Civitali Dental and Prosthetic Center srl

Clinical Cases and Dental Treatments


Clinical Cases Presentation

This section describes and presents through pictures the treatment and the resolution of some clinical cases. The aim is to inform about how therapies provided at the Civitali Dental and Prosthetic Center are delivered and testify their quality. Cases presented have all been treated at the Center.

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Re-treating a devitalized tooth

Deep caries, pulpitis and tooth destruction

Deep caries are a tooth destructive process affecting the whole thickness of the crown dentine, the tissue the crown is made of. The crown is lined by very hard tissue, the enamel. Dentine below is a far less hard and less demineralized tissue. For this reason, when caries pass through the enamel and reach dentine, they develop rapidly affecting mainly this softer tissue, which is less demineralized and more prone to assault of bacterial acids.

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Sometimes a devitalized tooth may give origin to a chronic inflammatory process, caused by infection, at the apex of the root. Such process is commonly known as granuloma.

This condition may be silent, not producing any sign or symptom, and diagnosed only during routine radiographic examinations. In other cases it can origin acute symptoms spanning from slight pain affecting the tooth involved (periapical chronic periodontitis) to intense pain, not responsive to analgesics and accompanied by swelling...

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Free gingival graft from the palate

A good gingival quality is fundamental for teeth health and stability. An attached gingival band around the tooth is necessary to provide periodontal and dental health and to preserve both over time.

Each individual has his/her own qualitative and quantitative characteristic as far as the gingiva is concerned, according to his/her hereditary traits. Some people show a high amount of gingival tissue (thick and flat biotype) while others, on the contrary, display a minimum quantity only (thin and scalloped biotype).

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Immediate loading post-extractive implant

A post-extractive immediate loading implant rehabilitation is, today, still an elective treatment. This is because this kind of surgery is quite more difficult than the traditional protocol applied to rehabilitate post-extractive sites that have already healed. In particular, the flapless approach (implying no gingival incision is performed) impairs visibility and the presence of a post-extractive socket reduces the probability of achieving a proper implant primary stability.

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Teeth mobility and migration: the periodontal disease

Oral Implantology: anterior single dental implant

Text under preparation...

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The periodontal disease (pyorrhea) causes the formation of periodontal pockets and bone resorption around the dental roots. Also gingival recession is observed.

As a consequence, teeth lose their stability and become mobile. Dental mobility, featuring different degrees, may cause migration, that is the displacement of teeth from their physiological position in the dental arch. Mobility and migration alter the smile and cause the classic “scattering” of anterior teeth which can be observed during the periodontal disease development...

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Traumatic fracture of an incisor

The case shows a fracture affecting a superior front tooth. After a car accident, a direct trauma has provoked the fracture of the crown of the left superior central incisor. The fragment was recovered and the patient presented to observation 30 hours after the accident.

The fragment was not kept in any wet environment (physiologic solution, milk, water) so it was completely dehydrated.

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Wisdom tooth extraction

Treating caries between adjacent teeth

Caries are often located at the interproximal level, affecting teeth surfaces touching each other between a tooth and the adjacent one.

Interproximal caries are often invisible at clinical inspection but may be easily detected with proper radiographs (Bite Wing Radiographs). The case presented shows how the radiographic assessment is a  fundamental tool to diagnose interproximal caries which would be – otherwise – invisible.

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The wisdom tooth is, in human permanent dentition, the third and last molar. It owes its name to the age when eruption is observed: usually from 17 to 21.

Wisdom teeth begin their formation, deep inside the alveolar bone, at 8-10 years of age. Their presence, therefore, may be assessed early through radiographs. Sometimes they don’t develop at all: the wisdom tooth is the dental element more often affected by dental agenesis, that is a lack of formation. Agenesis may affect one, two or all the four wisdom teeth.

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Aesthetic inlays in composite materials

Composite material inlays represent a really interesting solution to perform ample aesthetic restorations in the lateral-posterior sectors (pre-molars and molars) as an alternative to the traditional filling with composite material. The history of composite fillings is well-known. The main issue with this kind of restoration is its integrity over time, which can be conditioned by the presence of micro-infiltrations caused by the volume retraction such material shows during polymerization. This has been amply demonstrated by the researches of Brannstrom et al.

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Replacing old amalgam restorations

Sealing pits and fissures

Posterior teeth (premolars and molars) show fissures and pits that can house food residuals or bacteria. Especially at a younger age, the regular use of the brush is not always sufficient to guarantee a perfect oral hygiene. Caries onset occurs usually where the brush is not able to remove bacterial residuals. Molars and pre-molars are most exposed to such a risk. This is why a preventive action, called pits and fissures sealing, may be advisable.

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Continuous and demanding aesthetic requests from patients, on one side, and a more and more refined research on aesthetic material on the other, have prompted both researchers and clinicians to develop and use  materials “having the same color of teeth”. Last-generation composite materials (hybrid materials featuring ultrathin particles) represent a valid alternative to amalgam in the posterior sectors, provided that the dental cavity is small and filling is performed with the aid of the rubber dam.

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