Dental Tribune Middle East & Africa Edition

Woodside3 and McNamara4 describe a functional approach to the correction of the Class II malocclusion. Anterior reposi- tioning therapy has had a history of more than 50 years. Gelb5 referred to his reposi- tioning appliance in1959 and described the Gelb 4/7 position, which is currently ac- cepted in the literature and recognized by many practitioners treating TMJ dysfunc- tion to correlate with the physiologic posi- tion of the condyle in the fossa (Fig. 3). Sev- eral functional appliance designs and their efficacy of improving TMJ dysfunction through mandibular repositioning have vide restorations for only the upper in- cisor (Figs. 4, 5). The upper incisors were prepared conservatively and restored with porcelain IPS e.max CAD lithium disilicate veneers milled with the chairside E4D Den- tist CAD/CAM system (D4D Technologies, Richardson, Texas) (Figs. 6–8). There are numerous systems that are cur- rently available. Systems are available chairside or laboratory based. The E4D Dentist system allows the restorative den- tist to have complete control of design and delivery of restorations. The system uses a laser capture to acquire a digital impres- sively bonded.10 The pressable lithium di- silicate is indicated for inlays, onlays, thin veneers, veneers, partial crowns, three- unit anterior bridges, three-unit premolar bridges, telescope primary crowns and im- plant restoration while the machinable lith- ium disilicate is indicated for all the previ- ous applications except bridges.11–14 Summary Reconstructive treatment usually entails significant correction of malocclusion and the maxillomandibular relationship. Many been described in later literature.6,7 Sim- mons8 further describes the alleviation of symptoms after mandibular repositioning. As noted, there was a natural anterior repo- sitioning of the mandible upon removal of the centric interference in this patient, and appliance therapy was unnecessary. Pos- terior resin build-ups with Class II elastic therapy were sufficient to erupt the pos- terior teeth to achieve stability of the pos- terior segment. The condylar position was evaluated by use of progress tomograms and was supported and accompanied with the alleviation of TMJ related symptoms. To address concerns over the color of the teeth, the patient opted to whiten the teeth before the provision of the definitive resto- rations for the anterior teeth. Upon evalu- ation of the post-orthodontic occlusion, to provide an occlusion with anterior guid- ance at protrusion and canine guidance at lateral excursion, it was adequate to pro- sion. The information is condensed, aided by computer, to an intuitive format that al- lows the restorative dentist to modify the design and send the design to a precise au- tomated milling unit that uses robotic tech- nology. The system essentially automates many of the more mechanical and labor in- tensive procedures, such as waxing, invest- ing, burnout, casting and/or pressing in- volved in conventional fabrication of den- tal restorations.9 Lithium disilicate (IPS e.max) has the su- perior flexural strength of 360 MPa to 400 MPa, as compared to the strength of ceramic for PFM crowns, which has the strength of 80 MPa to 100 MPa; veneered zirconia, which has a flexur- al strength of 100 MPa; and leucite glass, which has the strength of approximately 150 MPa to160 MPa. Lithium disilicate is a highly esthetic, high-strength material that can be conventionally cemented or adhe- patients requiring reconstruction common- ly present with varying functional con- cerns, including TMJ dysfunction and asso- ciated symptoms. Technology, such as to- mogram series and the use of JVA, could serve as standard equipment in the diagno- sis and treatment of these patients as well as aid in objectively evaluating the TMJ condition during and after the treatment. The goal of any treatment is to provide the patient with good esthetics, comfort and long-term function. The innovative meld- ing of disciplines and the use of current materials and technology can allow conser- vation of dental tissue that is irreversibly altered and removed using the traditional reconstructive approaches. References 1. Ishigaki S, Bessette RW, Maruyama T. Diag- nostic Ability of the Surface Vibration Analysis of Temporomandibular Joint. Abstract. IADR. Seattle, WA, March, 1994. 2. Knutson M, Radke J. Artificial Neural Net- work Classification of TMJ Internal Derange- ment. Abstract. J Dent Res 74 (AADR Abstracts) March, 1995. 3. Woodside DG, Metaxas A, Altuna G, The In- fluence of Functional Appliance Therapy on Glenoid Fossa Remodelling. American Journal of Orthodontics and Dentofacial Orthopedics. 1987 Sep;92(3):181–198. 4. McNamara, Jr. JA, Carlson DS. Quantitative Analysis of Temporomandibular Joint Adap- tations to Protrusive Function, AJO, 1979;76: 593–611. 5. Gelb H, Arnold GE. Syndromes of the Head and Neck of Dental Origin. American Medical Association Archives of Otolaryngology, Vol. 70, December 1959; 681–691. 6. Clark WJ. The Twin Block traction tech- nique, European Journal of Orthodontics, 4, 129–138, 1982; and Lund, DI and Sandler, PJ, The effects of Twin Blocks: a prospective con- trolled study, American Journal of Orthodon- tics and Dentofacial Orthopaedics, 113, 104– 110. 1998. 7. Lund, D. I. and Sandler, P. J. The effects of Twin Blocks: a prospective controlled study, American Journal of Orthodontics and Dento- facial Orthopaedics, 113, 104–110. 1998 8. Simmons HC, 3rd, Gibbs SJ. Anterior repo- sitioning appliance therapy for TMJ disorders: specific symptoms relieved and relationship to disk status on MRI.J Tenn Dent Assoc. 2009 Fall;89(4):22–30) 9. Severance G, Swann L. The Take CARE Ap- proach to Treatment Planning, Preparation and Design for CAD/CAM Restorations. Oral Health. March 2009, 47–52. 10. Fabianelli A, Goracci C, Bertelli E, David- son CL, Ferrari MA. A Clinical Trial of Empress II Porcelain Inlays Luted to Vital Teeth with Du- al-Curing Adhesive System and a Self-Curing Resin Cement. Journal of Adhesive Dentistry, 2006 Dec;8(6):427–431. 11. Tysowsky G. The Science Behind Lithium Disilicate: Today’s Surprisingly Versatile, Es- thetic and Durable Metal Free Alternative, Oral Health. March 2009. 93–97 12. Sorenson JA, Cruz M, Mito WT, Raffeiner O, Meredith HR, Foser, HP. A Clinical Investi- gation on Three-Unit Fixed Partial Dentures Fabricated with Lithium Disilicate Glass Ce- ramic, Pract Periodontics Aesthet Dent. 1999 Jan-Feb;11(1):95–106. 13. Holland W, Schweiger M, Frank M, Rhein- berger V. A Comparison of the Microstructure and Properties of the IPS Empress 2 and the IPS Empress Glass Ceramics. Journal of Bio- medical Material Research, 2000;53(4):297– 303. 14. Kheradmandan S, Koutayas SO, Bernhard M, Strub JR. Fracture Strength of Four Differ- ent Types of Anterior Bridges After Thermo- mechanical Fatigue in the Dual-Axis Chew- ing Stimulator, Journal of Oral Rehabilitation. 2001 Apr;28(4):361-369. Fig. 4 Debracket photos. Fig. 5 Veneer post insert photos. Fig. 4 Fig. 5 Dental Tribune Middle East & Africa in collaboration with CAPP introduce to the market the new project mCME - Self Instruction Program. mCME gives you the opportunity to have a quick and easy way to meet your continuing education needs. mCME offers you the flexibility to work at your own pace through the material from any location at any time. The content is international, drawn from the upper echelon of dental medicine, but also presents a regional outlook in terms of perspective and subject matter. How can professionals enroll? They can either sign up for a one-year (10 exercises) by subscription for the magazine for one year ($400) or pay ($30) per issue. After the payment, participants will receive their membership number and will be able to attend to the program. How to earn CME credits? Once the reader attends the distance-learning program, he/she can earn credits in three easy steps: 1. Read the articles. 2. Take the exercises on www.cappmea.com 3. Fill in the Questionnaire and Submit the answers by Fax (+971 4 36868883) or Email info@cappmea.com After submission of the answers, (name and membership number must be included for processing) they will receive the Certificate with unique ID Number within 48 to 72hours. Articles and Questionnaires will be available in the website after the publication. www.cappmea.com MEDIA CME Self-Instruction Program Dr. Thomas Coli- na, DMD, is a gen- eral dentist prac- ticing in Winnipeg, Manitoba, Cana- da. He graduated from the Univer- sity of Manitoba Faculty of Dentist- ry in 1989. His fo- cus on providing comprehensive dental care often entails a multi- and interdis- ciplinary approach. Colina is a member of the Manitoba Dental Association, Ca- nadian Dental Association, Academy of General Dentistry and the International Association for Orthodontics. He is a se- nior certified instructor for the Interna- tional Association for Orthodontics as well as a clinical instructor for the De- partment of Dental Diagnostic and Sur- gical Sciences, University of Manitoba Dental Faculty. 1-737 Keewatin St. Winnipeg, Manitoba Canada R2X 3B9 tcolina@mts.net Contact Information Fig. 6 Fig. 7 Fig. 8 Figs. 6, 7_ E4D veneer design for teeth #22, #21, #11 and #12. Conservative design achieved, made possible with post-orthodontic idealized occlusion. Fig. 8_ Reflected frontal closeup. 7MEdIa cMEDental tribune Middle East & Africa Edition | November 2012