J Korean Acad Prosthodont.  2019 Oct;57(4):467-474. 10.4047/jkap.2019.57.4.467.

Maxillary anterior prosthetic treatment concerning anterior guidance of a patient who lost stable holding contact

• Park JH
• Cho JH

• KMID: 2461155
• DOI: http://doi.org/10.4047/jkap.2019.57.4.467

Abstract

Recently, many patients undergo anterior prosthetic treatment for esthetic reasons. In some patients complain about functional reasons such as inaccurate pronunciation and occlusal discomfort after the treatment. Anterior teeth are important esthetically but in the occlusal point of view, anterior guidance is the second most important factor in occlusion, next to centric relation. Failure to determine an appropriate anterior guidance might lead to posterior occlusal interference, which can highly affect the stability of the posterior teeth. Also, discomfort might occur if the customized interior guidance is not in harmony with the patient's envelope of function. The patient in this case complained of overall discomfort in the maxillary anterior area after prosthetic treatment. The expressed difficulty in pronunciation, unstable occlusion due to lack of stable holding contact and discomfort of the facial muscles. Maxillary anterior prostheses were refabricated through systematic diagnosis and treatment and thus, this case presents esthetical and functional satisfaction to both the patient and the dentist.

Keyword

Occlusion; Centric relation; Anterior guidance; Envelope of function

MeSH Terms

Centric Relation
Dentists
Diagnosis
Facial Muscles
Humans
Prostheses and Implants
Tooth

Figure

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  Fig. 1 Initial panoramic radiograph of the patient.

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  Fig. 2 Initial occlusion. (A) Upper and (B) lower occlusal view showing no stable holding contact on the anterior teeth.

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  Fig. 3 Diagnostic cast of patient's natural teeth showing (A) spacing and (B) attrition on the anterior teeth before anterior esthetic prosthodontic treatment.

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  Fig. 4 Comparison of patient's natural teeth before (A) & after (B) anterior esthetic prosthodontic treatment.

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  Fig. 5 Intra-oral view after fixed prosthesis removal. (A) Occlusal view, (B) Frontal View.

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  Fig. 6 Provisional restoration shell made from the patients diagnostic cast.

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  Fig. 7 Recovered stable holding contacts on the provisional restoration. (A) Occlusal view, (B) Frontal view.

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  Fig. 8 Provisional restoration adjustment and repair after 2 weeks follow up. (A) Before and (B) after adjustment.

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  Fig. 9 Occlusal view of provisional restoration showing stable holding contacts, anterior and partial group function.

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  Fig. 10 Preparation (A) and impression (B) of #13,12,11,21,22,23.

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  Fig. 11 Cast of the patient with the provisional restoration.

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  Fig. 12 Digital duplication of the palatal contour of the provisional restoration.

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  Fig. 13 Confirmed stable holding contacts during coping check.

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  Fig. 14 Putty guide to duplicate the incisal edge position of the provisional restoration.

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  Fig. 15 Stable holding contacts (A) and guidance which are in harmony with the envelope of function (B) showing on the permanent prostheses.

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  Fig. 16 Comparison of provisional (A) and definitive (B) prostheses.

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