in teeth 37 and 47 due to oncologic treatment (Figure 1(b)).
Intraoral (a) and radiographic (b) view of the patient after initial periodontal treatment and endodontic treatments.
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Endodontic treatment was performed between the teeth 15-25 and 35-45 except 17 and 25 (Figure 2).
Crown lengthening procedures. Labial frenectomy and osseous recontouring on maxilla (a), apically repositioned flap technique on mandibula anterior area (b), and postoperative view at 6th week (c).
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Labial frenectomy operation was performed prior to osseous recontouring procedure on maxilla (Figure 3(a)). Since the width of the keratinized gingival tissue was 2 mm from tooth 33 to tooth 43, apically repositioned flap technique was applied to the area to keep the keratinized tissue (Figure 3(b)). Postoperative recalls were scheduled at the 1st, 2nd, and the 6th weeks (Figure 3(c)).
Provisional restorations with new occlusal vertical dimensions.
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New occlusal vertical dimension (OVD) was established and provisional restorations were prepared in regard to new OVD (Figure 4).
Trial of permanent prosthodontic restorations.
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Trial of the ceramic veneers (Figure 5) was performed a week after the test of the metal framework.
Final intraoral view after cementation of the restorations.
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At the end of the 4-week orientation period, final adjustments were made on the proximal surfaces to facilitate proper interdental brushing and flossing, and then restorations were cemented permanently using glass ionomer cement (Kavitan Cem, Spofa Dental, Czech Republic) (Figure 6).