J Dent Rehabil Appl Sci.  2021 Sep;37(3):157-170. 10.14368/jdras.2021.37.3.157.

Full mouth rehabilitation in patient with deep bite, inter-dental arch discrepancy and loss of vertical dimension: a case report

• Song HS
• Lee YJ
• Ko KH
• Huh YH
• Cho LL
• Park CJ

• KMID: 2525990
• DOI: http://doi.org/10.14368/jdras.2021.37.3.157

Abstract

Loss of posterior bite support might cause unstable occlusal relationship and when the mandible slides forward in the centric or habitual occlusion, excessive load is applied to the anterior region followed by causing the occlusal plane to collapse or leading to a decrease in occlusal vertical dimension. In addition, disorder of temporomandibular joint function may occur. The inter-dental arch discrepancy causes a mismatch in the vertical and horizontal overlap of the anterior and posterior regions. The deep bite in the anterior region and the scissor bite in the posterior region cause unstable occlusal contact and insufficient occlusal contact area. This report was to rehabilitate a patient with above-mentioned complex problems. Physiologic adaptation to increased vertical dimension and new occlusal plane were evaluated using provisional prostheses, and definitive prostheses was fabricated using cross-mounting technique. Stable occlusion, harmonious teeth overlap and adequate occlusal plane were established, so functionally and aesthetically satisfactory results are obtained.

Keyword

deep bite; inter-dental arch discrepancy; inter-dental arch discrepancy; full mouth rehabilitation

Figure

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  Fig. 1 Initial panoramic radiograph.

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  Fig. 2 Intraoral photograph. (A - C) At first visit, (D - F) At re-visit after extraction of teeth.

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  Fig. 3 Diagnostic cast analysis on semi-adjustable articulator at re-visit after extraction of teeth. (A) Right unstable occlusal contact, (B) Maxillary occlusal view, (C) Left scissor bite, (D) Right lateral view, (E) Frontal view, (F) Left lateral view, (G) Irregular occlusal plane, (H) Mandibular occlusal view.

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  Fig. 4 Vertical dimension evaluation. (A) Facial appearance evaluation, (B) interocclusal rest distance evaluation (maximum intercuspation), (C) interocclusal rest distance evaluation (physiologic rest position).

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  Fig. 5 Diagnostic wax-up. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Right posterior teeth overlap, (F) Mandibular occlusal view, (G) Left posterior teeth overlap.

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  Fig. 6 Teeth preparation procedures. (A) Occlusal view (maxilla), (B) Frontal view with centric occlusion, (C) Occlusal view (mandible), (D) Frontal view of matrix.

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  Fig. 7 Mandibular movement registration. (A) Chewing pattern, (B) Centric relation.

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  Fig. 8 Intraoral photograph after the placement of 2nd provisional restoration. (A) Working side during right lateral excursion, (B) Maxillary occlusal view, (C) Non-working side during right lateral excursion, (D) Left lateral view at centric occlusion, (E) Frontal view at centric occlusion, (F) Right lateral view at centric occlusion, (G) Non-working side during left lateral excursion, (H) Mandibular occlusal view, (I) Working side during left lateral excursion.

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  Fig. 9 Cross-mounting procedure. (A - C) Interocclusal relationship registrations using 2nd provisional restorations and milled bonnet crown, (D - F) Cross-mounting of master cast with 2nd provisional restoration cast, (G) Anterior guide table, (H) Mounted mast cast.

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  Fig. 10 Wax-up pattern for definite prosthesis. (A) Working side during right lateral excursion, (B) Maxillary occlusal view, (C) Non-working side during right lateral excursion, (D) Left lateral view at centric occlusion, (E) Frontal view at centric occlusion, (F) Right lateral view at centric occlusion, (G) Non-working side during left lateral excursion, (H) Mandibular occlusal view, (I) Working side during left lateral excursion.

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  Fig. 11 Definitive prosthesis on master cast. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Mandibular occlusal view.

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  Fig. 12 Intraoral photograph after the placement of definitive prosthesis. (A) Working side during right lateral excursion, (B) Maxillary occlusal view, (C) Non-working side during right lateral excursion, (D) Left lateral view at centric occlusion, (E) Frontal view at centric occlusion, (F) Right lateral view at centric occlusion, (G) Non-working side during left lateral excursion, (H) Mandibular occlusal view, (I) Working side during left lateral excursion.

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  Fig. 13 Facial evaluation at lateral view. (A) Before treatment, (B) Provisional prosthesis, (C) Definitive prosthesis.

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  Fig. 14 Inter-dental arch discrepancy. (A) Before treatment, (B) After treatment.

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  Fig. 15 Chewing pattern analysis. (A) Initial stage of right side, (B) Initial stage of left side, (C) Definitive restoration stage of right side, (D) Definitive restoration stage of left side.

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  Fig. 16 T-scan (T-scan III, Tekscan Inc., Boston, USA) examination at Maximal Intercuspal Position (MICP). (A) Immediately after definitive restoration, (B) 3 months follow-up after definitive restoration.

Reference

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