J Korean Acad Prosthodont.  2019 Jan;57(1):66-74. 10.4047/jkap.2019.57.1.66.

Full-mouth rehabilitation with vertical dimension increase and computer tomography guided implant surgery in patient with excessive worn dentition and multiple loss of tooth

• Lee KS
• Lim YJ
• Kwon HB
• Kim MJ

• KMID: 2432004
• DOI: http://doi.org/10.4047/jkap.2019.57.1.66

Abstract

Excessive wear causes many complications when untreated, so that accurate diagnosis, analysis and predictive treatment plan should be made, and through evaluation of vertical dimension and stepwise treatment, a stable inter-arch relationship can be set. For the long-term success of implant treatment, ideal position and angle of implant is important, and its importance increases especially in multiple implant cases. Therefore, thorough diagnosis and planning, accurate surgery and prosthodontic procedures are significant. In this case, a 68-year-old male patient with a loss of vertical dimension due to multiple tooth loss and overall tooth wear was planned with systematic analyses from the pre-treatment stage to rehabilitate vertical dimension. Full-mouth fixed rehabilitation with computer tomography guided implant surgery was performed to the newly set vertical dimension and attained satisfactory outcomes both functionally and esthetically.

Keyword

Full mouth rehabilitation; Guided surgery; Occlusal Vertical dimension; Worn dentition

MeSH Terms

Aged
Dentition*
Diagnosis
Humans
Male
Rehabilitation*
Tooth Loss
Tooth Wear
Tooth*
Vertical Dimension*

Figure

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  Fig. 1 Preoperative intraoral photographs. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Mandibular occlusal view.

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  Fig. 2 Radiographic evaluation before treatment. (A) Panoramic radiograph at first visit, (B) TMJ panoramic, (C) Transcranial view.

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  Fig. 3 Diagnostic wax-up. (A) Right lateral view, (B) Frontal view, (C) Left lateral view.

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  Fig. 4 Provisional restoration before implant treatment. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Mandibular occlusal view.

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  Fig. 5 Fabrication of implant surgical guide using CAD program. (A) Digital wax up from frontal view, (B) Digital wax up from maxillary occlusal view, (C) Implant planning, (D) Closed sleeve type surgical guide.

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  Fig. 6 Implant installation with surgical guide. (A, B, C) CT guided implant surgery with surgical guide, (D) After implant 1st surgery, (E) Panoramic radiograph after implant 1st surgery, (F) After implant 2nd surgery.

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  Fig. 7 Digital wax-up for implant provisional prosthesis and design of titanium customized abutment. (A) Digital wax-up, (B) Titanium customized abutment design.

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  Fig. 8 Placement of the implant provisional restorations after the connection of titanium customized abutments. The abutments were tightened twice with a torque of 30 Ncm. (A) Right lateral view, (B) Frontal view, (C) Left lateral view.

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  Fig. 9 Definitive prostheses after porcelain glazing. (A) Pink porcelain amount decision at maxillary incisors by referring marginal gingiva level of right canine and Korean adults' average of clinical crown length, (B) Crowding of lower incisors.

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  Fig. 10 Placement of the definitive prostheses. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Mandibular occlusal view, (F) Panoramic radiograph after delivery.

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