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Dental Tribune Middle East & Africa No. 4, 2016

Dental Tribune Middle East & Africa Edition | 4/2016 18 restorative a pickup impression, described later intheseries. Once anterior impressions, jaw reg- istrations and facebow recodings are again taken the prototypes are relined, trimmed, cemented and are adjustedoncemore. TryInStage The anterior restorations are now produced by the technician to the biscuit bake or “try in” stage and are triedinthemouthandtheocclusion is adjusted using the mouth as the ultimatearticulator. Cementation As described earlier all articulators have limitations as do the materials and techniques we use. Once upper andlowerhavebeencheckedandad- justed they are sent back to the tech- nician for glazing and then to the dentist for cementation (Fig. 7). This same sequence is then performed ononesideofthemouthwithupper andlowerposteriorsandthenfinally theothersideofthemouth. Conclusions Patients requiring full mouth or partial reconstruction are or have usually been bruxists. As such they may often brux again which is one of the limiting factors to the longev- ity of our restorations. Careful post restoration occlusal adjustment and refinementareessential,followedby the post-restorative occlusal splint for night time wear (Fig. 8). The final smileisshowninFig9,10. CaseStudy2 This lady was referred with a fail- ing dentition, periodontal disease and TMJ dysfunction (Fig. 11). Her examination revealed several hopE- lessteethandanalmostedgetoedge occlusionwithlimitedanteriorguid- anceonheranteriorteeth. Inviewofthelimitedguidanceavail- able the fully-adjustable articulator was chosen as the posterior deter- minants of occlusion and posterior guidance (condyles) have a greater bearing on mandibular movements andocclusalanatomy. Following our standard diagnostic procedures, teeth prepared several teeth were removed (Fig. 12), proto- types fitted (Fig. 13), implants placed and the occlusion was adjusted so that RCP=ICP around RAP. A reor- ganized approach was used so as to reduce TMJ dysfunction and provide thepatientwiththeideal5principles of gnathology (occlusion) as dis- cussedinearlierarticles. The fully-adjustable was pro- grammed by using a facebow (Fig. 14) the cadiax (Denar) (Fig. 15,16) to record intercondylar distance, im- mediate and progressive side shifts and the shape of the superior and posteriorwallsofthefossa(Fig.17,18). The goal of the restoration was to move the maxillary teeth forwards and move the mandibular teeth posteriorly by occlusal adjustment, thereby establishing a deeper over- bite and overjet and better anterior guidance(Fig.19) The final restoration and smile can beseeninFigs20,21. Acknowledgements I would like to thank the following fortheirhelp: - Dr Ibrahim Hussain, BDS, M.Med. Sci.Implantology–ImplantSurgeon - Dr Andrew Watson, BDS, MSc, Spe- cialistinEndodontics - Dr Amit Patel, BDS, MSc, MClin- Dent, MFDS, RCSEd , MRD, RCSEng, SpecialistinPeriodontics - Mr Bradley Moore – Dental Techni- cian,ADSLaboratory,Harrogate ProfessorPaul TiptonBDS,MSc, DGDPRCS(UK) DENTALSURGEON VisitingProfessor ofRestorative andCosmetic Dentistry,Cityof LondonDental School SPECIALISTINPROSTHODONTICS TClinic@Manchester,London TIPTONTRAININGLtd President of theBritishAcademyof RestorativeDentistry(BARD) ◊Page17 Figure20:Finalsmile–closeup Figure19:Fullupperarchcompleted Figure21:Finalsmile-fullface

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