Esthetic and Functional Rehabilitation: Retreatment of Anterior Fixed Dental Prothesis With Biologically Oriented Preparation Technique and Digital Workflow.

Abstract

Objective: This clinical case describes a multidisciplinary retreatment of a patient with anterior fixed dental prostheses (FDPs) using minimally invasive restorations and a biologically oriented preparation technique (BOPT).

Clinical considerations: A 56-year-old female patient, treated 30 years ago with a metal-ceramic FDP due to dental agenesis, presented a misfit prosthesis at the gingival margin, black spaces, and food retention at the pontics. Notably, tooth number 2.6 was absent, and she exhibited a left crossbite. Her chief complaint was the compromised esthetics of her restorations. Given her coagulation disorder, von Willebrand disease, she declined mucogingival surgery. A diagnostic wax-up and mock-up was performed to establish treatment goals. The initial phase involved periodontal, orthodontic, and implant treatment. The orthodontic treatment with aligners to correct the crossbite. Subsequently, bleaching and a second mock-up were conducted to guide prosthetic treatment. In the prosthodontic treatment, the abutment teeth were prepared using a vertical BOPT to remodel the gingival tissues, achieving the esthetic goal of repositioning the gingival margin without surgery. The provisional phase was critical for soft tissue remodeling and ensured clinical success. After stabilization of the soft tissues, a monolithic zirconia FDP was delivered, with a follow-up of 2 years.

Conclusions: A multidisciplinary treatment plan, utilizing a digital workflow, resulted in stable clinical and esthetic outcomes at the two-year follow-up, effectively retreating an anterior bridge using BOPT in a patient with a coagulation disorder that contraindicated complex surgical interventions.