Full‐Mouth Rehabilitation of a Patient with Severe Deep Bite: A Clinical Report

Increasing the vertical dimension is essential to resolving problems associated with deep bite. Restorative dentistry, orthodontia, and oral surgery are the three disciplines that can help to gain the vertical dimension necessary in these patients. This clinical report presents the results of increasing vertical dimension with a full‐mouth restorative treatment procedure for a 40‐year‐old male patient who exhibited severe deep bite. After clinical evaluation, extraoral examination showed a reduction of the lower facial height and protuberant lips, wrinkles, drooping, and overclosed commissures. In addition, intraoral examination showed a severe anterior deep‐bite articulation, and upper incisors were in contact with the lower incisor labial tissue. A removable partial denture was made at increased occlusal vertical dimension (OVD) to use in the first stage of rehabilitation. Diagnostic wax‐up was performed at the increased vertical dimension. Then, provisional crowns were fabricated according to this increased vertical dimension. Interim prostheses were used for 3 months as a guide for preparing the definitive restorations. The adaptation of the patient to the increased OVD was evaluated. During this period, he was asymptomatic. Following the evaluation period, definitive restorations were completed, and routine clinical assessments were made after 1 week, 1 month, 3 months, and 6 months, then after 1 and 2 years with visual and radiographic examinations.     

重度磨耗牙垂直距离评估与固定修复

目的:探讨重度磨耗牙垂直距离的变化与固定修复方法的选择.方法:对65例129颗重度磨耗牙,根据垂直距离有无变化,分为三类修复:①重度磨耗牙,垂直距离未减小,(牙合 )龈距离尚能进行常规固定修复;②重度磨耗牙,垂直距离未减小,(牙合)龈距离不足进行常规固定修复;③重度磨耗牙伴有垂直距离减小,(牙合)龈距离不足进行固定修复...     

Minimally Invasive Treatment of an Adult with Severe Pseudo Class III Malocclusion

Pseudo class III malocclusion is reverse anterior occlusion or anterior cross‐bite with first molars and canines in a class I relationship. It is very important to diagnose the pseudo class III from true skeletal class III. The combination of anterior displacement of the mandible, tooth wear, and loss of occlusal vertical dimension (OVD) in adults may result anterior cross‐bite. The key factor in diagnosis of this malocclusion is an interdisciplinary approach with an orthodontist. Cephalometric images are essential for diagnosis of pseudo class III mal‐occlusion. Most relevant publications on correcting this condition have recommended either full‐coverage restorations or extraction and placement of implants to correct this malocclusion. Advances of material and technology may help dental practitioners to restore tooth wear and OVD with a conservative approach without removing more tooth structures. This clinical report shows the treatment of pseudo class III with minimally invasive treatment using partial coverage restorations fabricated with lithium disilicate.     

Reestablishing occlusal vertical dimension using a diagnostic treatment prosthesis in the edentulous patient: A clinical report

To maintain a harmonious craniofacial system, the dental practitioner must establish an appropriate occlusal vertical dimension (OVD). Several methods can be used to determine an appropriate OVD. The patient presenting with decreased OVD represents a particular challenge for the dental practitioner in fabricating conventional dentures. This clinical report describes the use of a diagnostic treatment prosthesis to evaluate the patient's ability to manage such an increase in vertical dimension and to reestablish an appropriate occlusal vertical dimension. The use of a diagnostic treatment prosthesis at a vertical dimension 5 mm greater than what the patient presented with was determined to not cause discomfort over a 2-month period. A conventional complete denture was fabricated based on the patient's ability to handle the increase during the trial period. This report reviews the literature on this topic and describes a clinical technique for reestablishing the OVD in edentulous patients.     

Full-mouth rehabilitation of a patient with severely worn dentition and uneven occlusal plane: a clinical report

Severe tooth wear is frequently multifactorial and variable. Successful management is a subject of interest in dentistry. A critical aspect is to determine the occlusal vertical dimension (OVD) and a systematic approach that can lead to a predictable and favorable treatment prognosis. Management of patients with worn dentition is complex and difficult. Accurate clinical and radiographic examinations, a diagnostic wax-up, and determining OVD are crucial. Using mini-implants as orthodontic anchorage may facilitate orthodontic movement of teeth to improve their position, which is necessary for favorable prosthetic treatment. A 46-year-old man was referred for restoration of his worn and missing teeth. After diagnostic work-up, provisional removable prostheses were fabricated for both jaws, evaluated clinically, and adjusted according to esthetic, phonetic, and vertical dimension criteria. Clinical crown lengthening and free gingival graft procedures were performed in appropriate areas. Drifting of the left posterior mandibular teeth was corrected using mini-implants as orthodontic anchorage. Two conventional implants were inserted in the right mandibular edentulous area. After endodontic therapy of worn teeth, custom-cast gold dowels and cores were fabricated, and provisional removable prostheses were replaced with fixed provisional restorations. Metal-ceramic restorations were fabricated, and a removable partial denture with attachments was fabricated for maxillary edentulous areas. An occlusal splint was used to protect the restorations. Full-mouth rehabilitation of the patient with severely worn dentition and an uneven occlusal plane was found to be successful after 3 years of follow-up. This result can encourage clinicians to seek accurate diagnosis and treatment planning to treat such patients.     

Efficient prosthodontic treatment in a young patient with long-standing bulimia nervosa: A clinical report

Time-saving, efficient dental treatment is essential for patients in poor dental condition. This clinical report describes a systematic technique for restoration of the visibly-destroyed dentition of a long-term bulimia nervosa patient, including occlusal vertical dimension increase, with composite resin core foundations and prosthetic rehabilitation with ceramic crowns, in only a few treatment sessions. The efficiency of this procedure is gained from composite resin core restorations that establish the new occlusal vertical dimension (OVD) and replace and form the foundation for the subsequent crown preparation.     

Immediate loading of the grafted maxillary sinus using platelet rich plasma and autogenous bone: a preliminary study with histologic and histomorphometric analysis

OBJECTIVE: The goal of this clinical study was to evaluate dental implant survival rates using the concept of a nonfunctional, immediate loading protocol with nonsplinted dental implants in the grafted maxillary sinus during a 52-week period. Random histomorphological and histomorphometric analysis was completed to evaluate the early healing effect of platelet rich plasma (PRP) and 50% autogenous bone combined with 3 different substitute graft materials. MATERIALS: Four to 8 months after grafting the sinus with PRP sprayed autogenous bone combined with 3 different substitute graft materials in a 50:50 composite ratio, 27 hydroxyapatite- coated dental implants were surgically placed in 41 patients and immediately loaded between 48 hours and 5 days later with custom titanium abutments and acrylic provisional restorations placed out of functional occlusion. Six months later, definitive ceramometal restorations were cemented on to the custom abutments. RESULTS: During a 52-week observation period, no implants were lost. Between 4 and 8 months of graft healing time, histologic and histomorphometric analysis revealed formation of new vital bone in different graft specimens ranging from 77% to 100%. CONCLUSION: The preliminary results of this clinical study indicate that immediate nonfunctional loading using PRP and 50% autogenous bone combined with different substitute graft materials is a predictable protocol in the grafted maxillary sinus as early as 4 months of postgrafting. The high implant survival rate is due to the early formation of large percentages of new vital bone as confirmed by using histologic and histomorphometric analysis.     

Combined prosthodontic and orthodontic treatment of a patient with a Class III skeletal malocclusion: a clinical report

This clinical report describes a multidisciplinary approach for the treatment of a patient with Angle Class III skeletal malocclusion and decreased occlusal vertical dimension. An overlay removable partial denture (ORPD) was used to reestablish the occlusal vertical dimension (OVD). After the trial and adjustment period, the reduced lower anterior dentofacial height was orthodontically increased and the negative horizontal overlap was corrected. A maxillary precision attachment RPD and a mandibular fixed partial denture and metal ceramic crowns were fabricated to satisfy esthetic and functional requirements.     

Adjustment of the occlusal vertical dimension in the bite-raised guinea pig

In humans, the inappropriate occlusal vertical dimension (OVD) causes several orofacial disorders, such as bruxism and pain in the masticatory muscles and temporomandibular joint. However, it is still unclear how strictly the OVD is adjusted. To answer this question, we studied the temporal change of the OVD in bite-raised young guinea pigs. The OVD was raised by fixation of a bite-raising appliance to the lower incisors, and increased by either 3 or 1.5 mm at the first molars. After the space produced between the upper and lower molars was filled within 10 days due to eruption of the molars, the appliance was removed. In the bite-raised animals, the raised OVD was reduced until it attained that observed in the control animals, after which the OVD increased according to cranial growth. These results show that the OVD is developmentally changed and strictly controlled.     

Immediate non-occlusal vs. early loading of dental implants in partially edentulous patients: a multicentre randomized clinical trial. Peri-implant bone and soft-tissue levels

Objectives: To compare peri‐implant bone and soft‐tissue levels of immediately non‐occlusally loaded vs. non‐submerged early loaded implants in partially edentulous patients up to 14 months after placement. Material and methods: Fifty‐two patients were randomized in five Italian private practices: 25 in the immediately loaded group and 27 in the early loaded group. To be immediately loaded, single implants had to be inserted with a torque of ≥30 N cm, and splinted implants with a torque of ≥20 N cm. Immediately loaded implants were provided with non‐occluding temporary restorations within 48 h. After 2 months, the provisional restorations were placed in full occlusion. Implants were early loaded after 2 months. Final restorations were provided 8 months after placement. Blinded assessors evaluated peri‐implant bone and soft‐tissue levels. Results: Fifty‐two implants were immediately loaded and 52 were early loaded. No drop‐out occurred. One single immediately loaded implant failed 2 months after placement. Both groups gradually lost peri‐implant bone in a highly statistically significant manner at 2, 8, and 14 months. After 14 months, patients of both groups lost an average of 1.1 mm of peri‐implant bone. There were no statistically significant differences between the two loading strategies for peri‐implant bone and soft‐tissue level changes (P>0.05). After 14 months, the position of the soft tissues did not change significantly from baseline (delivery of the final restorations 8 months after placement). Conclusions: There were no statistically or clinically significant differences between immediate and early loading of dental implants with regard to peri‐implant bone and soft‐tissue levels as evaluated in the present study.     

A multidisciplinary treatment approach to a complicated maxillary dental trauma: a case report

Abstract – This case report describes the treatment of an 18‐year‐old male who lost two central maxillary incisors due to dental trauma. Because of a deep overbite and serious occlusal instability, the lost teeth 11 and 21 could not be replaced by a conventional fixed prosthesis. The vertical dimension of occlusion was increased using a Hawley‐type appliance over a period of 1 year. When sufficient intermaxillary space was gained the alveolar ridge was augmented with a mandibular symphysis graft. Nine months later two one‐stage non‐submerged implants (ITI, Straumann, Waldenburg, Switzerland) were inserted. After further soft tissue adaptation to two temporary acrylic crowns, porcelain veneers were placed on the two implants and the lateral incisors.     

Esthetic transformation of a failed implant reconstruction to fixed-supported prosthesis: a case report

This article describes a clinical situation where an ill-fitting prosthesis supported by malpositioned dental implants was esthetically transformed to fixed definitive restorations. Provisional restorations were used as a blueprint for fabrication of definitive restorations.     

A multidisciplinary treatment approach to a complicated maxillary dental trauma: a case report

This case report describes the treatment of an 18-year-old male who lost two central maxillary incisors due to dental trauma. Because of a deep overbite and serious occlusal instability, the lost teeth 11 and 21 could not be replaced by a conventional fixed prosthesis. The vertical dimension of occlusion was increased using a Hawley-type appliance over a period of 1 year. When sufficient intermaxillary space was gained the alveolar ridge was augmented with a mandibular symphysis graft. Nine months later two one-stage non-submerged implants (ITI, Straumann, Waldenburg, Switzerland) were inserted. After further soft tissue adaptation to two temporary acrylic crowns, porcelain veneers were placed on the two implants and the lateral incisors.     

Biologic outcome of single-implant restorations as tooth replacements: a long-term follow-up study

Background: The replacement of a single tooth or several teeth by means of single‐implant restorations is an increasingly used method that needs long‐term validation. Purpose: The goal of this study was to evaluate the outcome of single‐implant restorations by means of fixed restorations and to define the prognosis through marginal bone level estimations. Materials and Methods: From November 1986 to June 1998, 270 Brånemark implants (215 in the upper jaw) were installed in 219 patients (106 males). Both anterior and posterior sites were involved. Of the 263 single restorations, 28 were placed in private dental offices. The patients were followed until June 1999. Results: Twelve implants failed before or at abutment connection or within 6 months afterward. Only four implants failed later. The cumulative success rates were 93% for the implants and 96.5% for the restorations over a period of 11 years. The marginal bone loss during the first 6 months after abutment connection reached 0.71 mm and then dropped to 0.036 mm annually over a period of 10 years. Conclusions: Single‐implant restorations (Brånemark System) are a reliable treatment with a good long‐term prognosis. Failures were concentrated during the healing period and early loading phase.     

Immediate loading of single-tooth ITI implants in the anterior maxilla: a prospective 5-year pilot study

The aim of the present study was to evaluate the success rate of immediately loaded single-tooth ITI solid plasma-sprayed (TPS) implants in the maxilla. Eight implants were loaded immediately after placement in eight different patients, and were followed for five years. Temporary acrylic resin restorations, which were fabricated from impressions that were taken immediately after implant placement, were connected one week later. These temporary restorations were adjusted in order to avoid any direct occlusive contacts. After six months, the provisional crowns were replaced by definitive ceramic crowns. Regular follow-ups were performed during the investigation period. No implants were lost, and the mean marginal bone level for the eight implants increased by 0.53 mm (range - 0.83 to + 1.54 mm) from placement to the final examination. Only minor complications were noted, and overall patient satisfaction was high.     

Immediate loading using cross-arch fixed restorations in heavy smokers: nine consecutive case reports for edentulous arches

PURPOSE: Immediate loading of oral implants has been extensively documented in different clinical indications, but no studies on heavy smokers have been reported. The aim of this study was to evaluate the long-term success and the peri-implant soft and hard tissue conditions around immediately occlusal loaded implants in edentulous jaws of heavy smokers. MATERIALS AND METHODS: Implants (progressive thread design and platform switching) were connected with their abutments and splinted immediately after surgery using cross-arch fixed temporary restorations. Provisional fixed prostheses had centric occlusal contacts and group function in the lateral movements of the mandible (immediate occlusal loading). Patients were advised to adhere to a soft diet for the first 6 to 8 weeks of healing to reduce excessive loading in the bone-implant interface. The definitive restorations were delivered 4 to 8 weeks after surgery and cemented temporarily to evaluate the peri-implant soft tissue condition after removal of the restoration. Clinical and radiographic indices were evaluated at the start of loading and at 3-month intervals after loading. RESULTS: After a mean loading period of 33.7 +/- 19.0 months (range, 6 to 66 months), 1 implant was mobile. All clinical indices had values in normal ranges. The Periotest values decreased with time, indicating increased security of implants in bone. Crestal bone level was stable, with only 2 sites presenting minimal vertical bone loss and 6 presenting minimal horizontal bone loss. In all other sites no bone loss was observed. Results of this study demonstrated a long-term success (98.6%) of immediately loaded implants placed in occlusal function in smokers restored with fixed cross-arch implant-supported restorations. CONCLUSIONS: This study showed that immediate loading of oral implants may be successful in heavy smokers under some circumstances.     

Clinical considerations for increasing occlusal vertical dimension: a review

The purpose of this article is to discuss the clinical considerations related to increasing the occlusal vertical dimension (OVD) when restoring a patient's dentition. Thorough extraoral and intraoral evaluations are mandatory to assess the suitability of increasing OVD. In the literature, multiple techniques have been proposed to quantify OVD loss. However, the techniques lack consistency and reliability, which in turn affects the decision of whether to increase the OVD. Therefore, increasing OVD should be determined on the basis of the dental restorative needs and aesthetic demands. In general, a minimal increase in OVD should be applied, though a 5 mm maximum increase in OVD can be justified to provide adequate occlusal space for the restorative material and to improve anterior teeth aesthetics. The literature reflects the safety of increasing the OVD permanently, and although signs and symptoms may develop, these are usually of an interim nature. Whenever indicated, the increase in OVD should be achieved with fixed restorations rather than a removable appliance, due to the predictable patient adaptation. The exception to this is for patients with TMD, where increasing the OVD should still be achieved using removable appliances to control TMD-associated symptoms before considering any form of irreversible procedure.     

老年牙体重度磨耗伴牙列缺损关系处理的临床研究

目的探讨老年牙体重度磨耗伴牙列缺损关系处理问题。方法对86例老年牙体重度磨耗伴牙列缺损关系分为三类处理：①垂直距离不改变;②一次升高垂直距离修复;③一次升高垂直距离过渡修复,采用了多种修复方式。随访时间为3个月～5年,其中72例两年以上。结果患者的咀嚼功能均得到了明显改善;美观方面获得了不同程度的满意度;修复后多数未出现颞下颌关节问题（TMD）,偶发者经调后消失,修复前有TMD者,经修复治疗得到了缓解或并未加重;牙体牙髓牙周及修复体等一般情况多数良好。结论按本研究分类处理老年牙体重度磨耗伴牙列缺损关系的方法,临床易于掌握,既可保证患者疗效又适当缩短了疗程,取得了良好的临床效果。     

Temporal alteration of chewing jaw movements after a reversible bite-raising in guinea pigs

Previous studies analysed the temporal changes of occlusal vertical dimension (OVD) with natural molar tooth contacts in bite-raised guinea pigs and found that the OVD is strictly maintained in the growing guinea pigs. Since the OVD is considered to be the influencing factor for performing mastication, we hypothesised that a control of the OVD is integrated with maintenance of an appropriate chewing behavior. In young adult guinea pigs with or without bite-raised treatment, the OVD was measured by micro-CT and stable chewing movements were recorded during 11 days after the removal of the bite-raising appliance. In control animals, the OVD increased developmentally up to 10.5 ± 6.0% for 11 days. In the bite-raised animals, the increased OVD was increased by 19.1 ± 6.7% with the bite-raising appliance, and the OVD rapidly decreased to the same level as that of controls within 4 days after the removal of the appliance. During chewing on the first day after the removal of the appliance, the most closed position of the jaw was lower in bite-raised animals than in controls while the most opened position did not differ between the two groups, i.e., the jaw gape was decreased. These changes disappeared when OVD returned to the same level as that of controls. Any other variables for movements (e.g., rhythm) did not differ between the both groups throughout the experimental period. These results suggest that there is a robust association between an innate OVD and a centrally-programmed pattern of chewing movements for functional integrity.     

种植义齿冠修复后失败病例的临床报告

目的:分析影响种植义齿修复成功率的原因。方法:收集临床上的10例种植修复前各项检查无异常,但恢复上部机构后发生种植体炎症或冠折裂等问题的病例,对其原因进行综合分析。结果:2例患者原因为咬合过紧,且后牙未及时修复导致种植体周围炎;3例患者未能成功控制牙周问题;1例患者夜磨牙;其余原因无法确定。结论:种植治疗前的咬合判断及治疗后的维护对种植成功率至关重要。