J Dent Rehabil Appl Sci.  2017 Jun;33(2):154-162. 10.14368/jdras.2017.33.2.154.

Maxillary full-arch fixed dental prosthesis of the elderly patient with worn dentition

• Lee JH
• Choi YJ
• Ryu JJ

• KMID: 2388022
• DOI: http://doi.org/10.14368/jdras.2017.33.2.154

Abstract

Tooth wear, one of the physiological changes in the elderly patient's mouth, generally does not require treatment, but requires prosthodontic restoration when occlusal disharmony, poor masticatory function, pulp exposure occurs. One of the primary considerations in prosthodontic restoration for tooth wear is vertical dimension. It is necessary to make an accurate diagnosis and analysis, correct judgement of the interdental relationship for predictive treatment plan. A step-by-step approach considering dental care for aged is also required. In this case, a 93-year-old male patient presented with worn dentition and mobility of existing fixed dental prosthesis. After diagnosis and evaluation, maxillary rehabilitation without any change in the occlusal vertical dimension was performed and this shows satisfactory results both functionally and morphologically.

Keyword

dental care for aged; tooth wear; vertical dimension

MeSH Terms

Aged*
Dental Care for Aged
Dental Prosthesis*
Dentition*
Diagnosis
Humans
Male
Mouth
Rehabilitation
Tooth Wear
Vertical Dimension

Figure

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  Fig. 1 Intra-oral status in the initial examination. Generalized toothwear was shown. Dentoalveolar abscess was observed around #36. #47 was missing. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view at maximum inter-cuspal position, (D) Left lateral view, (E) Mandibular occlusal view.

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  Fig. 2 Initial panoramic radiographic image. Alveolar bone resorption was observed around #16, #21, #25. Distal caries was observed at #17. Periapical radiolucency was observed at #36.

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  Fig. 3 Initial TMJ series. No evidence of pathologic change. (A) Right side in closed state, (B) Right side in opened state, (C) Left side in closed state, (D) Left side in opened state.

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  Fig. 4 Vertical dimension analysis. In the Willis analysis, the ratio of the distance from the pupil of the eyes to the parting line of the lips and the distance from the bony shelf under the nose to the bottom of the mandible was 1:0.97. No decrease in the occlusal vertical dimension was observed. (A) Frontal view, (B) Lateral view.

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  Fig. 5 Face-bow transfer (Right side view).

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  Fig. 6 Diagnostic wax up without any change in the occlusal vertical dimension. There was enough space for the prosthesis. The distance between both bottoms of labial vestibules of upper and lower casts was 35.0 mm which is the average distance in Korean adults with natural dentition. (A) Right side view, (B) Frontal view, (C) Left side view.

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  Fig. 7 Provisional restoration after 3 months. Provisional restoration functioned in the patient’s mouth without any problems in mastication, pronunciation, and esthetics. (A) Frontal view, (B) Maxillary occlusal view.

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  Fig. 8 Final abutment preparation and impression taking for definitive prosthesis. (A) Maxillary abutment preparation, (B) Maxillary abutment impression.

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  Fig. 9 Registration of inter-occlusal relationship with provisional restoration. (A) Anterior bite registration with posterior portion of provisional restoration displaying the interpupillary line and midline, (B) Posterior bite registration with anterior zig.

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  Fig. 10 Full contour wax up for definitive prosthesis. (A) Frontal view, (B) Maxillary occlusal view.

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  Fig. 11 Definitive prosthesis was delivered. Esthetics and function were restored with the PFM prosthesis. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view at maximum inter-cuspal position, (D) Left lateral view, (E) Mandibular occlusal view.

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  Fig. 12 Panoramic radiographic image after definitive prosthesis delivery. No additional pathologic change was seen.

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  Fig. 13 Extra-oral photos after definitive prosthesis delivery. Stable occlusion was observed. (A) Frontal view, (B) Lateral view.

Reference

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