J Korean Acad Prosthodont.  2016 Oct;54(4):413-422. 10.4047/jkap.2016.54.4.413.

Prosthetic restoration of the patient with inaccurate pronunciation after prosthesis fabrication through systematic diagnosis and treatment procedure: A case report

• Choi YS
• Lee SM

• KMID: 2388221
• DOI: http://doi.org/10.4047/jkap.2016.54.4.413

Abstract

Recently, there are cases where anterior esthetic prostheses are fabricated for better esthetics, but biologic, mechanical factors could be overlooked, too focusing on esthetic factor. This leads to changes in neutral zone, dentition, position of tongue and lips, occlusion and anterior guidance causing inaccurate pronunciation. Therefore, consideration of systematic diagnosis and treatment procedure are required. In this case, prosthesis was refabricated through a systematic diagnosis and treatment procedure using four factor (acoustic analysis, esthetic analysis, occlusion, neutral zone) for the patient who complained of inaccurate pronunciation and esthetics of the fixed prosthesis fabricated 10 years ago. Thus, by promoting functional, esthetic recovery, this case report demonstrates satisfying results to both the patient and dentist.

Keyword

Pronunciation; Acoustic analysis; Esthetic analysis; Occlusion; Neutral zone

MeSH Terms

Dentists
Dentition
Diagnosis*
Esthetics
Humans
Lip
Prostheses and Implants*
Tongue

Figure

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  Fig. 1. Lower formant value in phonetic analysis by Praat software before treatment.

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  Fig. 2. Initial extraoral examination. (A) Facial midline with the midline of central incisors in frontal view, (B) Rickett's E-plane indicating the distance to the upper lip less than 4 mm and nasio-labial angle less than 90° in lateral view.

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  Fig. 3. Initial intraoral examination. (A) Old prosthesis in right lateral view, (B) Generalized gingival recession and inappropriate zenith line in frontal view, (C) Extrusion of the maxillary left central incisor in left lateral view.

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  Fig. 4. Old prosthesis and generalized gingival recession in initial panoramic radiograph.

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  Fig. 5. Semi-articulator mounting procedures for diagnosis. (A) Facebow transfer, (B) Mounting the diagnostic model to an articulator in lateral view.

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  Fig. 6. Analysis of diagnostic model. (A) Inappropriate emergence profile in right lateral view, (B) Lower width/length ratio of maxillary anterior teeth in frontal view, (C) Excessive overjet and overbite in left lateral view.

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  Fig. 7. First temporary bridge fabrication by generalized anterior guidance. (A) Right lateral view, (B) Frontal view, (C) Left lateral view.

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  Fig. 8. Abutment evaluation after old prosthesis removal. (A) Maxillary occlusal view, (B) Mandibular occlusal view.

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  Fig. 9. Secondary temporary bridge fabrication by piezography technique and generalized anterior guidance. (A) Right lateral view, (B) Frontal view, (C) Left lateral view.

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  Fig. 10. Customized anterior guidance table fabrication. (A) Increased length of maxillary central and lateral teeth in diagnostic model, (B) Customized anterior guidance table.

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  Fig. 11. Full contour wax-up try-in for final temporary bridge fabrication. (A) Right lateral view, (B) Frontal view, (C) Left lateral view.

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  Fig. 12. Third and final temporary bridge fabrication by customized anterior guidance. (A) Right lateral view, (B) Frontal view, (C) Left lateral view.

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  Fig. 13. Fourth temporary bridge fabrication. (A) Right lateral view, (B) Frontal view, (C) Left lateral view.

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  Fig. 14. Final temporary bridge evaluation by smile line. (A) Improved smile line in frontal view, (B) Improved upper lip line in lateral view.

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  Fig. 15. Final impression taking. (A) Maxillary impression, (B) Mandibular impression.

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  Fig. 16. Duplicated final temporary bridge fabrication for CAD-CAM. (A) Maxillary temporary bridge, (B) Mandibular temporary bridge.

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  Fig. 17. Duplicated final temporary bridge evaluation by smile line. (A) Frontal view, (B) Improved smile line.

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  Fig 18. Final prosthesis fabricaion by calculating the length of the teeth using the width/length ratio of 78%. (A) Right lateral view, (B) Determination of the size of the lateral incisors and canines using principles of tooth proportions, the "golden proportion" in frontal view, (C) Left lateral view.

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  Fig 19. Smile line evaluation of final prosthesis. (A) Frontal view, (B) Improved smile line.

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  Fig. 20. Increased formant value in phonetic analysis by Praat software after treatment.

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  Fig. 21. Praat software analysis after treatment. (A) Increased F1 value, (B) Increased F2 value.

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  Fig. 22. Reduced vowel working spaces after treatment.

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  Fig. 23. Panoramic radiograph after treatment.

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