J Korean Acad Prosthodont.  2015 Jan;53(1):26-38. 10.4047/jkap.2015.53.1.26.

Full mouth rehabilitation of deep bite patient with segmental osteotomy and orthodontic treatment

• Chu SS
• Cho WR
• Huh YH
• Park CJ
• Cho LR

• KMID: 2057204
• DOI: http://doi.org/10.4047/jkap.2015.53.1.26

Abstract

Teeth wear and extrusion of antagonist are commonly observed in deep bite patient having severe vertical and horizontal overlap. These problems cause collapse of occlusal plane and abnormal anterior guidance. Without restoring harmonious occlusion, loss of multiple teeth and decreased masticatory function could not be prevented. To resolve problems associated with deep bite, multidisciplinary treatment including oral surgical, orthodontic and prosthetic treatment should be performed. This clinical report describes the results of increasing occlusal vertical dimension with a full-mouth restoration procedure. The treatment procedures include extraoral and intraoral examination, diagnosis, treatment planning, diagnostic wax-up, segmental osteotomy, orthodontic intrusion and prosthodontic rehabilitation. Full mouth rehabilitation with increasing occlusal vertical dimension can solve esthetic and functional problems.

Keyword

Deep bite; Orthodontic treatment; Segmental osteotomy; Vertical dimension; Full mouth rehabilitation

MeSH Terms

Dental Occlusion
Diagnosis
Humans
Methods
Mouth Rehabilitation*
Osteotomy*
Overbite*
Prosthodontics
Rehabilitation
Tooth
Vertical Dimension

Figure

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  Fig. 1. Intraoral view at first visit. (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. Initial panoramic radiograph.

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  Fig. 3. Orthodontic treatment plan.

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  Fig. 4. Supraeruption of right posterior teeth.

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  Fig. 5. Segmental osteotomy. (A) Palatal incision, (B) Horizontal, vertical osteotomy, (C) Surgical stent.

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  Fig. 6. Molar intrusion procedures. (A) First visit, (B) During treatment, (C) After treatment.

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  Fig. 7. Vertical dimension evaluation. (A) Free-way space evaluation (maximum intercuspation), (B) Free-way space evaluation (centric occlusion), (C) Facial appear-ance evaluation.

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  Fig. 8. Post-orthodontic intraoral views. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Mandibular occlusal view.

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  Fig. 9. Diagnostic waxup. (A) Working side during right lateral excursion, (B) Maxillary occlusal view, (C) Non-working side during right lateral excursion, (D) Left lateral view at centric occlusion, (E) Frontal view at centric occlusion, (F) Right lateral view at centric occlusion, (G) Non-working side during left lateral excursion, (H) Mandibular occlusal view, (I) Working side during left lateral excursion.

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  Fig. 10. Teeth preparation procedures. (A) Occlusal view (maxilla), (B) Occlusal view (mandible), (C) Frontal view of centric occlusion, (D) Frontal view with matrix.

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  Fig. 11. (A) Provisional restorations in diagnostic cast, (B) Cementation of provisional restorations.

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  Fig. 12. Die preparation. (A) Occlusal view (maxilla), (B) Occlusal view (mandible).

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  Fig. 13. Interocclusal relationship registrations using provisional restorations.

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  Fig. 14. Full-contour waxup.

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  Fig. 15. Metal coping try-in and porcelain build-up.

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  Fig. 16. Clinical remounting using anterior programming device and pick-up impression. (A) Anterior programming device, (B) Interocclusal relation recording, (C) Pick-up impression for maxillary prosthesis, (D) Pick-up impression for mancibular prosthesis.

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  Fig. 17. Definitive prosthesis. (A) Working side during right lateral excursion, (B) Maxillary occlusal view, (C) Non-working side during right lateral excursion, (D) Left lateral view at centric occlusion, (E) Frontal view at centric occlusion, (F) Right lateral view at centric occlusion, (G) Non-working side during left lateral excursion, (H) Mandibular occlusal view, (I) Working side during left lateral excursion.

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  Fig. 18. Transcranial view at (A) placement of definitive prosthesis, (B) 1 year recall check.

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  Fig. 19. Occlusal plane modification. (A) Occlusal view (pretreatment), (B) Occlusal view (posttreatment).

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  Fig. 20. Cephalometric analysis (Superimposition of debonding stage and initial examination stage. Dotted line: initial examination, solid line: post-treatment).

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