A 20-year-old male patient came to the clinic requesting an aesthetic solution for his anterior forehead.
During his first 5 years of life he underwent 3 surgical interventions to achieve closure of blade tissues of lip and palate.
Extra-oral examination revealed the presence of upper lip due to various operations to which it was subjected in childhood.
The intraoral examination reveals an evident dental malposition and malocclusion as well as different dental agenesis (15,12,11,25,34,33 and 44) and maxillomandibular discrepancy.
Moderate gingivitis was also observed due to lack of plaque control.
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We see that the patient has a severe maxillomandibular dysmorphosis that recommended the realization of an orthodontic treatment prior to any prosthodontic decision making.
The case was consulted to the orthodontic specialist and this raised the need for orthognathic surgery prior to prosthetic treatment.
The patient was explained and he refused to undergo surgical treatment.
After analyzing the hygienic habits of the patient and observing a clear deficiency in his plaque control, it is decided to perform a fixed prosthesis on telescopic crowns, optionally removable palatal plate, for both sides the treatment will be improved.
The telescopic crowns as a prosthodontic system of double crown allow making a cross ferulization of the dental arch (in our patient is limited to the anterior area of the maxilla), which will allow a long-term stabilization.
The concept of double crown and their intrinsic design makes the transmission of masticatory forces more favorable to the tooth since these will always be produced axially to the axis of the tooth.
The possibility that the patient may remove the secondary structure makes it easier to clean the abutment teeth especially when compared to the cleaning difficulty of a conventional fixed bridge, this circumstance was one of the main reasons for not performing telescopic treatment previously mentioned.
From the first moment the patient is informed that the aesthetic and functional result will not be the ideal, a question that at all times understands and accepts.
Before the prosthodontic treatment the extraction of the root rest of tooth 13 was carried out and once the wound healed, the final treatment was carried out.
This consisted in the preparation of abutment teeth 15, 21,22,23 and 24, performing conventional carving for telescopic crowns.
It is worth noting the important size that had to be made to the crown of tooth 21, in order to achieve parallelism between pillars, an issue that is crucial in all studies with telescopic crowns.
Then proceeded to the collection of imprints and intermaxillary records that with the obtained models were made in the laboratory primary caps.
These are tested in the patient's mouth, where the correct adjustment is verified, so as to take a second patient's self-perception of the mouth that postpones primary caps with respect to other structures of the mouth.
Obtaining a new model where the secondary crowns that make up the optionally removable fixed prosthesis will be built.
This secondary structure is tested in the patient's mouth where both adjustment and occlusal relationship are verified.
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Once the color is selected, it is finished and placed.
The final result, observed in the image, can be seen as a result that from our point of view is simply acceptable, but that the patient valued as very satisfactory, perhaps due to logically impossible predisposition to the initial state that the patient presented.
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The case has been reviewed over five consecutive years and despite the poor plaque control by the patient, we have not managed to acquire adequate hygiene habits, the pillars of the prosthesis are still in perfect comfort and aesthetic patient.
In this way it is clear the correct functioning of the treatments with telescopic crowns in the medium and long term being a possibility that we must always take into account when planning our treatments, especially in patients with prolonged telescopic behavior.
