J Korean Acad Prosthodont.  2019 Oct;57(4):405-415. 10.4047/jkap.2019.57.4.405.

Full mouth rehabilitation in patient with loss of vertical dimension and deep bite due to tooth wear

• Chae HS
• Jeon BS
• Lee JJ
• Ahn SG
• Seo JM

• KMID: 2461148
• DOI: http://doi.org/10.4047/jkap.2019.57.4.405

Abstract

Excessive tooth wear can cause irreversible damage to the occlusal surface and can alter the anterior occlusal relationship by destroying the structure of the anterior teeth needed for esthetics and proper anterior guidance. The anterior deep bite is not a morbid occlusion by itself, but it may cause problems such as soft tissue trauma, opposing tooth eruption, tooth wear, and occlusal trauma if there are no stable occlusal contacts between the lower incisal edge against its upper lingual surface. The most important goal of treatment is to form stable occlusal contact in centric relation. In this case report, patients with decrease in vertical dimension and anterior deep bite due to maxillary posterior tooth loss and excessive tooth wear were treated full mouth rehabilitation with increased vertical dimension to regain the space for restoration and improve anterior occlusal relationship and esthetics. The functional and aesthetic problems of the patient could be solved by the equal intensity contact of all the teeth in centic relation (CR), anterior guidance in harmony with the functional movement, and restoration of the wear surface beyond the enamel range.

Keyword

Tooth wear; Vertical dimension; Deep bite; Full mouth rehabilitation

MeSH Terms

Centric Relation
Dental Enamel
Esthetics
Humans
Mouth Rehabilitation*
Mouth*
Overbite*
Tooth Eruption
Tooth Loss
Tooth Wear*
Tooth*
Vertical Dimension*

Figure

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  Fig. 1 Pre-treatment state. (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 Pre-treatment panoramic radiograph.

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  Fig. 3 Diagnostic cast. (A) Ligual view of mounted diagnostic cast, (B) There are no stable holding contacts on anterior teeth of the mounted diagnostic cast.

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  Fig. 4 Evaluation of vertical dimension. (A) Willis method, (B) Cephalometric radiograph.

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  Fig. 5 Recontouring of the anterior teeth. (A) Ligual view of diagnostic wax-up cast model, (B) On the diagnostic wax up, a definite holding stops can be provided for each lower incisal edge against its upper lingual surface.

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  Fig. 6 Diagnostic wax-up model. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Lateral movement-right side, (F) Mandibular occlusal view, (G) Lateral movement-left side.

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  Fig. 7 Provisional restorations. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Mandibular occlusal view.

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  Fig. 8 Radiographic stent for implant placement.

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  Fig. 9 Cone beam computed tomography images for implant placement in maxillary edentulous area.

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  Fig. 10 Implant surgery on maxillary edentulous area. (A, B, C) #25, 26 implantation and guided bone regeneration, (D, E, F) #16, 17 implantation.

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  Fig. 11 The equal intensity contacts of all the teeth in centric occlusion of provisional restoration. And incisal and canine guidance were achieved during each protrusive and lateral movement of mandible.

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  Fig. 12 Master cast fabrication. (A) Tooth final preparation, (B) Final impression taking, (C) Working model for fixed prosthesis.

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  Fig. 13 The shape of anterior teeth and the occlusal relationship of provisional restorations are reflected in the final restoration. (A) Customized anterior guide table, (B) Maxillary and mandibular models of provisional restoration mounted on articulator.

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  Fig. 14 Aesthetic improvement according to occlusal vertical dimension elevation. (A) Facial photo before treatment, (B) Facial photo after provisional restoration.

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  Fig. 15 Definitive prosthesis. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Lateral movement-right side, (F) Mandibular occlusal view, (G) Lateral movement-left side.

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  Fig. 16 Occlusal adjustment on definitive prosthesis. (A, B) Equal intensity contact of all the teeth in centric occlusion, (C) Inner incline of lingual cusp of #36 was adjusted to eliminate working side interference during mandibular movements in left side, (D) Occlusal analysis using T scan III.

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  Fig. 17 Solving deep bite problems. (A) Frontal view of before treatment, (B) Frontal view of after treatment, (C) Post-treatment panoramic radiograph.

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