J Dent Rehabil Appl Sci.  2023 Sep;39(3):146-157. 10.14368/jdras.2023.39.3.146.

New anterior guidance induction through spontaneous gap closure after an increase in vertical dimension: a case report

• Nam JH
• Kim JH
• Yi YJ

• KMID: 2549281
• DOI: http://doi.org/10.14368/jdras.2023.39.3.146

Abstract

The bite collapses due to posterior teeth loss or wear results in inadequate space for restoration and esthetic concerns. Increasing the occlusal vertical dimension to improve space deficiency rotates the mandible posteriorly, creating a gap between the maxillary and mandibular anterior teeth, leading to loss of anterior guidance. To solve this problem, the prosthodontics or orthodontics treatments are the commonly used methods for proper anterior guidance. However, it is reasonable to assume that the anterior teeth can naturally relapse to their original position when the occlusal force is eliminated. Therefore, this case report aimed to test whether natural relapse could recover the lost anterior guidance to develop a less invasive and more convenient treatment method. Digital superimposition was used to evaluate the changes in anterior teeth alignment to confirm the change of the recovered anterior guidance. The appropriate indications for this new treatment method were defined and applied clinically.

Keyword

occlusal vertical dimension; implant; anterior guidance; superimposition; axial displacement

Figure

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  Fig. 1 Initial panoramic view with implants installed.

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  Fig. 2 Initial intra-oral photo showing insufficient restoration space and anterior deep bite (2020.8).

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  Fig. 3 Horizontal and vertical anterior gaps observed between the opposite teeth after vertical dimension increase with temporary restoration on #10, and #25i,26i (2020.9.11 & 9.25).

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  Fig. 4 Gap closure between the anterior teeth with a change in the interproximal space after 4 months (2021.1 & 2021.4).

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  Fig. 5 Panoramic view after restorations at increased vertical dimension.

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  Fig. 6 New occlusal contact with re-establishment of an anterior guidance.

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  Fig. 7 Quantitative analysis using digital superimposition method of pre-and post-treatment.

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  Fig. 8 Panoramic view before and after the implant restoration in the posterior region.

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  Fig. 9 Limited clearance of posterior region and anterior deep bite due to bite collapse (2021.8).

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  Fig. 10 An anterior gap after the provisional restoration of the posterior region at an increased vertical dimension (2021.8).

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  Fig. 11 Gap closure of anterior teeth & final restoration in the posterior region (2021.11).

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  Fig. 12 Quantitative analysis using digital superimposition of pre-and post-treatment.

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  Fig. 13 Panoramic view before and after the implant restoration.

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  Fig. 14 Pre-treatment cast model.

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  Fig. 15 Gap in the anterior region after VD increase using posterior implants.

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  Fig. 16 Occlusal change observed with space closure in the anterior teeth.

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  Fig. 17 Quantitative analysis using digital superimposition of pre-and post-treatment.

Reference

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