Prosthetic and Conservative Rehabilitation with 3 step technique: a clinical case
Franco De Chiesa
The patient M. D. (years 52) comes to our observation showing the need to improve in a less invasive way his dental situation that has deteriorated over the years, alarmed by the pigmentation and wear of the front group (fig 1,2,3).
The general anamnesis is negative, while the dental history presents: grinding and nocturnal lock, chewing problems, cigarette smoke (30 a day), frequent use of mate grass (infusion). These habits have generated over the years a problem of abrasion and reduction of the upper and lower incisal length and slight collapse of the perilabial soft tissues with consequent functional problems (reduced masticatory capacity) and aesthetic problems (dyschromia, reduced incisor length).
Fig.1
Fig.2
Fig.3
The intraoral visit we see numerous incongruous restorations (old composites and amalgams, implants and Richmond on natural teeth) in the lateral sectors and the periodontal survey shows a slight horizontal reabsorption. Considering the patient's expectations, and the precise request to adopt the least invasive treatment possible, and after a careful evaluation of the clinical photos, study models and digital waxing (digital smile system), the dental technician performs the waxing of the 2nd sextant and creates a silicone mask for direct molding of the mock-up (fig 4-6).
Fig.4
Fig.5
Fig.6
This test is carried out with the necessary modifications then transferred through an impression in the laboratory, in order to respect the correct incisal length of the frontal group from the phonetic point of view and the correct aesthetic plan. During the second appointment the waxing of the lateral sectors is transferred into the oral cavity, with the use of rigid transparent silicone keys (fig 4,5). Then the lower incisal group is temporarily reconstructed with the aid of a lingual support template (fig 6). Once the occlusal contacts have been adjusted, the patient is discharged in order to test the new vertical dimension.
At the next follow-up visit, the patient does not report any muscular or articular problems, so we decide to proceed with the definitive restoration with palatal composite facets of the 2nd sextant, using a plaster model CAD / CAM technique, trying to be the most conservatives possible (Fig 7-14).
Fig.7
Fig.8
Fig.9
Fig.10
Fig.11
Fig.12
Fig.13
Fig.14
The next phase of the treatment consists in rehabilitating the posterior sectors by means of indirect restorations of CAD / CAM in lithium disilicate (onlays, crowns, inlays) both on the residual dental elements and on the implants (Fig 15-26).
Fig.15
Fig.16
Fig.17
Fig.18
Fig.19
Fig.20
Fig.21
Fig.22
Fig.23
Fig.24
Fig.25
Fig.26
Finally, the vestibular composite faces CAD / CAM on the lower incisors were applied in order to restore the correct aesthetics and function.It is important to specify that the buccal veneers (as in the sandwich technique) were not applied on the 2nd sextant because the patient was largely satisfied with the result achieved. To complete the rehabilitation performed, a night-time protective bite was delivered to the patient to limit the damages due to his parafunctions (Fig 27-31).
Fig.27
Fig.28
Fig.29
Fig.30
Fig.31
Related articles
Editorials 27 September 2026
Dentistry33 survey highlights replacement care, deep caries and evolving restorative workflows
Reader survey finds direct composites remain dominant, secondary caries is the leading reason for restoration replacement, and clinicians want more training in pulp preservation
Reader survey finds direct composites remain dominant, secondary caries is the leading reason for restoration replacement, and clinicians want more training in pulp preservation
Editorials 20 September 2026
Dentistry33 survey shows small practices balancing growth, costs and technology modernization
Reader survey finds solo and small practices remain prominent while staffing, rising costs and digital adoption shape business priorities
Reader survey finds solo and small practices remain prominent while staffing, rising costs and digital adoption shape business priorities
Digital Dentistry 20 April 2026
To report a fully digital and guided immediate-load All-on-4 protocol conducted in Brazil on a 59-year-old male patient with an edentulous maxilla and a history of oropharyngeal cancer surgery,...
Digital Dentistry 03 April 2026
The purpose of this review is to provide the readers with current information and state-of-the-art of digital scanning systems within the orthodontics.
Digital Dentistry 16 February 2026
An original procedure for the ovoid pontic technique in ortho-restorative cases
In the multidisciplinary treatments, especially in case of missing teeth in aesthetic area, the compliance of patient during retention time post orthodontic therapy is evidently very high, even among...
Read more
Products 16 October 2026
Karen Davis on Philips Sonicare DiamondClean 9900 Prestige & Smarter Brushing
News 16 October 2026
Align Technology to Report Q3 2026 Financial Results October 28
(Nasdaq: ALGN), a leading global medical device company that designs, manufactures, and sells the Invisalign® System of clear aligners, iTero™ intraoral scanners, and exocad™ CAD/C
News 16 October 2026
Fewer people on intake, faster turnaround, and no lost cases: Relu’s new automation captures and centralizes every scan and Rx from every source within a minute of arrival
Editorials 16 October 2026
Achievement and service take center stage as the University of Colorado Anschutz School of Dental Medicine honors the Doctor of Dental Surgery (DDS) Class of 2026.
Implantology 16 October 2026
This peer-reviewed implantology article summarizes clinical evidence from Clinical oral implants research (2026). It focuses on findings that may help dental professionals evaluate treatment...
Copyright © 2026 - All Rights Reserved
ISSN 2767-1178