Brief summary DIAGNOSIS:
Improper prosthetic restorations, leached, infiltrated endodontic treatments, multiple carious lesions; Incorrect intermaxillary relationships, lack of anterior and lateral guidance being present active interferences in the laterality movement and premature contacts at the end of the propulsion movement. Space deficit in the lower arch;

UPDATE: the case won 1st Place at the Romanian Dental Awards.

Case summary. Complex rehabilitations could not be performed without rigorous planning and a medical team that provides interdisciplinary treatment. The main step was the data acquisition stage so that the medical team could decide on the treatment stages so as to achieve the patient's wishes.

After the sanitation stage in which carious processes were removed, incorrectly adapted prosthetic restorations, and infiltrated endodontic treatments were restored - the prosthetic stabilization stage was passed. Subsequently, the patient was applied orthodontic appliance at the level of the mandible. The lower first premolars were extracted due to the lack of space, and at the maxillary level, dental implants were inserted at the level of 1.3, 1.2, 2.4, 2.5 and 6 months were waited for osseointegration.

The stage of discovering the implants followed. Digital impressions were taken for hybrid prosthetic posts and temporary composite cad-cam prosthetic restorations,  dental implants  undergoing gradual loading. After the tissues matured, the final stage was reached, where the patient's teeth were restored at the maxillary level with fixed prosthetic restorations, and at the lower arch level, the incisal edges and cusps of the canines were restored with composite in order to restore function in dynamic movements.

TREATMENT PLAN: hygienization, data acquisition, sanitation, prosthetic stabilization, orthodontic treatment, oral surgery (augmentation and implant insertion), fixed prosthetic restorations.

WORKING PROTOCOL: data acquisition consisting of: intra/extraoral photos for aesthetic and functional analysis, odontal and periodontal evaluation, impressions and intermaxillary and facial arch recordings, planning of the orthodontic, surgical and prosthetic stage. Implant insertion was performed using surgical guides made according to the final design of the prosthetic restorations. Impression in one step with materials of different consistencies. Fixation - under isolation with a dam. The adhesive protocol being correlated with the type of final prosthetic restoration.
Patient follow-up at 2 weeks, 1 month, 6 months, 9 months, 1 year, 2 years, 2.5 years.

In high-performance dentistry, a team of professional dentists is needed so that the results of oral reconstruction and treatments are successful in the long term. This case is in the finals of Ectopic Society 2023 - Interdisciplinary Oral Rehabilitation.