Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2018-02-22, 15:28:43 | version 1.38.0
20 Dental Tribune Middle East & Africa Edition | January-February 2016 aesthetics > Page 21 Advanced Restorative Techniques and the Full / Partial Mouth Reconstruction - Part 1 By Prof. Paul Tipton, UK M ost advanced restor- ative dentistry tech- niques, including that of full mouth reconstruction, have changed very little over the last 20 to 30 years. How- ever, the impact of new dental materials, such as titanium and zirconia, has had a major influence on aesthetic den- tistry and implantology during this time period. As a result, the profession may have an over-reliance on new materi- als rather than tried and tested techniques. Some fundamental techniques are just as relevant today as they were when I started my Masters degree in conserva- tive dentistry at the Eastman Dental Hospital in 1987. Dur- ing the course of this series of articles on advanced restor- ative techniques, some old techniques will be revisited in light of today’s aesthetic and restorative requirements and some newer concepts will be discussed in greater detail whilst dealing with the overall topic of full mouth reconstruc- tion. This article previews the restorative techniques that will be discussed during the next 10 clinical articles on ad- vanced restorative techniques. Occlusal concepts During my Masters degree at the Eastman and prior to that, my training in occlusion has been in gnathology and its principles as taught at the University of Michigan and by Derek Setchell, Richard Ibbot- son and staff at the Eastman Dental Hospital during the last 20 years. This includes the five principles of occlusion, which are: 1. Retruded contact position (RCP) = intercuspal position (ICP) around retruded axis po- sition (RAP) 2. Mutually protected occlu- sion 3. Anterior guidance 4. No non-working side inter- ferences 5. Posterior stability. The article on occlusion will review these concepts and also discuss when alternatives, such as long centric, are re- quired (Figures 1-3). Treatment of severe wear cases One of the fundamental approaches to partial or full mouth reconstruction (and aesthetic dentistry) is envis- aging the end result prior to starting the case. There is no better way to see the end result than the full and complete di- agnostic wax-up. The aesthetic ability of both dentist and tech- nician is stretched during this essential procedure. The ar- ticle on diagnostics will review the procedures to complete a full mouth reconstruction at an increased vertical dimen- sion with establishment of the lower occlusal plane, in- cisal edge positions, curves of Spee and Monson and anterior guidance prior to preparation, prototypes and fitting of the fi- nal restorations (Figures 4-6). Full mouth reconstruction Following on from diagnostic procedures in the previous article, the techniques of full mouth reconstruction will be reviewed including the use of various forms of articulators from the fixed condyle (aver- age value) articulator through to the semi adjustable and on to the fully adjustable for the customisation of the condylar settings. The programming of these will also to looked at and discussed from ‘fixed’ settings to use of lateral and protrusive check bites, and finally the pantograph and newer ‘Cadi- ax’ machine (Figures 7-9). Vertical dimension Changes in vertical dimension are often required for either gaining restorative space dur- ing restorative procedures or for improving facial aesthet- ics. Occlusal splints are used to first verify that the increase in vertical dimension can be tolerated and this is easily ac- complished in most cases as long as this increase is done around RAP or centre rela- tion so that the condyles are in their most relaxed, bone braised and reproducible posi- tion. Increases and decreases in vertical dimension will be discussed showing positive changes in facial aesthetics as treatment is completed (Fig- ures 10-12). Dahl appliances Bjorn Dahl first described the Dahl appliance in the early 1970s. Since then they have gradually been incorporated into the field of restorative dentistry although many Or- thodontists still dispute their efficacy and relevance. Figure 1: Severe aesthetic problems Figure 5: Diagnostic waxing Figure 9: Final restorations Figure 13: Palatal erosion Figure 3: Final restorations Figure 7: Anterior wear and erosion Figure 11: Facebow recording Figure 15: Space for final restorations Figure 2: Diagnostic waxing Figure 6: Final restorations Figure 10: Pre-treatment Figure 14: Dahl appliance Figure 4: Severe anterior wear Figure 8: Increased vertical dimension Figure 12: Post-treatment Figure 16: Combined periodontal/restorative/ implant case As an introduction to a series of articles, Prof. Paul Tipton looks at restorative techniques and the impact of new dental materials