J Korean Acad Prosthodont.  2018 Jan;56(1):56-63. 10.4047/jkap.2018.56.1.56.

Full mouth rehabilitation of the elderly patient on anticoagulant medication with loss of vertical dimension due to severely worn dentition

• Kang CK
• Heo SJ
• Kim SK
• Koak JY

• KMID: 2402988
• DOI: http://doi.org/10.4047/jkap.2018.56.1.56

Abstract

Severe dental attrition causes pathological changes of the tooth, collapsed occlusion, and functional and aesthetic complications and can also result in a decrease in occlusal vertical dimension. Before increasing the vertical dimension with full-mouth rehabilitation, it is important to determine the amount of vertical dimension through accurate diagnosis. In this case, a 77 year old elderly male patient on anticoagulant medication with generalized attrition and fracture of teeth was treated with full-mouth rehabilitation in order to recover vertical dimension and aesthetics. Accurate clinical and radiographic examination, diagnostic, wax-up, and occlusal vertical dimension evaluation were step by step performed considering pre-medical history and old age. Patient adaptability was evaluated using an occlusal splint and interim restoration. After 3 months of stabilization with interim restoration, definitive prostheses were fabricated. Satisfactory functional and esthetic outcomes are observed after 6 months of follow up.

Keyword

Full mouth rehabilitation; Occusal vertical dimension; Attrition

MeSH Terms

Aged*
Dentition*
Diagnosis
Esthetics
Follow-Up Studies
Humans
Male
Mouth Rehabilitation*
Mouth*
Occlusal Splints
Prostheses and Implants
Rehabilitation
Tooth
Tooth Attrition
Vertical Dimension*

Figure

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  Fig. 1 Intraoral photograph before treatment. (A) Maxillary, (B) Right, (C) Frontal, (D) Left, (E) Mandibular.

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  Fig. 2 Panoramic radiograph before treatment.

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  Fig. 3 Occlusal splint with an increase of vertical dimension.

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  Fig. 4 Diagnostic wax up model.

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  Fig. 5 Provisional restoration.

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  Fig. 6 Cross articulation. (A) Mounting of provisional restoration, (B) Customized guide table, (C) Mounting of working cast.

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  Fig. 7 Full contour wax up cut back. (A) Maxilla, (B) Mandible.

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  Fig. 8 (A) Metal coping try-in, (B) Porcelain build up before glazing.

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  Fig. 9 Clinical remounting procedure. (A) Maxillary pick-up impression, (B) Mandibular pick-up impression, (C) Remounting.

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  Fig. 10 Definitive prosthesis. (A) Maxillary, (B) Right, (C) Frontal, (D) Left, (E) Mandibular.

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  Fig. 11 Panoramic radiograph after treatment.

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  Fig. 12 TMJ Panoramic view after treatment. (A) Right opening, (B) Left opening.

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  Fig. 13 Comparision image before (A) and after (B) treatment.

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