J Korean Acad Prosthodont.  2019 Oct;57(4):456-466. 10.4047/jkap.2019.57.4.456.

Full mouth rehabilitation in a patient with reduced vertical dimension due to numerous tooth loss and excessie worn dentition: A case report

• Lee EH
• Lim YJ
• Kwon HB
• Kim MJ

• KMID: 2461154
• DOI: http://doi.org/10.4047/jkap.2019.57.4.456

Abstract

As digital dentistry technology is being developed, it is being used in various ways. This case covers how digital dentistry technology is being applied on the treatment of patients with loss of vertical dimension due to worn dentition and multiple loss of teeth. The loss of vertical dimension was carefully assessed and recovered, and implants were placed with surgical guides, designed considering the final restoration. The movement of the mandibular was measured with the electronic instrument for recording mandibular movement. Wax-up process was done with Naturgemäße Aufwachs-Technik (N.A.T.) and Natural functional reconstruction (N.F.R.). It was scanned, and the provisional restoration was fabricated using Computer-Aided-Design/Computer-Aided-Manufacturing (CAD/CAM) technology, and the adjustment process was done at the clinic to meet with the satisfaction both functionally and esthetically, and then, using double scanning and CAD/CAM technology, it was carried out as a final restoration. As a result, the patient obtained satisfying results, utilizing the benefits of digital dentistry technology and traditional methods.

Keyword

Full mouth rehabilitation; Digital dentistry; Guided surgery; Occlusal vertical dimension; Worn dentition

MeSH Terms

Dentistry
Dentition*
Humans
Mouth Rehabilitation*
Mouth*
Tooth Loss*
Tooth*
Vertical Dimension*

Figure

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  Fig. 1 Preoperative intraoral photographs and radiographic evaluation. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Mandibular occlusal view, (F) Panoramic radiograph, (G) Transcranial view.

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  Fig. 2 Centric relation and eccentric movement of mandible. (A) Gothic arch appliance, (B) Gothic arch tracing, (C) Data measured using Arcus digma 2.

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  Fig. 3 Implant surgery with implant stent. (A, D) Implants were planned on maxilla and mandible, (B, E) Adaptation of surgical stent, (C, F, G) Implants were installed and healing abutments were inserted.

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  Fig. 4 Impression taking and recording of centric relation for provisional restoration. (A, E) Impression body obtained by individual tray with polyvinylsiloxane, (B, F) Master cast, (C, G) bite zig, (D) Bite registration of posterior area using anterior centric stop, (H) Bite registration of anterior area using posterior bite.

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  Fig. 5 Diagnostic wax-up and provisional restoration. (A) Diagnostic wax-up, (B) Provisional restoration.

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  Fig. 6 Intraoral photographs and eccentric guidance of provisional restoration. (A) T-scan diagram showing canine guidance at right side, (B) Maxillary occlusal view, (C) T-scan diagram showing group function at left side, (D) Right lateral view, (E) Frontal view, (F) Left lateral view, (G) Canine guidance at right side, (H) Mandibular occlusal view, (I) Group function at left side.

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  Fig. 7 Adjustment process of anterior provisional restoration. (A) The process of fitting the cervical line of the central anterior teeth using ovate pontic (#21), (B) The pink esthetic of the mandibular incisor obtained by adjusting the countour of cervical embrassure and using ovate pontic, (C) ovate pontic adjustment process at the chair side, (D) The process of fabricating customized pick-up copings after gingival molding to adjust the cervical line of the canine (#23) where implant installed.

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  Fig. 8 Definitive prosthesis design procedure. (A, D) Master cast and its scanned data, (B, E) Model of provisional restoration and its scanned data, (C, F) Definitive prosthesis fabricated by double scan technique.

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  Fig. 9 Postoperative intraoral photographs, radiographic evaluation and night guard. (A) Post-operative panoramic radiograph, (B) Maxillary occlusal view, (C) 3D printed night guard, (D) Right lateral view, (E) Frontal view, (F) Left lateral view, (G) Canine guidance at right side, (H) Mandibular occlusal view, (I) Group function at left side.

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  Fig. 10 Distance between zenith of canine is increased 2.5 mm and It was maintained without change during treatment procedure. (A) Distance between zenith of canine is 17.5 mm before rehabilitation of vertical dimension, (B) Distance between zenith of canine is 20.0 mm at newly determined centric relation, (C) Distance between zenith of canine is 20.0 mm at provisional restoration, (D) Distance between zenith of canine is 20.0 mm at final restoration.

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