Visio.lign article by Mark Bladen

   

Visio/Diagnostic Systematic approach

to produce long term appliances.

Visio.lign is a veneering system made up of anterior and posterior, 1mm thick veneers highly aesthetic with many indications including facings for long term provisions, permanent veneering of implant structures and combination cases which can be used with matching denture teeth.  The system is backed up by dual curing, composites and gingival materials.

Clinical description of case by Dr  Ghaleb Karein.

Miss R.G. is  a 23 year old healthy female who following initial consultation it appeared that she was unhappy about the appearance of her central incisors..

Clinical and radiographic examination revealed an apical abscess affecting tooth 11 with a draining buccal sinus and incomplete root filling.  Tooth 12 was non-vital and showed a crack line palatally that extended beyond the gingival margin. Both teeth have been displaced labially and have also over-erupted due to the lack of opposing occlusal contact following the aforementioned labial displacement.

After careful consideration and discussion of the available treatments, the patient opted for extraction and replacement of both incisors with two all ceramic crowns supported by dental implants.

The final treatment plan was agreed with the patient, and will include the following phases:

1. Extraction and immediate replacement of the two incisors with a Rachette bridge utilising viso.lign veneering system from Bredent. This stage will also include a mucosal graft to ensure complete socket closure.
2. Two-stage dental implant placement of two 4.0s Osseospeed Astratech dental implants 6 weeks after extraction.
3. Implant exposure and connection of implant supported provisional crowns to allow for soft tissue maturation and contouring for 3 to 4 months prior to construction of the final restoration. Soft tissue manipulation might be necessary during the second stage surgery to optimise the aesthetic outcome.
4. The final restoration will be made  using two zirconium supported crowns constructed over two zirconia abutments. The fixture pick up impression will be customised to match the final emergence profile achieved with the provisional crowns.

   

1. Pre –op situation

2.    Original  centrals  articulated

3.  Socketed to produce ovate pontic areas

4.    Novo-lign anteriors chosen for best shape in the shade prescribed.  The veneers are 1mm thick over the main buccal area still maintaining very good shade and vitality. 

5. The veneers are trimmed and waxed into position and a matrix formed

6. Framework for rochette bridge to be cemented to laterals in position pontics sandblasted then treated with metal primer and opaqued.  The veneers are sandblasted and treated with Visio link PMMA and composite primer.  Curing time – 90 seconds.

7. Combo.lign dual setting resin is injected through the palatal  in the same shade or the next darkest shade.  Can be set with light to save time or self cure. 

8. Finished with stones and silicones and polished.

9. A removable appliance was also produced easily using the matrix and a second set of veneers to be used for first placement after extraction and as a back up patient requested a temporary bridge for comfort so the bridge was fitted after 2 weeks.

10. View of bridge on excursion to show the shared contact due to lack of canine guidance – the original situation was guided on the centrals but the new position shares the force. 

11. Patient was very happy with result with the shade and form.  Implant placement stents  may be produced from this situation and final crowns are copied from this sound planning.

Dental technician: Mark Bladen

Dental Surgeon: Ghaleb Karein