J Korean Acad Prosthodont.  2013 Jan;51(1):39-46. 10.4047/jkap.2013.51.1.39.

Full-mouth rehabilitation of a patient with reduced occlusal vertical dimension due to severe wear: a clinical report

• Kim MJ
• Kim HS
• Woo YH

• KMID: 2000185
• DOI: http://doi.org/10.4047/jkap.2013.51.1.39

Abstract

The loss of posterior support may cause attrition of anterior teeth, and loss of occlusal vertical dimension (OVD). The collapse of the posterior support will eventually cause the pathologic change of the TMJ and masticatory muscles, unesthetic facial appearance and decreased masticatory function. Patients with destroyed dentition need extensive prosthetic treatments. Proper diagnosis and treatment planning are necessary for the stability of the neuromuscular system and the TMJ, and esthetic and functional definitive restorations. In this case, 63 year-old male presented with decreased masticatory force and esthetic problems due to pathologic destruction of teeth structure on entire dentition. Based on assessment of OVD including intraoral findings, radiographic examination and diagnostic cast, full-mouth rehabilitation with increase of OVD was planned using fixed partial denture and removable partial denture. Diagnostic wax-up was done after 4 mm increase of OVD determined by assessment of OVD. The OVD was maintained with the overlay type removable interim prostheses for 12 weeks to ascertain his comfort and adaptation to the new OVD. After the adaptation period, second interim prostheses with tooth preparation maintaining the established OVD was delivered. After 4 weeks, final prostheses were fabricated and delivered. After 7 month follow-up period, occlusal stability is maintained. Through this procedure, satisfactory outcomes were achieved both in functional and esthetic aspects.

Keyword

Tooth wear; Occlusal vertical dimension; Full mouth rehabilitation

MeSH Terms

Bite Force
Dentition
Denture, Partial, Fixed
Denture, Partial, Removable
Follow-Up Studies
Humans
Male
Masticatory Muscles
Prostheses and Implants
Temporomandibular Joint
Tooth
Tooth Preparation
Tooth Wear
Vertical Dimension

Figure

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  Fig. 1. Intraoral view before treatment. A: Right lateral view, B: Frontal view, C: Left lateral view, D: Maxillary occlusal view, E: Mandibular occlusal view.

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  Fig 2. Radiographic exam before treatment. A: Panoramic view, B: Maxillary right posterior teeth, C: Mandibular left posterior teeth, D: Mandibular anterior teeth, E: TMJ series Right opened, F: Left opened, G: Right closed, H: Left closed.

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  Fig. 3. Cast analysis. A: Premature contact on maxillary right first molar and mandibular right first molar is observed. There is light curve of Spee, B: Premature contact on maxillary left first molar and mandibular right second premolar is observed. Severe wear on mandibular anterior teeth are observed.

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  Fig. 4. Interocclusal distance record. A: Vertical dimension at rest, B: Occlusal vertical dimension.

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  Fig. 5. Mounted diagnostic wax-up.

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  Fig. 6. Radiograpic exam for implantation. Mucosal thickening on left sinus is observed. A: Panoramic view, B: Sagittal view of left sinus (CBCT).

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  Fig. 7. Removable interim overlay prosthesis. A: Frontal view, B: Maxillary occlusal view, C: Mandibular occlusal view.

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  Fig. 8. Fixed interim prosthesis and maxillary posterior removable interim prosthesis.

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  Fig. 9. Final impression taking for fixed prosthodontics. A: Maxilla, B: Mandible.

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  Fig. 10. Cast articulation. A: Facebow transfer, B: Customized anterior guide table, C: Cross articulation.

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  Fig. 11. Pick up impression taking for maxillary removable partial denture.

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  Fig. 12. Final prosthesis. A: Frontal view, B: Maxillary occlusal view, C: Mandibular occlusal view.

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