Full mouth habitation with dental implants and multilayer zirconia crown

คนไข้ที่สูญเสียฟันหลัง จะมีการใช้ฟันหน้าเคี้ยว และร่วมกับพฤติกรรมบางอย่างเช่น การกัดฟัน เคี้ยวของแข็ง จะทำให้ฟันสึกทั้งหมด การบูรณะจึงต้องยกความสูงของการสบฟัน ร่วมกับการทำครอบฟันทุกซี่ เพื่อให้ฟันและระบบการบดเคี้ยวกลับมาได้ดังเดิม

The 58-year-old patient came into our office complaining for get back his smile and ability to eat. He denied any history of systemic disease, dental trauma.     
We requested a panoramic x-ray, facial photo for facial and smile analysis, dental photo for diagnosis and proper treatment plan.

From clinical and radiographic examination

17        Non functional tooth

15,16  Edentulous area with insufficient vertical bone height

25,26  Edentulous area with left maxillary sinusitis

27        Previously Root canal treatment & Crown with periapical infection that may lead to      maxillary sinusitis

35,45  Edentulous area

34,36  Large defective amalgam restoration

44       Edentulous area

45,46  Large defective amalgam restoration

Generalize Tooth wear, attrition and abrasion

Fair oral hygiene


#27 Questionable

Others Good


My treatment plan objective was restoring the esthetic and function with dental implant and multilayer zirconia crown

Treatment plan

1.Periodontal by scaling and root planning

2.Pre-prostetic restorative with resin composite.

3. Surgical placement of Dentium super line fixture dental implant at 26,44

   Crestal approach sinus augmentation with implant placement at #25,26

   Surgical extraction 27,   Immediate implant placement at 25

4.Applications of acrylic provisional crown on 45,46

5. 3 months after place dental implant. Second stage surgery was performed, healing abutment were place for gingival molding.

One week after second stage surgery, all soft tissue was stable.

6. Prosthetic habitation with preparation on 14,13,12,11,21,22,23,24,44,43,42,41,31,32,33,36 were preparations for zirconia crowns.

45,46,36 old crowns were removed, core build-up, preparation.

Fixture level implant impression technique with implant coping

The final impression was performed with PVSFacebow registration establishes the relationship of the maxillary dentition to the horizontal reference plane so that the maxillary cast can be mounted on the articulator in the correct anatomical position and centered Bite record by Esthetic Cross Esthetic CrossRef™

VDO was recorded in Centric relation to increase the overjet and overbite and get proper front guide, as the result of opening the bite, there’s room for increase the length of the incisal .
Laboratory transferred all record to 3shapes dental system Bite registration on virtual articulator(In centric relation) use the virtual articulator from 3shape for increase the VD as recorded.

Dental crowns were design with 3Shape Dental System,3-D positioning of upper incised edge by digital smile analysis and design, PMMA crowns were milled as designed
Temporary PMMA crowns were try-in and temporary fix with tempbond NE, Weekly follow up and occlusal adjustment was performedAfter 5 weeks with new VDO, patient s satisfied and had no TMJ or muscle problem
FINAL SCANNING implant and teeth abutment with iTero intraoral scanner
(Chair side milling mode/High definition)
Temporary crowns was scanned Intraorally UPPER AND LOWER PMMA crown in occlusion for gave technician all the bite information
Cross-mounting technique forgetting correct occlusal relation
Final design using 3shape digital system
Multilayer zirconia crown were milled & try in on model
Zirconia crowns were temporary fix with tempbond and let patient try for 2 weeks
Permanent cementation with PANAVIA V5 SYSTEM
Follow up and maintenance every 6 months