Caso clinico 3

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Caso clinico 3

La paziente presentava tre carie profonde sui diatorici del lato destro. Il 46 aveva una carie profonda che arrivava in polpa, pertanto è stato rimosso il tessuto cariato e si è eseguita la devitalizzazione. Il 47 presenta una carie profonda occlusale che mina le cuspidi. Si decide di non estrarre ma di curare il 48 da una carie occlusale profonda per mantenere l’armonia della bocca che presenta tutti gli ottavi in arcata e in occlusione.

Si procede alla preparazione simultanea di tre cavità per ricevere tre intarsi. È stata presa la scansione intraorale e creato il file STL, quest’ultimo è stato inviata al laboratorio per la valutazione della preparazione e

dell’occlusione. Infine ricevuto gli intarsi in clinica si è potuto procedere alla prova del manufatto e alla sua cementazione con cemento composito.

Successivamente è stato ancora verificato il contatto con l’antagonista tramite cartina di articolazione ed infine si ha provveduto alle fasi di rifinitura e lucidatura. Segue galleria fotografica del caso.

46 devitalizzato.

47 e 48 ancora non trattati.

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Preparazioni delle cavità.

Sul fondo del 46 viene posto composito flow per regolarizzare la superficie.

Su 47 e 48 viene rimosso il tessuto cariato.

Scansione del cavo orale:

arcata superiore, arcata inferiore e occlusione.

Sono riportate le foto della

scansione delle preparazioni.

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Finita la prima seduta, viene posta nelle cavità un’otturazione

provvisoria fotopolimerizzabile.

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Progettazione CAD in laboratorio Viene segnato il margine esterno della

preparazione.

Il software identifica due aree: una gialla che segna l’area dove si posizionerà il cemento e una verde che segna l’area

frizionante.

Il tecnico sceglie una morfologia dentale simile a quella del paziente e la adatta alle

dimensioni e alla posizione del dente preparato.

Il software definisce l’intarsio in base alla morfologia e al margine di preparazione.

Infine valuta occlusione con l’antagonista.

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In seconda seduta, ricevuti gli intarsi, si procede rimuovendo otturazione provvisoria e mettendo diga di gomma

per isolare i denti.

Si provano gli intarsi per verificare alloggiamento nella cavità e precisione

dei margini.

Si procede con mordenzata, risciacquo

accurato, asciugatura,

primer, bonding e

fotopolimerizzazione.

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Si procede alla cementazione con composito, si posizionano gl intarsi, si rimuove l’eccesso di cemento e si

fotopolimerizza.

Si verifica occlusione con cartina di articolazione, si rifiniscono e si

lucidano gli intarsi.

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Il risultato è soddisfacente con un buon

adattamento iniziale del manufatto e del margine, sicuramente reso preciso e stabile dopo la cementazione

grazie al composito duale.

Dopo rifinitura e lucidatura

sicuramente il restauro si può

definire estetico e funzionale.

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Conclusioni

La realizzazione degli intarsi con il flusso interamente digitale è stata una procedura semplice ed efficace. La possibilità di comunicare con il tecnico in tempo reale è sicuramente utile per la valutazione della preparazione dentale e permette di risparmiare tempo. D’altro canto la preparazione dentale e la cementazione dell’intarsio coincidono con la sequenza che avremmo seguito anche in un flusso analogico. L’alloggiamento nella cavità e la precisione marginale si possono considerare buoni, infatti in qualche caso abbiamo provveduto ad aggiustare l’intarsio prima della cementazione o a

perfezionare il contorno dopo la cementazione. Comunque il risultato

estetico e funzionale definitivo sono di alta qualità. Valuteremo la durata delle

caratteristiche estetiche e meccaniche nel tempo.

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Ringraziamenti

Vorrei ringraziare prof. Stefano Benedicenti, relatore e guida non solo per la stesura di questo elaborato ma anche per il percorso di studi, nonostante il mio sia stato breve a Genova, ho potuto apprezzare la sua passione e

dedizione agli studenti.

Vorrei ringraziare prof. Paolo Nicoli relatore e traghettatore della

sottoscritta dalla studio sui libri alla pratica clinica odontoiatrica. È stato un immenso piacere seguire i suoi consigli per poter sviluppare al meglio l’elaborato ma soprattutto per poter seguire i casi clinici.

Vorrei ringraziare prof. Gian Paolo Barbera per la gentile collaborazione per la realizzazione dei manufatti e per la guida attraverso il mondo del CAD- CAM.

Infine ringrazio mamma e papà, senza il loro sostegno non sarei

diventata ciò che sono, non avrei potuto coltivare le mie passioni e non sarei qui oggi a tagliare questo importante traguardo.

Ringrazio Matteo, nei momenti in trasferta ha saputo starmi vicino e nei momenti difficili mi ha aiutato a superare gli ostacoli lungo il percorso.

Ringrazio Davide e gli amici più cari per l’affetto e la stima che riservano

nei miei confronti.

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https://www.dentalmachine.it/caratteristiche-principali-di-un-fresatore-per-cad-cam-dentale/

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https://www.dentalmachine.it/caratteristiche-principali-di-un-fresatore-per-cad-cam-dentale/

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https://www.feniqx.com/blog/2021/09/21/tecnologia-cnc-quali-vantaggi-per-la-produzione-dentale/

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http://www.ilmegliodellagranda.it/macchine-cnc-5-assi-e-fresa-tradizionale-un-confronto-diretto-

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per-comprendere-tutte-le-differenze/

SYSTEMATIC REVIEW-Marginal and internal fit of CAD-CAM inlay/onlay restorations: A systematic 117

review of in vitro studies; Alexis Goujat, MSD,a Hazem Abouelleil, MSD,b Pierre Colon, PhD,c Christophe Jeannin, PhD,d Nelly Pradelle, PhD,e Dominique Seux, PhD,f and Brigitte Grosgogeat, PhDg. 2019

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