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Gold-palladium framework efficiently veneered with VITA VM 13 metal ceramics

Complete tooth loss can create a stressful and emotional situation, particularly for young patients. In these cases, the challenge is to offer the patient an age-appropriate, esthetic restoration with reliable long-term stability. VMK restoration (VITA metal ceramics) can be used in this case and is a proven material combination that has been used for many years in clinical situations. In the following case report, Master Dental Technician Cyril Perregaux (Geneva, Switzerland) shows the production of an implant-supported gold-palladium framework, which he veneered with VITA VM 13 (VITA Zahnfabrik, Bad Säckingen, Germany).

1. Clinical challenge

A 20-year-old patient suffered from a general tooth formation disorder. For this reason, all of the teeth in her upper and lower jaw had to be extracted under full general anesthetics. For the healing process, immediate prostheses were fabricated with VITA PHYSIODENS prosthesis teeth (VITA Zahnfabrik, Bad Säckingen, Germany) to give the patient a natural, young appearance. However, the prostheses also provided important prosthetic information for the planned permanent, implant-supported rehabilitation. After a healing phase of several months, eight implants were inserted in the upper jaw and six in the lower jaw.

2. Set-up and fabrication of provisional material

After the shaping and bite registration, a new set-up with VITA PHYSIODENS enabled a precise prosthetic orientation, taking into account the implant positioning in the new, post-operative situation. With the vestibular and lingual silicone keys of the set-up, the prosthetic teeth could be adjusted to the temporary abutments screwed on to the master model. Using the vestibular and lingual silicone keys, the set-up was transferred to plastic and inserted as a long-term provisional restoration.

3. Framework completion and veneering

After several weeks of adjustments, new fixation molds were taken to produce a master model. The articulation was carried out in a similar way to the provisional bridges. The framework was also modeled and cast in wax using the silicone key. Successively controlled by means of a silicone key, the finished bridge frameworks were finally veneered with VITA VM 13. Cyril Perregaux recommends: "Before the blending is complete, a clinical try-in should be carried out in order to prevent any possible issues such as interfering contacts. This minimizes the risk of cracks occurring after insertion through milling."

4. Seating and final results

All six bridges were screwed in intraorally and the screw channels were sealed with a composite. The gold-palladium framework provided a solid and economical solution. VITA VM 13 allowed for a highly esthetic and age-appropriate veneering. Meticulous planning and regular clinical testing were the key factors for success. The young patient was very satisfied with the final results of the treatment.

Report 05/17

Cyril Perregaux, Master Dental Technician Geneva, Switzerland
"VITA VM 13 allowed for a highly esthetic and age-appropriate veneering."
Cyril Perregaux, Master Dental Technician
Geneva, Switzerland
Fig. 1: Master models with implant posts and immediate prostheses.
Fig. 1: Master models with implant posts and immediate prostheses.
Fig. 1: Master models with implant posts and immediate prostheses.
Fig. 2: The new set-up for prosthetic orientation and treatment planning.
Fig. 2: The new set-up for prosthetic orientation and treatment planning.
Fig. 2: The new set-up for prosthetic orientation and treatment planning.
Fig. 3: The silicone keys reflect the dimensions of the set-up.
Fig. 3: The silicone keys reflect the dimensions of the set-up.
Fig. 3: The silicone keys reflect the dimensions of the set-up.
Fig. 4: An implant-supported provisional restoration was fabricated using the silicone matrix.
Fig. 4: An implant-supported provisional restoration was fabricated using the silicone matrix.
Fig. 4: An implant-supported provisional restoration was fabricated using the silicone matrix.
Fig. 5: The matrix allows dimensional control of the framework.
Fig. 5: The matrix allows dimensional control of the framework.
Fig. 5: The matrix allows dimensional control of the framework.
Fig. 6: The bridge frameworks are cast in a similar way to the wax-up.
Fig. 6: The bridge frameworks are cast in a similar way to the wax-up.
Fig. 6: The bridge frameworks are cast in a similar way to the wax-up.
Fig. 7: The three screwed-in bridge frameworks per jaw in the articulator.
Fig. 7: The three screwed-in bridge frameworks per jaw in the articulator.
Fig. 7: The three screwed-in bridge frameworks per jaw in the articulator.
Fig. 8: The opaque framework according to the selected basic tooth shade.
Fig. 8: The opaque framework according to the selected basic tooth shade.
Fig. 8: The opaque framework according to the selected basic tooth shade.
Fig. 9: Approximate and morphological finalization after the last fitting.
Fig. 9: Approximate and morphological finalization after the last fitting.
Fig. 9: Approximate and morphological finalization after the last fitting.
Fig. 10: The final restorations in the articulator, ready to be screwed in.
Fig. 10: The final restorations in the articulator, ready to be screwed in.
Fig. 10: The final restorations in the articulator, ready to be screwed in.
Fig. 11: A beautiful smile with natural, age-appropriate care.
Fig. 11: A beautiful smile with natural, age-appropriate care.
Fig. 11: A beautiful smile with natural, age-appropriate care.
Fig. 12: Red and white esthetics in balanced harmony.
Fig. 12: Red and white esthetics in balanced harmony.
Fig. 12: Red and white esthetics in balanced harmony.
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