Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2018-02-22, 14:25:50 | version 1.38.0
Dental Tribune Middle East & Africa Edition | 3/2016 18 restorative Advanced Restorative Techniques and the Full / Partial Mouth Reconstruction PART 3 : Treatment of severe wear cases Inpartthree,DrPaulTiptondescribesthediagnosticworkrequiredforthefullmouthreconstruction atanincreasedverticaldimension. ByProf.PaulTipton,UK Prosthodontists are often called upon to reconstruct the occlusion in patientswithseverewear.Theremay be a multitude of issues to address in such cases, including attrition, abrasion, and erosion – all of which contribute to uneven wear and com- pensatory eruption throughout the arches. There may also be incisal wear and/or interproximal wear and, as a result, the occlusal plane may need leveling and lengthening for enhanced aesthetics and to allow correctionandcontroloftheocclusal relationship. Theaestheticandfunctionalrequire- ments include a decision of the oc- clusal scheme to be used (part two) followed by determination of the incisal edge positions at rest, the oc- clusal plane, vertical dimension to work to anterior guidance, lip sup- port etc. All this is achieved by the diagnostic wax-up. This article de- scribes the diagnostic work required for the full mouth reconstruction at anincreasedverticaldimension. Treatment planning All comprehensive treatment plan- ning should begin with an occlusal aesthetic evaluation. Evaluation of the face is essential in determining the ideal aesthetic orientation of the teeth from both a horizontal and vertical perspective. The horizontal reference planes will help the clini- cian align the occlusal plane and the soft tissue levels along with other related aesthetic determinants. The horizontal reference planes should be evaluated from two perspectives: thefrontalandthesagittal. The frontal perspective is assessed by having the patient look out into the horizon and choosing the ideally leveled plane. The most commonly used horizontal reference planes include inter-pupillary line and inter-commissural line (Figure 1). Intra-oral photographs are also key at this stage (Figures 2-4). The follow- ingstepsareessentialtofulfillingthe correctdiagnosis. Step1:Mountedstudycasts This is achieved by taking accurate alginate impressions of upper and lower jaws in rim-lock trays, face- bow recording and jaw registration around RAP. The technician can now mount the study casts in a semi-ad- justablearticulator(Figures5-8). Step2:Verticaldimension The first treatment planning deci- sion is what vertical dimension to work at (part five). This can be estab- lishedbytheuseofawaxsquashbite placed into the patient’s mouth. As the patient is manipulated into RAP the lower teeth indent the wax bite. This can be removed, chilled in iced water and replaced as the patient and clinician now assess profile and facial aesthetics. In this way changes in vertical dimension can be trans- ferred early to the technician on the articulated casts and the initial new occlusal plane assessed via an elastic band (Figures 7-8). Once mounted, the degree of over-eruption of either arch can be assessed (Figures 9-10) andcastsadjusted(Figures11-12). Step3:Lowerincisaledgepo- sition The incisal edge position, incisal plane and occlusal plane are the three most important aesthetic de- terminants in the development of the treatment plan. These determi- nants enable the clinician to transfer information throughout the treat- ment, and are related in specific ways to other aesthetic criteria. The firststepindeterminingtheposition oftheteethisevaluationofthelower incisal edge position with the lips at rest (Figure 13). Tooth exposure is Figure1:Pre-opsmileshowinginter-commissureline Figure4:Viewoflower teeth Figure 7: Mounted study cast showing rubber band indicating approxocclusalplane–right handside Figure10:Left handside Figure5:Mountedstudycasts Figure8:Left handside Figure11:Upperocclusalplaneadjusted–right handside Figure6:Upperstudycast showingdegreeofwear Figure 9: Study cast showing amount of over-eruption of upper teeth–right handside Figure12:Left handside Figure2:Patient inICP Figure3:Viewofupper teeth ÿPage22