J Korean Acad Prosthodont.  2018 Apr;56(2):141-153. 10.4047/jkap.2018.56.2.141.

Re-establishment of occlusal plane in a patient with a failed implant prosthesis

• Kang HG
• Ko KH
• Huh YH
• Cho LR
• Park CJ

• KMID: 2410118
• DOI: http://doi.org/10.4047/jkap.2018.56.2.141

Abstract

A non-physiological occlusal plane caused by continuous tooth loss, occlusal wear, and failure of a prosthesis may result in an unattractive appearance and functional problems, such as reduced masticatory efficiency and occlusal interference. Therefore, when undertaking prosthetic treatment for edentulous patients or patients with a collapsed occlusal plane, it is important to establish an occlusal plane that is compatible with masticatory function. The patient in this case report had undergone restoration of a completely edentulous maxilla using an implant-supported fixed prosthesis. On follow-up examination in the following 6 years, mechanical complications were observed in the existing implant prosthesis, including porcelain chipping, occlusal wear, and screw loosening. Moreover, due to occlusal wear and supraeruption of the opposing anterior teeth, as well as loss of some posterior teeth, the occlusal plane had collapsed. Following diagnosis, the patient underwent full mouth rehabilitation, involving additional implant installation in edentulous sites, recreation of the existing prosthesis, and prosthetic restoration of all remaining teeth.

Keyword

Occlusal plane; Full mouth rehabilitation; Anterior guidance

MeSH Terms

Dental Occlusion*
Dental Porcelain
Diagnosis
Follow-Up Studies
Humans
Maxilla
Mortuary Practice
Mouth Rehabilitation
Prostheses and Implants*
Recreation
Tooth
Tooth Attrition
Tooth Loss
Dental Porcelain

Figure

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  Fig. 1. Intraoral examination in 6 years ago. (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. Prosthetic rehabilitation in 6 years ago. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Mandibular occlusal view.

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  Fig. 3. (A) Horizontal root fracture of the mandibular right first premolar, (B) Vertical root fracture of the mandibular left first molar.

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  Fig. 4. Re-evaluation after 6 years of prothetic rehabilitation. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Mandibular occlusal view.

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  Fig. 5. Radiographic examination. Misfit between the abutment and the prosthesis.

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  Fig. 6. (A) Lateral cephalometric radiograph, (B) Transcranial radiograph. Hypermobility of the left condyle and no specific findings related with pathologic bony change in both TMJs.

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  Fig. 7. Evaluation of occlusal vertical dimension using the Willis method and the McGee method.

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  Fig. 8. (A) Facebow transfer, (B) Mounting procedure to semi-adjustable articulator.

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  Fig. 9. Reverse curve of Wilson due to excessive occlusal wear.

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  Fig. 10. Occlusal plane analysis by reference landmarks. (A) Commissure line of lip, (B) Hamular notch-incisive papilla plane, (C) Retromolar pad.

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  Fig. 11. First provisional restorations. (A) Maxillary occlusal view. Immediate loading after implant installation of maxillary left incisor, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Mandibular occlusal view.

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  Fig. 12. Occlusal morphology changes of provisional restoration after 2 months. (A) Curve of Spee, (B) Curve of Wilson.

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  Fig. 13. Adaptive bony changes on the medial wall of the mandibular fossa.

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  Fig. 14. Axiographic tracing in mastication by ARCUSdigma II. (A) Right TMJ, (B) Hinge axis movement, (C) Left TMJ, (D) Incisor edge in sagittal view, (E) Incisor edge in frontal view, (F) Incisor edge in horizontal view.

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  Fig. 15. Second provisional restorations with flatter occlusal plane.

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  Fig. 16. Definitive prosthesis showing harmonious occlusal relationship.

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  Fig. 17. Periapical radiographs at 1 year follow-up.

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