J Korean Acad Prosthodont.  2015 Oct;53(4):377-391. 10.4047/jkap.2015.53.4.377.

Rehabilitation of unstable occlusion caused by inter-dental arch discrepancy

• Won S
• An K
• Park CJ
• Cho LR
• Huh YH

• KMID: 2118811
• DOI: http://doi.org/10.4047/jkap.2015.53.4.377

Abstract

Inter-dental arch discrepancy between maxilla and mandible could cause three dimensional occlusal problems, and collapse of occlusal plane, multiple teeth loss and decrease of masticatory efficiency could be observed in patient having unstable occlusal contact. Patient showing posterior bite collapse, unstable occlusal contact and improper anterior guidance should be treated to recover stable centric occlusion, occlusal contact, and anterior guidance in conjunction between prosthodontics and orthodontic treatment. This clinical report describes the favorable results of orthodontic and prosthodontics rehabilitation of patient with above mentioned problems.

Keyword

Inter-dental arch discrepancy; Posterior bite collapse; Unstable occlusal contact

MeSH Terms

Dental Occlusion
Humans
Mandible
Maxilla
Prosthodontics
Rehabilitation*
Tooth

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, (F) Anterior lateral view.

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  Fig. 2. Initial panoramic radiograph.

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  Fig. 3. Transcranial radiograph (A) Initial stage, (B) Provisional restoration stage, (C) Definitive restoration stage.

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  Fig. 4. (A) Extraoral view at first visit, (B) Posteroanterior cephalometric radiograph, (C) Lateral cephalometric radiograph.

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  Fig. 5. The progress of orthodontic treatment (A) Initial leveling of the upper teeth, (B) Retraction of maxillary incisors with chain elastic and initial leveling of the lower teeth, (C) Intrusion of #13 (not seen in the picture) and #44, 45 using the miniscrews to correct scissors bite.

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  Fig. 6. Cephalometric superimposition of initial stage (red) and post-orthodontic stage (blue), (A) Overall superimposition, (B) Maxillary superimposition, (C) Mandibular superimposition.

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  Fig. 7. Intraoral views at post-orthodontic state. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Mandibular occlusal view.

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  Fig. 8. Diagnostic wax pattern. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Mandibular occlusal view, (F) Anterior lateral view.

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  Fig. 9. (A) Facebow transfer, (B), (C) Mounting procedure to semi-adjustable articulator, (D) Customized anterior guidance table.

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  Fig. 10. (A) Working cast with a separate die (maxilla), (B) Working cast with a separate die (mandible), (C) Resin coping and pattern resin (maxilla), (D) Resin coping and pattern resin (mandible).

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  Fig. 11. Interocclusal relationship registrations using provision restorations and resin coping.

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  Fig. 12. Wax pattern for definitive restoration. (A) Working side during right lateral excursion, (B) Maxillary occlusal view, (C) Non-working side during right lateral excursion, (D) Right lateral view at centric occlusion, (E) Frontal view at centric occlusion, (F) Left 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. 13. 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 mandibular prosthesis.

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  Fig. 14. 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. 15. Transversal discrepancy analysis.

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  Fig. 16. Horizontal and vertical overlap analysis of anterior tooth.

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  Fig. 17. Electromyographic recordings of the anterior temporal muscle and masseter muscle, (A) Initial stage, (B) Definitive restoration stage.

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  Fig. 18. Chewing pattern analysis (A) Initial stage of right side (scissor-bite state; chopping chewing pattern), (B) Initial stage of left side, (C) Definitive restoration stage of right side (grinding chewing pattern), (D) Definitive restoration stage of left side.

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