Minimally invasive treatment for a beautiful smile
Thanks to the work of a well-practiced team of experts, a young man receives a new smile and gains new confidence. The impressive result is achieved through a systematic procedure and carefully coordinated materials. This digital case documentation presents the treatment of a patient with tooth agenesis.
About the patient
Name: Krešo
Age: 23
Country: Croatia
Krešo is twenty-three years old and lives in Croatia. He showed hypodontia: seven teeth were missing in both the upper and the lower jaw. The young man was burdened with the non-esthetic appearance of his teeth.
Krešo's sadness was clearly visible during his first visit: It took some time to convince him to smile for the camera. He kept covering his mouth with his hand when he spoke.
Krešo had a clear aim: He wanted his teeth to be more beautiful. However, since he is afraid of surgeries he wanted to avoid a surgical intervention (treatment with implants). Furthermore, the treatment should not be too expensive because of his financial constraints. A challenging task for the treatment team, Dr Marko Jakovac (dentist) and Michele Temperani (dental technician).








Clinical examination and treatment planning
The first part of the oral rehabilitation process involved a clinical examination in which the facial and dental conditions were analyzed. Krešo's vertical dimension was substantially reduced. The patient was missing 14 permanent teeth due to dental agenesis (hypodontia). Furthermore, several deciduous teeth were still in place. Tooth 36 had been destroyed by caries, making its extraction inevitable. There was no way around a total prosthetic treatment. The treatment team, together with the patient, decided to do a full mouth reconstruction with conventional fixed prosthodontic therapy due to the patient's financial constraints. The therapy should be minimally invasive.
The tailored solution for Krešo:
- All-ceramic bridge in the upper jaw (Zirconium oxide)
- Lithium disilicate veneers in the lower jaw
- Metal-ceramic restorations in the posterior region
In order to provide the dental technician with the information required for waxing up a restoration, details related to the vertical dimension of occlusion and a facebow record must be supplied in addition to the impressions. If the vertical dimension of occlusion needs to be increased, the correct centric position has to be evaluated first. Dr Jakovac used a muscle relaxation splint together with an anterior Lucia jig of thermoplastic material as registration aid.
The facebow record provides information about the relationship of the maxillary jaw to the horizontal reference plane or the interpupillary line.
In the fabrication of extensive restorations, the protrusive and laterotrusive positions have to be recorded in order to make any necessary adjustments in the articulator. For this purpose, the addition silicone Virtual CADbite was used.
In most cases, the record with Virtual CADbite is faster and more accurate than with wax.
In most cases, this type of material produces faster and more accurate results than wax. When wax is used for bite taking, the patient has to be shown how move into the protrusive and laterotrusive position. Experience has shown that it is easier to let the patients produce these movements of their own accord and stop them when they arrive at the "right" position. Virtual CADbite is injected while the teeth are in this closed position.
Dr Jakovac in Zagreb sent all the collected data and information to Michele Temperani in Florence.
What is hypodontia?
Hypodontia refers to missing teeth. This means the lack of development of one or more teeth due to dental agenesis. Hypodontia can have negative effects on the masticatory function. In addition, it can affect the esthetic appearance. More information (Source: Wikipedia)




















Interview
How did Dr Marko Jakovac and Michele Temperani decide on the correct treatment and the materials to be used?
Treatment
The final result
The result is impressive! The treatment team succeeded in transferring the situation which was established during the therapeutic treatment phase exactly to the final restoration. All parties involved were completely satisfied. The treatment team has done a good job and the patient was overwhelmed. Now, he is finally enough confident to smile.
Patient is finally enough confident to smile!
All treatment steps of this exciting patient case are based on a well thought-out plan including all treatment steps, which need to be followed. Dental technician Michele Temperani used different but exactly coordinated ceramic materials to produces the harmonious result. The anterior teeth in the upper jaw were restored with a Wieland Zenostar, layered with IPS e.max Ceram, and the lower anterior region with lithium disilicate veneers (IPS e.max Press). For the posterior teeth he decided to use metal-ceramic restorations (IPS Style).


What does Dr Marko Jakovac say about this case?
The treatment team

Dr Marko Jakovac
Marko Jakovac was born in Zagreb, Croatia, in 1974. He completed his studies at the School of Dental Medicine of the University of Zagreb in 1998 and launched his career as junior scientist and assistant at his alma mater in 2001. Specializing in prosthodontics, he embarked on a PhD program in 2004. Since 2005, he has been working as a specialist in prosthodontics at the University of Zagreb. Three years later he became the owner and manager of Aesthetica dental office in Croatia’s capital and he also completed his PhD in 2008. From 2009 till 2015, Marko Jakovac had been assistant professor and since 2015 he is Associate Professor at the department of Fixed Prosthodontics and Head of Preclinical and laboratory fixed prosthodontics, Microscope in dental medicine for undergraduate students and Esthetic therapy on teeth and implants for postgraduate students at the School of Dental Medicine in Zagreb. He is also head of various study programs and further education courses and has authored and co-authored numerous scientific publications. He is also an active contributor to international meetings.

Michele Temperani
After completing his Diploma in Dental Technology, Michele Temperani undertook specialization in fixed denture prosthetics in the USA, where he attended the courses of the Tanaka Dental Technology Institute and the seminars of Masahiro Kuwata at the University of Washington. For three years, he was the head of the ceramic department at Kijosato Okamoto dental lab in Seattle (USA). He regularly participates in the "Continuing Education Project" which is held in Seattle each year.
Since 1990, he has been the co-owner of a dental lab in Florence, Italy, together with his brother, specializing in ceramic restorations. He has been using the press technique for the fabrication of all-ceramic restorations since 1998.
He conducts courses and holds lectures at international meetings and is the author of numerous publications.
The products
Dr Marko Jakovac and Michele Temperani relied on both long-term proven and relatively new products for this challenging patient case. See what products they used:
A patient case goes viral
Dr Marko Jakovac and Michele Temperani are not only successful in their practice or lab. The Croatian-Italian duo participates in international congresses and seminars time and again. Find out how they work together seemingly with ease – beyond language boundaries and national frontiers. Watch the two experts presenting this exciting case at the third International Expert Symposium from Ivoclar Vivadent in Madrid (June 2016) in front of an audience of 1,000 people from all over the world!
You can also find the current patient case of Dr Marko Jakovac and Michele Temperani in the issue 2/2016 of the international dental magazine Reflect.